• The Korean Journal of Nuclear Medicine
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• v.39 no.6
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• pp.430-437
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• 2005

Purpose: The objectives of this study were - First, to determine the normal range of left ventricular end diastolic volume (EDV), end systolic volume (ESV) and election fraction (EF) from gated myocardial perfusion SPECT for Quantitative Gated SPECT (QGS) and 4D-MSPECT (4DM), respectively. Second, to evaluate the relationships between values produced by both software packages. Materials & Methods: Tc-99m MIBI gated myocardial perfusion SPECT were performed for 77 patients (mean age: $49.6{\pm}13.7y$, n=37(M), 40(F)) with a low likelihood (<10%) of coronary artery disease (CAD) using dual head gamma camera (E.CAM, Siemens, USA). Left ventricular EDV, ESV and EF were automatically measured by means of QGS and 4DM, respectively. Results: in QGS, the mean EDV, ESV and EF for all patients were $78.2{\pm}25.2ml,\;27.4{\pm}12.9ml\;and\;66.6{\pm}8.0%$ at stress test respectively, not different from rest test (p>0.05). In 4DM, the mean EDV, ESV and EF for all patients were $89.1{\pm}26.4ml,\;29.1{\pm}12.8ml\;and\;68.5{\pm}6.7%$ at stress test. Most cases in 4DM, there was no significant difference statistically between stress and rest test (p>0.05). But statistically significant difference was found in EF ($68.5{\pm}6.7%$ at stress vs $70.9{\pm}8.0%$ at rest, p<0.05). Correlation coefficients between the methods for EDV, ESV and EF were comparatively high (0.95, 0.93, 0.71 at stress test and 0.95, 0.90, 0.69 at rest test, respectively). However, Bland-Altman plots showed a large range of the limit value of agreement for EDV, ESV and EF between both methods ($-30ml{\sim}10ml,\;-12ml{\sim}8ml,\;-14%{\sim}11%$ at stress test and $-32ml{\sim}5ml,\;-13ml{\sim}13ml,\;-18%{\sim}12%$ at rest test). Conclusion: We found the normal ranges of EDV, ESV and EF for patients with a low likelihood of CAD in both methods. We expect these values will be a good reference to interpret gated myocardial perfusion SPECT. Although good correlation was observed between both methods, they should not be used interchangeably. Therefore, when both programs are used at the same site, it will be important to apply normal limits specific to each method.

• The Korean Journal of Nuclear Medicine
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• v.35 no.1
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• pp.33-42
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• 2001

Purpose: The purpose of this study was to evaluate the effect of scatter correction on the assessment of myocardial perfusion and left ventricular function by gated Tc-99m myocardial SPECT. Materials and Methods: Subjects were 11 normal volunteers, 20 patients with non-cardiac chest pain and 13 patients with coronary artery diseases. We classified above 3 groups into normal and diseased groups. Scatter correction was done using dual-energy-window scatter correction method (DEW-SC). We compared acquired counts, image contrast, corrected maximum relative counts, indices of left ventricular function, extent and severity of perfusion defects calculated by 'CEqual program' between scatter non-corrected and corrected images. Results: Scatter corrected studios was lower in counts by $18{\pm}3%$ than uncorrected studies, but image contrast were improved in all cases. Scatter correction using DEW-SC took 3 minutes to complete, and 512 kB memory to store. There were no significant differences among indices of left ventricular function between scatter non-corrected and corrected images. Although extents of perfusion defects were not significantly different, severity was severer in scatter corrected images. Conclusion: Scatter correction using DEW-SC is simple to do, and improves image contrast without changing other indices of myocardial perfusion and function.

• Nuclear Medicine and Molecular Imaging
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• v.41 no.3
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• pp.194-200
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• 2007

Purpose: $^{13}N$-ammonia is a well known radiopharmaceutical for the measurement of a myocardial blood flow (MBF) non-invasively using PET-CT. In this study, we investigated a correlation between MBF obtained from dynamic imaging and myocardial perfusion score (MPS) obtained from static imaging for usefulness of cardiac PET study. Methods: Twelve patients (11 males, 1 female, $57.9{\pm}8.6$ years old) with suspicious coronary artery disease underwent PET-CT scan. Dynamic scans (6 min: $5\;sec\;{\times}\;12,\;10\;sec\;{\times}\;6,\;20\;sec\;{\times}\;3,\;and\;30\;sec\;{\times}\;6$) were initiated simultaneously with bolus injection of 11 MBq/kg $^{13}N-ammonia$ to acquire rest and stress image. Gating image was acquired during 13 minutes continuously. Nine-segment model (4 basal walls, 4 mid walls, and apex) was used for a measurement of MBF. Time activity curve of input function and myocardium was extracted from ROI methods in 9 regions for quantification. The MPS were evaluated using quantitative analysis software. To compare between 20-segment model and 9-segment model, 6 basal segments were excluded and averaged segmental scores were used. Results: There are weak correlation between MBF (rest, 0.18-2.38 ml/min/g; stress, 0.40-4.95 ml/min/g) and MPS (rest 22-91%, stress, 14-90%), however the correlation coefficient between corrected MBF and MPS in rest state was higher than stress state (rest r=0.59; stress r=0.80). As a thickening increased, correlation between MBF and MPS also showed good correlation at each segments. Conclusions: Corrected and translated MPS as its characteristics using $^{13}N$-ammonia showed good correlation with absolute MBF measured by dynamic image in this study. Therefore, we showed MPS is one of good indices which reflect MBF. We anticipate PET-CT could be used as useful tool for evaluation of myocardial function in nuclear cardiac study.

• Journal of Dairy Science and Biotechnology
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• v.16 no.2
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• pp.119-136
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• 1998

The lipids of milk provide energy and many essential nutrients for the newborn animal. They also have distinctive physical properties that affect the processing of dairy products. Milk fat globules mainly consist of neutral lipids like triacylglycerols, whereas the globule membranes contain the complex lipids mostly, Phospholipids are a small but important fraction of the milk lipids and are found mainly in the milk fat globule membrane and other membranous material in the skim-milk phase. The milk fats of ruminant animals are characterized by the presence of relatively high concentrations of short-chain fatty acids, especially butyric and hexanoic acids, which are rarely found in milks of non-ruminants. The fatty acids of milk lipids arise from de novo synthesis in the mammary gland and uptake from the circulating blood. The fatty acid compositions of milks are usually complex and distinctive, depending on the nature of the fatty acids synthesized de novo in the mammary gland and those received from the diet in each species. The content and composition of milks from different species vary widely; presumably, these are evolutionary adaptations to differing environments. The actual process by which these globules are formed is unkonwn, but there are indications that triglyceride-containing vesicles which bleb from endoplasmic reticulum may serve as nucleation sites for globules. Recent studies on milk have centred on the manipulation of milk lipids to increase specific fatty acids, i.e. 20-carbon omega-3 fatty acids (eicosapentaenoic acid 20:5n3, decosahexaenoic acid 22:6n3) from marine sources because the fatty acids are closely associated with a decreased risk of coronary heart disease.

• The Korean Journal of Nuclear Medicine Technology
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• v.16 no.1
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• pp.86-90
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• 2012

Purpose: Quantification of myocardial blood flow (MBF) using dynamic PET imaging has the potential to assess coronary artery disease. Rb-82 plays a key role in the clinical assessment of myocardial perfusion using PET. However, MBF could be overestimated due to the underestimation of left ventricular input function in the beginning of the acquisition when the scanner has non-linearity between count rate and activity concentration due to the scanner dead-time. Therefore, in this study, we evaluated the count rate linearity as a function of the activity concentration in PET data acquired in list mode. Materials & methods: A cylindrical phantom (diameter, 12 cm length, 10.5 cm) filled with 296 MBq F-18 solution and 800 mL of water was used to estimate the linearity of the Biograph 40 True Point PET/CT scanner. PET data was acquired with 10 min per frame of 1 bed duration in list mode for different activity concentration levels in 7 half-lives. The images were reconstructed by OSEM and FBP algorithms. Prompt, net true and random counts of PET data according to the activity concentration were measured. Total and background counts were measured by drawing ROI on the phantom images and linearity was measured using background correction. Results: The prompt count rates in list mode were linearly increased proportionally to the activity concentration. At a low activity concentration (<30 kBq/mL), the prompt net true and random count rates were increased with the activity concentration. At a high activity concentration (>30 kBq/mL), the increasing rate of the prompt net true rates was slightly decreased while the increasing rate of random counts was increased. There was no difference in the image intensity linearity between OSEM and FBP algorithms. Conclusion: The Biograph 40 True Point PET/CT scanner showed good linearity of count rate even at a high activity concentration (~370 kBq/mL).The result indicates that the scanner is useful for the quantitative analysis of data in heart dynamic studies using Rb-82, N-13, O-15 and F-18.

• Pediatric Infection and Vaccine
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• v.23 no.1
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• pp.10-17
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• 2016

Purpose: The diagnosis of Kawasaki disease depends on clinical symptoms, which makes it difficult to diagnose early in patients with only cervical lymphadenopathy. The purpose of this study is to understand the clinical characteristics of cervical-lymph-node-first presentation of Kawasaki disease and compare them with those of typical Kawasaki disease. Methods: We surveyed 283 patients who were admitted to Hallym Sacred Heart Hospital and were diagnosed with Kawasaki disease from January 2012 to December 2014. The patients were divided into two groups: cervical-lymph-node-first presentation of Kawasaki disease (LKD, N=24) and typical Kawasaki disease (KD, N=259). The medical records were retrospectively reviewed. Results: The mean age of the LKD group was higher than that of the KD group (P=0.04). At admission, the LKD patients had on average 1.62 out of 5 symptoms, whereas the KD patients had 3.47. The time from fever to diagnosis and administration of IV immunoglobulin was longer in the LKD group than in the KD group (P<0.001). The mean C-reactive protein of the LKD group was higher than that of the KD group (P=0.01). There were no statistical differences in the presence of coronary artery complications between the two groups at two weeks or at two months after diagnosis (P=0.52, P=0.08). Conclusions: The Kawasaki disease patients with fever and cervical lymphadenopathy usually do not present obvious clinical symptoms, which makes it hard to diagnose in the early phase of disease. Clinician must pay attention when examining these patients.

• Journal of Chest Surgery
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• v.34 no.11
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• pp.848-853
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• 2001

Background: Sternal infection or dehiscence after cardiac surgery through median sternotomy is rare. If suitable treatment is not performed for the complication, however, the mortality is high. For 12 patients with sternal dehiscence or infection, we performed wide excision of the infected and necrotic tissue and covered with muscle flap(s) to obliterate the mediastinal dead space. Material and method: Sternal infection or dehiscence occurred in 13 of patients who underwent cardiac surgery One patient, who died of cerebral infarction before the sternal complication was treated, was excluded in this study. The sternal wound complication occurred in 6 of patients with valve replacement and 6 of patients with coronary bypass surgery, respectively. Since 1991, 9 patients underwent definite surgical debridement and muscle transposition as soon as fever was controlled with closed irrigation and drainage. The necrotic tissue and bone was widely excised and the sternal dead space was eradicated with the single flap or the combined flaps of right pectoralis flap(turnover flap), left pectoralis flap(turnover flap or rotation-advancement flap), and right rectus muscle flap. Result : There was no mortality in 12 patients with coverage of muscle flap(s) for sternal infection or dehiscence The mean interval between the diagnosis of sternal complication and the myoplasty was 6.6$\pm$3.9 days. In 4 patients, one pectoralis muscle flap was used, and in 8 patients both pectoralis muscle flaps were used. For each 1 patient and 2 patients in each group, right rectus muscle flap was added. For the last 3 patients, a single pectoralis flap was used to eradicate the mediastinal dead space and the longer placement of the mediastinal drain catheter was needed. One patient, who had suffered from necrosis of left pectoralis flap(rotation-advancement flap) with subsequent chest wall abscess after coverage of both pectoralis flaps, was managed with reoperation using right rectum flap. Conclusion : Sternal dehiscence or infection after cardiac operation can be readily managed with wide excision of necrotic infected tissue(including bone) and muscle flap coverage after short-term irrigation of sternal wound. The sternal(mediastinal) dead space may be completely eradicated with right pectoralis major muscle flap alone.

• Journal of Chest Surgery
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• v.34 no.11
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• pp.809-822
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• 2001

Background: Ischemic preconditioning(IP) is known to be effective in the protection of myocardial necrosis, arrhythmia, and the restoration of the myocardial function in the ischemia-reperfusion state of the heart. However the exact mechanism is not clearly understood. The purpose of this study was to elucidate the trigger mechanism 7f IP on the restoration of the myocardial function after ischemia-reperfusion. Material and Method: By connecting a Langendorff perfusion apparatus with an isolated heart of a rat, the normal temperature of the heart was maintained. The experiment was conducted in seven groups, which were divided according to the preconditioning stimuli and blockage methods Group I(n=10) was a group without IP, Group II(n=10) a group of three-minute IP, Group III(n=10) a group of PEIP, Group IV(n=10) a group of clonidine IP, Group V(n=10) a group of If after reserpine, Group Vl(n=10) a group of PE & prazosin IP, and Group Vll(n=10) a group of clonidine & yohimbine IP. Hemodynamic parameters of DP, LVEDP, $\pm$dP/dT and the changes of perfusion in the coronary artery were evaluated. Result: Developed pressure and +dP/dT changed per unit time. After 20 minutes of reperfusion, those of Group II and III were 63.1$\pm$3.7%, 64.8$\pm$4.6% and 64.5$\pm$4.6%, 63.8$\pm$4.4%, which improved more significantly than those of Group I(P<0.05), However, there were no significant differences between the Groups V and Vl, and Group I. Conclusion: The Brief ischemic preconditioning and pharmacological preconditioning using $\alpha$-receptor sympatho-mimetics have protecting effects on the restoration of myocardial function after reperfusion. And the protecting effect of preconditioning seems to be related to sympathetic neurotransmitters and to the selective action of the $\alpha$$_1$-adrenergic receptor.

• Journal of Chest Surgery
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• v.37 no.9
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• pp.755-761
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• 2004

We evaluated the efficacy of Dor procedure in patients with ischemic left ventricular dysfunction. Material and Method: Between April 1998 and December 2002, 45 patients underwent the Dor procedure con-comitant with coronary artery bypass grafting (CABG). Left ventricular ejection fraction (LVEF) and left ventricular end-diastolic/end-systolic volumes (LVEDV/LVESV) were measured by echocardiography, myocardial SPECT, and cardiac catheterization and angiography performed at the sequence of preoperative, early postoperative, and one year postoperative stage. Result: Cardiopulmonary bypass and aortic clamp times were mean 141$\pm$64, 69$\pm$24 minutes, respectively. Intraaortic balloon pump (IABP) therapy was required in 19 patients (42%; 7 preoperatively, 9 intraoperatively, 3 postoperatively). Operative mortality rate was 2.2% (1/45). Postoperative morbidities were low cardiac output syndrome (12), atrial fibrillation (5), acute renal failure (4), and postoperative bleeding (4). Functional class (NYHA) was improved from classes 2.8 to 1.1 (p < 0,01). When we compared between the preoperative and early postoperative values, LVEF was improved from 32$\pm$9% to 52$\pm$11% (p<0.01). The asynergy portion decreased from 57$\pm$12% to 22$\pm$9%, and LVEDV/LVESV indexes improved from 125$\pm$39 mL/$m^2$, 85$\pm$30 mL/$m^2$ to 66$\pm$23 mL/$m^2$, 32$\pm$16 mL/$m^2$ (p<0.01). Although these changes in volumes were relatively preserved at postoperative one year, the left ventricular volumes showed a tendency to increase. Conclusion: After the Dor procedure for ischemic left ventricular dysfunction, LVEF improvement and left ventricular volume reduction were maintained till postoperative one year. The tendency for left ventricular volume to increase at postoperative one year suggested the requirement of strict medical management.

• Journal of Chest Surgery
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• v.38 no.10 s.255
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• pp.693-698
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• 2005

Background: Sinus valsalva aneurysm (SVA) is a rare disease, and it is frequently accompanied by ventricular septal defect and aortic valve regurgitaion. For treatment of SVA, several surgical mordalities were applied, but there was no report on the long-term result after surgical repair in Korea. We reviewed our 28 years of experiences and analyzed the long-term results after treatment of sinus valsalva aneurysm with or without rupture. Material and Method: Between March 1974 and February 2002, 81 patients were operated under the impression of sinus valvsalva aneurysm or sinus valsalva aneurym rupture. Retrospectively we reviewed the patients' record. Mean age of patients was $29.2\pm11.5$ and there were 49 males. Accompanyng diseases were as follows: VSD in 50, PDA in 2, Behcet's disease in 2, TOF in 1, RVOTO in 1, AAE in 1. Seventy-seven $(95\%)$ patients had sinus valsalva rupture and in 14 patients, subacute bacterial endocarditis was accompanied. Degree of aortic valve regurgitation was as follows: grade I: 8, II: 10, III: 9, IV: 4. Most common rupture site was right coronary sinus (66 patients, $81\%$) and most common communication site was right ventricle (53 patients). In repair of sinus valsalva rupture, patch was used in 37 patients, and direct suture was done in 38 patients. Result: There was one surgical death $(1.2\%)$. Follow up was done in 78 patients $(97.5\%)$, mean follow up period was $123.3\pm80.9(3\~330\;months)$. During the follow up period, 3 patients died $(3.8\%)$. One patient died of heart failure, another patient died of arrhythmia and the other one died of unknown cause. In two patients, complete atrio-ventricular block was developed during follow up period, and there was no operation related event or complication. Kaplan-Meier survival analysis revealed $92.5\pm3.5\%$ survival at 15 and 27 years and it seems to be satisfactory. Conclusion: Long-term surgical results and survival is satisfactory after repair of sinus valsalva aneurysm with or without rupture.