• Title/Summary/Keyword: Diagnostic Errors

검색결과 146건 처리시간 0.024초

Basal cell carcinoma misdiagnosed as trichoepithelioma

  • Wee, Sung Jae;Park, Myong Chul;Chung, Chan Min
    • 대한두개안면성형외과학회지
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    • 제21권3호
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    • pp.202-205
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    • 2020
  • Trichoepithelioma is a benign hair follicle tumor that can undergo malignant transformation into basal cell carcinoma in rare cases. Due to the similar clinical and histological features of trichoepithelioma and basal cell carcinoma, distinguishing between these types of tumors can be a diagnostic challenge. Punch biopsy obtains only a small sample of the entire lesion, and thus inherently involves a risk of misdiagnosis between histologically similar diseases. Therefore, if the possibility of misdiagnosis can reasonably be suspected, clinicians should conduct an excisional biopsy or immunohistochemical staining (e.g., CD10 and Bcl-2) to ensure an exact diagnosis. Although trichoepithelioma is benign, the surgical excision of solitary trichoepithelioma should be considered in order to avoid the possibility of malignant transformation, which has occasionally been documented for multiple familial trichoepitheliomas. Herein, we report a case that was initially misdiagnosed as trichoepithelioma before ultimately being diagnosed as basal cell carcinoma through excision and immunohistochemical staining.

누설전류측정에 의한 피뢰기 열화진단에 있어 전원고조파의 영향 (Influence of Harmonics in Power System Voltage on Arrester Deterioration Diagnostics by Leakage Current Measurement)

  • 길경석;한주섭;주문노
    • 대한전기학회논문지:전기물성ㆍ응용부문C
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    • 제52권1호
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    • pp.42-46
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    • 2003
  • Arresters are deteriorated by overvoltages or impulse currents, and the resistive leakage current of arresters increases as the deterioration of the arrester progresses, showing an increase in the 3$^{rd}$ harmonic component of the leakage current. In this reason, arrester diagnostic techniques based on the 3$^{rd}$ harmonic leakage current as a reference parameter of deterioration are widely used. The technique, however, includes an error due to the harmonics of power system voltage. Therefore, the influence of the harmonics on arrester diagnostics should be considered. In this paper, we designed a PSpice ZnO arrester model to simulate the influence of the voltage harmonics described above. A pure sinusoidal voltage and its the 3r harmonic voltage were applied to the model, and the leakage current components were analyzed. From the simulation results, it is confirmed that the peak value of resistive leakage current depends not only on the phase of the 3$^{rd}$ harmonic voltage but also on the magnitude of it. Consequently, the errors caused 1)y the harmonic voltage could be minimized by correcting the magnitude of leakage current upon analyzing the harmonics.cs.

Concept of an intelligent operator support system for initial emergency responses in nuclear power plants

  • Kang, Jung Sung;Lee, Seung Jun
    • Nuclear Engineering and Technology
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    • 제54권7호
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    • pp.2453-2466
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    • 2022
  • Nuclear power plant operators in the main control room are exposed to stressful conditions in emergency situations as immediate and appropriate mitigations are required. While emergency operating procedures (EOPs) provide operators with the appropriate tasks and diagnostic guidelines, EOPs have static properties that make it difficult to reflect the dynamic changes of the plant. Due to this static nature, operator workloads increase because unrelated information must be screened out and numerous displays must be checked to obtain the plant status. Generally, excessive workloads should be reduced because they can lead to human errors that may adversely affect nuclear power plant safety. This paper presents a framework for an operator support system that can substitute the initial responses of the EOPs, or in other words the immediate actions and diagnostic procedures, in the early stages of an emergency. The system assists operators in emergency operations as follows: performing the monitoring tasks in parallel, identifying current risk and latent risk causality, diagnosing the accident, and displaying all information intuitively with a master logic diagram. The risk causalities are analyzed with a functional modeling methodology called multilevel flow modeling. This system is expected to reduce workloads and the time for performing initial emergency response procedures.

Metabolic evaluation of children with global developmental delay

  • Eun, So-Hee;Hahn, Si Houn
    • Clinical and Experimental Pediatrics
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    • 제58권4호
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    • pp.117-122
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    • 2015
  • Global developmental delay (GDD) is a relatively common early-onset chronic neurological condition, which may have prenatal, perinatal, postnatal, or undetermined causes. Family history, physical and neurological examinations, and detailed history of environmental risk factors might suggest a specific disease. However, diagnostic laboratory tests, brain imaging, and other evidence-based evaluations are necessary in most cases to elucidate the causes. Diagnosis of GDD has recently improved because of remarkable advances in genetic technology, but this is an exhaustive and expensive evaluation that may not lead to therapeutic benefits in the majority of GDD patients. Inborn metabolic errors are one of the main targets for the treatment of GDD, although only a small proportion of GDD patients have this type of error. Nevertheless, diagnosis is often challenging because the phenotypes of many genetic or metabolic diseases often overlap, and their clinical spectra are much broader than currently known. Appropriate and cost-effective strategies including up-to-date information for the early identification of the "treatable" causes of GDD are needed for the development of well-timed therapeutic applications with the potential to improve neurodevelopmental outcomes.

Intra-Operative Frozen Sections: Experience at A Tertiary Care Centre

  • Preeti, Agarwal;Sameer, Gupta;Kulranjan, Singh;Abhinav, Sonkar Arun;Preeti, Rani;Sunita, Yadav;Mati, Goel Madhu
    • Asian Pacific Journal of Cancer Prevention
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    • 제17권12호
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    • pp.5057-5061
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    • 2016
  • The present study was conducted to assess error rates with diagnosis using intra-operative frozen sections, and to indicate ways to increase overall performance. Over a period of two years, 227 cases were biopsied intra-operatively. Errors were observed in 14 cases. Four of these were sampling errors, one by a pathologist and three by surgeons. In seven cases incorrect interpretations were made. Epithelial dysplasia was observed on definitive histology in two cases which was not reported intra-operatively. One case was of ectopic thyroid. In cases of oral cancer where sentinel lymph nodes were sampled, immunohistochemistry for cytokeratin was performed to facilitate identification of micrometastasis. Only single case displayed tumor deposits which was not evident morphologically. Resection margins were reported in seventy eight cases. Some 18% (14/50) benefited from revision of margins; overall sensitivity of intra-operative frozen sections for marginal status was 71.4%, with a specificity of 90.3%. Overall sensitivity was 75% and specificity was 97.5%. Careful observation, pathologist experience and knowledge of limitations help in improving the overall diagnostic outcome.

맥파검출용 트랜스듀서의 개발 (Development of P-5 Transducer or Detection of the Pulse Wave)

  • 한성현;권오상;박승환;홍승홍
    • 대한의용생체공학회:학술대회논문집
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    • 대한의용생체공학회 1997년도 추계학술대회
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    • pp.395-398
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    • 1997
  • Human pulse represents the physical characteristics of heart and cardiovascular system. Therefore, malfunctions and errors of heart and cardiovascular system can be determined by using an automatic diagnosis system that can detect the pulse signal. Not only will the computerised system preclude the possibilities of observational errors by giving an accurate measurement with great stability, but minimize the possibilities of misinterpretation by using an automated diagnostic logic. A new combinational fiber-optic sensor, which has a detecting part and a transmitting part was used to acquire radial pulse signal noninvasively. The development of P-5 transducer makes it possible to obtain more effective detection and obvious display of pulse signals in the aspect of reliability. Using P-5 transducer in the field of plethysomography and MAC- JIN, one of our diagnoses in Korean traditional medicine, it is expected that we can ontain quantitative and valuable information or the diagnosis of human pulses.

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원격판독 의료기관에서 시행한 원격판독의 동료평가: 세부전공분야와 촬영장비에 따른 판독 불일치 정도와 불일치 판독의 임상적 의의 비교 (Peer Review of Teleradiology at a Teleradiology Clinic: Comparison of Unacceptable Diagnosis and Clinically Significant Discrepancy between Radiology Sections and Imaging Modalities)

  • 서형석;박재성;오유환;성동욱;이아름
    • 대한영상의학회지
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    • 제82권6호
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    • pp.1545-1555
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    • 2021
  • 목적 동료평가를 시행하여 원격판독 불일치의 정도와 불일치 판독의 임상적 의의를 세부전공분야와 촬영장비별로 평가하고자 하였다. 대상과 방법 한 국내 원격판독 의료기관에서 2018년과 2019년에 시행한 동료평가를 대상으로 세부전공분야와 촬영장비별로 판독 불일치를 분석하였다. 동료평가 점수를 적격 진단과 부적격 진단으로 분류하였고, 판독 불일치는 임상적 의의에 따라 무의한 불일치와 유의한 불일치로 분류하였다. 카이제곱 검증으로 통계를 시행하였다. 결과 총 1312건의 동료평가 중 부적격 진단은 117건(8.9%)이고, 총 462건의 진단 불일치 중 유의한 불일치는 104건(21.6%)이었다. 세부전공분야에서 부적격 진단율은 근골격(21.4%)이 가장 높았고(각각 p < 0.05), 복부(7.3%)는 신경두경부(1.3%)에 비해 높았다(p < 0.05). 유의한 불일치는 흉부(32.7%)가 복부(17.1%)와 근골격(19.5%)에 비해 높았다(각각 p < 0.05). 촬영장비에서 부적격 진단은 MR (16.2%)이 일반촬영(7.8%)에 비해 높았고(p < 0.05), 유의한 불일치는 차이가 없었다. 결론 동료평가를 통해서 원격판독의 부적격 진단과 임상적 유의한 불일치의 정도, 세부전공분야와 촬영장비에 따른 차이를 알 수 있었다.

Digora$\textregistered$에서 노출시간의 변화가 근관치료용 file의 첨부식별에 미치는 영향 (The effects of various exposure times in the detectability on the tips of the endodontic files in Digora$\textregistered$)

  • 고지영;박창서
    • 치과방사선
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    • 제27권1호
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    • pp.55-71
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    • 1997
  • Digora/sup (R)/ an intraoral digital radiography system utilizing image plate (IP) - has a dynamic range of exposure time which allows it to decrease the patient's exposure time and to increase diagnostic ability through image processing, transmission and storage. The purpose of this study was to evaluate the Digora/sup (R)/ system by assessing the effects of various exposure times on the detectability on the tip of the endodontic file. Examining the root canals of 45 extracted sound premolars, K -files No. 10, 15, and 20 were placed at slightly varying distances from the apex. The teeth were glued onto resin-plaster blocks. Five exposure times varying between 0.01 seconds and 0.25 seconds were used. Four observers were asked to measure the distance between the tip of the file and a reduction of crown portion, and obtained mean errors (subtracting true file length from the measured file length), comparing Digora/sup (R)/ monitors with E-plus films, which were both obtained under the same geometrical positions. The results were as follows : 1. Comparing E-plus film with Digora/sup (R)/ at 0.01 seconds, the mean errors in E-plus film showed -4.453 nun, -4.497 nun, and -3.857 nun, while the mean errors in Digora/sup (R)/ showed 0.065 nun, 0.607 nun, and 0.719 mm according to the file groups. Therefore there was a significant difference between E-plus film and Digora/sup (R)/(p<0.05). 2. By comparison of mean errors according to the various exposure times in the Digora/sup (R)/ system, the mean error at 0.01 seconds was significantly lower than that at 0.12 and 0.25 seconds in the No. 10 file group(p<0.05). And the standard deviation was the highest at 0.01 seconds. 3. Comparing E-plus film at 0.25 seconds with the Digora/sup (R)/ system, the mean errors showed a significant difference between E-plus film at 0.25 seconds and the Digora/sup (R)/ system at 0.25 seconds in No. 10 and 20 file groups(p<0.05). 4. Comparing E -plus film at 0.25 seconds with other exposure times, the mean errors showed a significant difference between E-plus film at 0.25 seconds and E-plus film at 0 .. 01 and 0.03 seconds in 10 file group(p<0.05). In the No. 15 and 20 file groups, there was a significant difference between E-plus film at 0.25 seconds and E-plus film at 0.01 seconds(p<0.05). In conclusion, Digora/sup (R)/ was better than E-plus film in detectability on the tip of the file at the exposure time of 0.01 seconds in all file groups. And we concluded that Digora/sup (R)/ can shorten exposure times up to 4% of 0.25 seconds (0.01 sec), which is adequate exposure time for premolar in E-plus film using No. 15 and 20 files.

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세침흡인 세포검사와 조직검사의 진단 일치율 및 정확도에 대한 조사 (Diagnostic Correlation and Accuracy Between Fine Needle Aspiration Cytology and Histopathologic Examination)

  • 손진희;채승완;조은윤;김어진
    • 대한세포병리학회지
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    • 제14권2호
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    • pp.53-59
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    • 2003
  • Fine needle aspiration cytology (FNAC) has been known as a very sensitive and effective method for preoperative diagnosis. We studied cases preoperatively diagnosed by FNAC and confirmed by the histopathologic examination to define the effectiveness of FNAC. A total of 567 cases including breast, thyroid gland, lymph node, and soft tissue confirmed histologically after FNAC were enrolled, among 2,844 FNAC cases from January 1996 to March 2000. Overall sensitivity and specificity of FNAC were 93% and 100%, respectively. Sensitivity and specificity of FNAC by sites or organs were 91% and 100% in breast, 100% and 100% in thyroid, 97% and 100% in lymph node, and 71% and 100% in soft tissue, respectively. Nine cases showed diagnostic discrepancy; eight cases of sampling error and one case of interpretation error. Five cases, diagnosed as fibrocystic change at FNAC but invasive ductal carcinoma after the histopathologic examination, were categorized as sampling error due to the presence of diffuse fibrosis or deep seated location. One case of breast, diagnosed descriptively as atypical ductal and stromal cells suggesting invasive ductal carcinoma at FNAC but malignant phyllodes tumor histologically, was categorized as interpretation error. Other cases of sampling errors were two cases of soft tissue, a case of lymph node, and a case of salivary gland.

Relaxographic 분석법을 이용한 뇌의 다중 자기이완특성에 관한 연구 (Multi-Component Relaxation Study of Human Brain Using Relaxographic Analysis)

  • Yongmin Chang;Bong Soo Han;Bong Seok Kang;Kyungnyeo Jeon;Kyungsoo Bae;Yong-Sun Kim;Duk-Sik Kang
    • Investigative Magnetic Resonance Imaging
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    • 제6권2호
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    • pp.120-128
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    • 2002
  • 목적: 자기공명영상과 자기이완분포 분석법을 통합적으로 이용하는 경우 기존의 자기이완시간 분석기법에서 제공할 수 없었던 자기이완 시간의 분포 및 해당 분포의 상대적인 물분자 함유량등의 추가적인 정보를 제공할 수 있음을 보이고자 하였다. 대상 및 방법: 자기이완분포 분석법(CONTIN)의 정확도 및 신뢰성을 검증 하기 위하여 먼저 자기이완시간이 일정한 분포를 가지도록 고안된 모의 자기이완 데이터를 사용하였다. 다음으로 지질의 함유량이 99% 이상인 식용유와 증류수를 일정비율(0, 10, 2 0, 30%)로 혼합한 실험 팬텀을 제작하고 inversion-recovery시퀀스 (TI: 40 -1160 msec, TR/TE=2200/20 msec)를 사용하여 MR 영상을 획득하여 CONTIN을 사용하여 분석하였다. 그 리고 사람의 뇌 영상에서 뇌척수액, 백질, 회백질에 관심영역을 설정하고 CONTIN을 사용하여 각 관심영역에서의 자기이완분포를 분석하였다. 결과: 신호대잡음비를 달리한 모의 자기이완 데이터의 분석결과 자기이완시간의 위치에 대한 오차는 신호대잡음비에 관계없이 긴 자기이완시간 ($T_1=600$ msec)에 비해 짧은 자기이완시간 ($T_1$=150 msec)에서 크게 나타났으며 반대로 자기이완시간 분포면적에 대해서는 긴 자기이완시간 ($T_1$=600 msec)의 면적 오차가 짧은 자기이완시간 ($T_1=150$ msec)에 비해 큰 것으로 나타났다. 실험 팬톰을 이용한 분석결과는 실제 오일대 증류수의 비율을 1:2:3으로 한 팬톰들에서 분석결과는 1:1.3:1.9으로 나타났다. 자원자의 뇌영상에서는 CSF의 경우에는 하나의 $T_1$ 자기이완시간만이 나타난 반면 백질과 회백질에서는 2개의 $T_1$ 자기이완분포를 가지는 것으로 분석되었다. CSF와 백질의 평균 자기이완시간은 기존의 보고된 값들과 잘 일치하였다. 결론: 자기공명영상과 자기이완분포 분석법을 통합적으로 이용하는 경우 기존의 자기이완시간 분석기법에서 제공 할 수 없었던 자기이완시간의 분포 및 해당 분포의 상대적인 물분자 함유량등의 추가적인 정보를 제공한다는 사실을 규명하였고 이러한 추가적인 정보들은 임상적 유용성이 있을 것으로 추정된다.

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