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The efficacy of continuous positive airway pressure (CPAP) for patient with left breast cancer (좌측 유방암 방사선치료에서 CPAP(Continuous Positive Airway Pressure)의 유용성 평가)

  • Jung, Il Hun;Ha, Jin Sook;Chang, Won Suk;Jeon, Mi Jin;Kim, Sei Joon;Jung, Jin Wook;Park, Byul Nim;Shin, Dong Bong;Lee, Ik Jae
    • The Journal of Korean Society for Radiation Therapy
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    • v.31 no.2
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    • pp.43-49
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    • 2019
  • Purpose: This study examined changes in the position of the heat and lungs depending on the patient's breathing method during left breast cancer radiotherapy and used treatment plans to compare the resulting radiation dose. Materials and methods: The participants consisted of 10 patients with left breast cancer. A CT simulator(SIMENS SOMATOM AS, Germany) was used to obtain images when using three different breathing methods: free breathing(FB), deep inspiration breath hold(DIBH with Abches, DIBH), inspiration breath hold(IBH with CPAP, CPAP). A Ray Station(5.0.2.35, Sweden) was used for treatment planning, the treatment method was volumetric modulated arc therapy (VMAT) with one partial arc of the same angle, and the prescribed dose to the planning target volume (PTV) was a total dose of 50Gy(2Gy/day). In treatment plan analysis, the 95% dose (D95) to the PTV, the conformity index(CI), and the homogeneity index (HI) were compared. The lungs, heart, and left anterior descending artery (LAD) were selected as the organs at risk(OARs). Results: The mean volume of the ipsilateral lung for FB, DIBH, and CPAP was 1245.58±301.31㎤, 1790.09±362.43 ㎤, 1775.44±476.71 ㎤. The mean D95 for the PTV was 46.67±1.89Gy, 46.85±1.72Gy, 46.97±23.4Gy, and the mean CI and HI were 0.95±0.02, 0.96±0.02, 0.95±0.02 and 0.91±0.01, 0.90±0.01, 0.92±0.02. The V20 of Whole Lung was 10.74±4.50%, 8.29±3.14%, 9.12±3.29% and The V20 of the ipsilateral lung was 20.45±8.65%, 17.18±7.04%, 18.85±7.85%, the Dmean of the heart was 7.82±1.27Gy, 6.10±1.27Gy, 5.67±1.56Gy, and the Dmax of the LAD was 20.41±7.56Gy, 14.88±3.57Gy, 14.96±2.81Gy. The distance from the thoracic wall to the LAD was measured to be 11.33±4.70mm, 22.40±6.01mm, 20.14±6.23mm. Conclusion: During left breast cancer radiotherapy, the lung volume was 46.24% larger for DIBH than for FB, and 43.11% larger for CPAP than FB. The larger lung volume increases the distance between the thoracic wall and the heart. In this way, the LAD, which is one of the nearby OARs, can be more effectively protected while still satisfying the treatment plan. The lung volume was largest for DIBH, and the distance between the LAD and thoracic wall was also the greatest. However, when performing treatment with DIBH, the intra-fraction error cannot be ignored. Moreover, communication between the patient and the radiotherapist is also an important factor in DIBH treatment. When communication is problematic, or if the patient has difficulty holding their breath, we believe that CPAP could be used as an alternative to DIBH. In order to verify the clinical efficacy of CPAP, it will be necessary to perform long-term follow-up of a greater number of patients.

Organizational Buying Behavior in an Interdependent World (상호의존세계중적조직구매행위(相互依存世界中的组织购买行为))

  • Wind, Yoram;Thomas, Robert J.
    • Journal of Global Scholars of Marketing Science
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    • v.20 no.2
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    • pp.110-122
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    • 2010
  • The emergence of the field of organizational buying behavior in the mid-1960’s with the publication of Industrial Buying and Creative Marketing (1967) set the stage for a new paradigm of thinking about how business was conducted in markets other than those serving ultimate consumers. Whether it is "industrial marketing" or "business-to-business marketing" (B-to-B), organizational buying behavior remains the core differentiating characteristic of this domain of marketing. This paper explores the impact of several dynamic factors that have influenced how organizations relate to one another in a rapidly increasing interdependence, which in turn can impact organizational buying behavior. The paper also raises the question of whether or not the major conceptual models of organizational buying behavior in an interdependent world are still relevant to guide research and managerial thinking, in this dynamic business environment. The paper is structured to explore three questions related to organizational interdependencies: 1. What are the factors and trends driving the emergence of organizational interdependencies? 2. Will the major conceptual models of organizational buying behavior that have developed over the past half century be applicable in a world of interdependent organizations? 3. What are the implications of organizational interdependencies on the research and practice of organizational buying behavior? Consideration of the factors and trends driving organizational interdependencies revealed five critical drivers in the relationships among organizations that can impact their purchasing behavior: Accelerating Globalization, Flattening Networks of Organizations, Disrupting Value Chains, Intensifying Government Involvement, and Continuously Fragmenting Customer Needs. These five interlinked drivers of interdependency and their underlying technological advances can alter the relationships within and among organizations that buy products and services to remain competitive in their markets. Viewed in the context of a customer driven marketing strategy, these forces affect three levels of strategy development: (1) evolving customer needs, (2) the resulting product/service/solution offerings to meet these needs, and (3) the organization competencies and processes required to develop and implement the offerings to meet needs. The five drivers of interdependency among organizations do not necessarily operate independently in their impact on how organizations buy. They can interact with each other and become even more potent in their impact on organizational buying behavior. For example, accelerating globalization may influence the emergence of additional networks that further disrupt traditional value chain relationships, thereby changing how organizations purchase products and services. Increased government involvement in business operations in one country may increase costs of doing business and therefore drive firms to seek low cost sources in emerging markets in other countries. This can reduce employment opportunitiesn one country and increase them in another, further accelerating the pace of globalization. The second major question in the paper is what impact these drivers of interdependencies have had on the core conceptual models of organizational buying behavior. Consider the three enduring conceptual models developed in the Industrial Buying and Creative Marketing and Organizational Buying Behavior books: the organizational buying process, the buying center, and the buying situation. A review of these core models of organizational buying behavior, as originally conceptualized, shows they are still valid and not likely to change with the increasingly intense drivers of interdependency among organizations. What will change however is the way in which buyers and sellers interact under conditions of interdependency. For example, increased interdependencies can lead to increased opportunities for collaboration as well as conflict between buying and selling organizations, thereby changing aspects of the buying process. In addition, the importance of communication processes between and among organizations will increase as the role of trust becomes an important criterion for a successful buying relationship. The third question in the paper explored consequences and implications of these interdependencies on organizational buying behavior for practice and research. The following are considered in the paper: the need to increase understanding of network influences on organizational buying behavior, the need to increase understanding of the role of trust and value among organizational participants, the need to improve understanding of how to manage organizational buying in networked environments, the need to increase understanding of customer needs in the value network, and the need to increase understanding of the impact of emerging new business models on organizational buying behavior. In many ways, these needs deriving from increased organizational interdependencies are an extension of the conceptual tradition in organizational buying behavior. In 1977, Nicosia and Wind suggested a focus on inter-organizational over intra-organizational perspectives, a trend that has received considerable momentum since the 1990's. Likewise for managers to survive in an increasingly interdependent world, they will need to better understand the complexities of how organizations relate to one another. The transition from an inter-organizational to an interdependent perspective has begun, and must continue so as to develop an improved understanding of these important relationships. A shift to such an interdependent network perspective may require many academicians and practitioners to fundamentally challenge and change the mental models underlying their business and organizational buying behavior models. The focus can no longer be only on the dyadic relations of the buying organization and the selling organization but should involve all the related members of the network, including the network of customers, developers, and other suppliers and intermediaries. Consider for example the numerous partner networks initiated by SAP which involves over 9000 companies and over a million participants. This evolving, complex, and uncertain reality of interdependencies and dynamic networks requires reconsideration of how purchase decisions are made; as a result they should be the focus of the next phase of research and theory building among academics and the focus of practical models and experiments undertaken by practitioners. The hope is that such research will take place, not in the isolation of the ivory tower, nor in the confines of the business world, but rather, by increased collaboration of academics and practitioners. In conclusion, the consideration of increased interdependence among organizations revealed the continued relevance of the fundamental models of organizational buying behavior. However to increase the value of these models in an interdependent world, academics and practitioners should improve their understanding of (1) network influences, (2) how to better manage these influences, (3) the role of trust and value among organizational participants, (4) the evolution of customer needs in the value network, and (5) the impact of emerging new business models on organizational buying behavior. To accomplish this, greater collaboration between industry and academia is needed to advance our understanding of organizational buying behavior in an interdependent world.

Effect of Experimental Muscle Fatigue on Muscle Pain and Occlusal Pattern (실험적으로 유발되는 근피로가 근통증 및 교합양상에 미치는 영향)

  • Kim, Jae-Chang;Lim, Hyun-Dae;Kang, Jin-Kyu;Lee, You-Mee
    • Journal of Oral Medicine and Pain
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    • v.33 no.3
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    • pp.279-294
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    • 2008
  • This study aimed to make an analysis of the occlusion in the state of muscle fatigue produced by excessive mouth opening and clenching during the dental treatment to control the dental pain and to evaluate the sensory nerve in the muscle pain state. Most of the reasons why patients visit the dental office result in pain-either conceivably the dental origin pain or the non-dental origin pain. The dental offices have many therapeutic actions to produce the masticatory muscle fatigue for the treatment. Dental treatment with long minutes of mouth opening can cause some headaches, masticatory muscle pain and mouth opening difficulties. Patients with mastication problems who visits a dental office to alleviate pain run against another unexpected pain with other aspects. This study uses T-scan II system(Tekscan Co., USA) for the evaluation on the occlusal pattern in the experimental muscle fatigue after clenching, opening the mouth excessively and chewing gum. The occlusal contact pattern is analyzed by the contact timing, namely first, intercuspal, maximum and end point of contact. This inspection was performed at frequencies of 2000Hz, 250 Hz and 5 Hz before and after each experimental muscle pain was produced to 24 subjects who had normal occlusion without the orthodontic treatment or a wide range of the prosthesis by using $neurometer^{\circledR}$ CPT/C(Neurotron, Inc. Baltimore, Maryland, USA). The measuring sites were mandibular nerve experimental muscle fatigue respectively. This study could obtain the following results after the assessment of occlusion and sensory nerve of the experimental muscle fatigue. 1. There were the fastest expression after the excessive mouth opening in muscle fatigue and after tooth clenching in muscle pain. In the visual analog scale that records the subjective level, there was the highest scale after the clenching in the muscle fatigue in jumping off the point of pain. 2. Tooth contact time, contact force, relative contact force on the point of the first contact had no difference, and there were decreases in the contact force after the excessive mouth opening on intercuspal position point, after the excessive mouth opening and the gum chewing on the point of the maximum, and in the contact time after all the experimental muscle fatigue state on the point of the end contact. 3. There was no statistic significance in the current perception threshold before and after the experimental muscle fatigue. 4. There was no significant difference in the contact number, the maximal contact number on the point of the first contact, and the contact number after the mouth opening and gum chewing on the point of the intercuspal position and the contact number after the experimental muscle fatigue on the maximum point, and showed significant decreases. In conclusion, it was found that the occlusal pattern can cause the changes on the case of the clinical muscle weakness by intra-external oral events. It was important that the sedulous attention to details is required during dental treatment in case of excessive mouth opening, mastication and clenching.

Clinical Results and Optimal Timing of OPCAB in Patients with Acute Myocardial Infarction (급성 심근경색증 환자에서 시행한 OPCAB의 수술시기와 검색의 정도에 따른 임상성적)

  • Youn Young-Nam;Yang Hong-Suk;Shim Yeon-Hee;Yoo Kyung-Jong
    • Journal of Chest Surgery
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    • v.39 no.7 s.264
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    • pp.534-543
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    • 2006
  • Background: There are a lot of debates regarding the optimal timing of operation of acute myocardial infarction (AMI). Off pump coronary artery bypass grafting (OPCAB) has benefits by avoiding the adverse effects of the cardio-pulmonary bypass, but its efficacy in AMI has not been confirmed yet. The purpose of this study is to evaluate retrospectively early and mid-term results of OPCAB in patients with AMI according to transmurality and timing of operation. Material and Method: Data were collected in 126 AMI patients who underwent OPCAB between January 2002 and July 2005, Mean age of patients were 61.2 years. Male was 92 (73.0%) and female was 34 (27.2%). 106 patients (85.7%) had 3 vessel coronary artery disease or left main disease. Urgent or emergent operations were performed in 25 patients (19.8%). 72 patients (57.1%) had non-transmural myocardial infarction (group 1) and 52 patients (42.9%) had transmural myocardial infarction (group 2). The incidence of cardiogenic shock and insertion of intra-aortic balloon pump (IABP) was higher in group 2. The time between occurrence of AMI and operation was divided in 4 subgroups (<1 day, $1{\sim}3\;days,\;4{\sim}7\;days$, >8 days). OPCAB was performed a mean of $5.3{\pm}7.1$ days after AMI in total, which was $4.2{\pm}5.9$ days in group 1, and $6,6{\pm}8.3$ days in group 2. Result: Mean distal an-astomoses were 3.21 and postoperative IABP was inserted in 3 patients. There was 1 perioperative death in group 1 due to low cardiac output syndrome, but no perioperative new MI occurred in this study. There was no difference in postoperative major complication between two groups and according to the timing of operation. Mean follow-up time was 21.3 months ($4{\sim}42$ months). The 42 months actuarial survival rate was $94.9{\pm}2.4%$, which was $91.4{\pm}4.7%$ in group 1 and $98.0{\pm}2.0%$ in group 2 (p=0.26). The 42 months freedom rate from cardiac death was $97.6{\pm}1.4%$ which was $97.0{\pm}2.0%$ in group 1 and $98.0{\pm}2.0%$ in group 2 (p=0.74). The 42 months freedom rate from cardiac event was $95.4{\pm}2.0%$ which was $94.8{\pm}2.9%$ in group 1 and $95.9{\pm}2.9%$ in group 2 (p=0.89). Conclusion: OPCAB in AMI not only reduces morbidity but also favors hospital outcomes irrespective of timing of operation. The transmurality of myocardial infarction did not affect the surgical and midterm outcomes of OPCAB. Therefore, there may be no need to delay the surgical off-pump revascularization of the patients with AMI if surgical revascularization is indicated.

Clinical Analysis of the Recent Results of Coronary Artery Bypass Grafting (관상동맥 우회술의 최근성적에 대한 임상적 고찰)

  • Han, Sung-Ho;Kim, Hyuck;Lee, Chul-Bum;Chung, Won-Sang;Jee, Heng-Ok;Kang, Jung-Ho;Kim, Young-Hak
    • Journal of Chest Surgery
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    • v.35 no.7
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    • pp.523-529
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    • 2002
  • Background: Previous reports present that the early results of coronary artery bypass grafting (CABG) has been improving with the accumulation of surgical experience. We conducted a retrospective analysis of the patients who received CABG to evaluate the recent results of CABG. Material and Method: Between January 1996 and August 2001, 154 patients underwent CABG at Hanyang University Hospital. There were 47 patients(group I) who were operated between 1996 and 1998, and 107 patients(group II) who were operated thereafter. The preoperative diagnosis, operative procedure, mortality, and complications were analyzed retrospectively. Result: There were 35 males and 12 females in group I, and 78 males and 29 females in group II, which shows similar ratio of sexes between the two groups. The average age of patients for group I and group II was $55.9{\pm}6.2$ years and $61.0{\pm}8.0$ years, respectively, showing a significant increase in group II(p<0.05). The average left ventricular ejection fraction(LVEF) for group I and group II was $54.6{\pm}11.8$% and $56.9{\pm}13.0$%, respectively. The number of patients who had previous MI in group I and group II were 13 patients(27.7%) and 14 patients(13.1%), respectively, which shows a significant difference (p<0.05). All procedures were performed using the cardiopulmonary bypass(CPB) and moderate systemic hypothermia. Myocardial protection was achieved using intermittent hypothermic ischemia under ventricular fibrillation state or cold crystalloid cardioplegic solution for most of group I patients, whereas cold blood cardioplegic solution was used for group II patients. The mean CPB times for group I and group II were $149.2{\pm}48.7$ minutes and $113.1{\pm}30.6$ minutes, respectively. The mean aortic cross clamp times for group I and group II were $81.3{\pm}26.5$ minutes $72.2{\pm}23.9$ minutes, respectively. These figures show that CPB and aortic cross clamp times were significantly reduced in group II(p<0.05). The use of the left internal thoracic artery(LITA) was increased from 42%(20/47) for group I to 81% (87/107) for group II. The mean number of grafts also significantly increased from $2.5{\pm}0.6$ for group I to $3.0{\pm}1.1$ for group II(p<0.05). Intra-aortic balloon pump(IABP) was applied in 7 cases in group I and 17 cases in group II. Of these, 28.6%(2/7) and 52.9%(9/17) were broadly applied preoperatively in patients with LVEF<40% or congestive heart failure. The operative mortalities for group I and II were 10.6%(5/47) and 0.9%(1/107), respectively, which shows significant decrease for group II(p.0.05). Conclusion: This report suggest that CABG using CPB can recently be performed more safely in virtue of the accumulation of surgical experience with reduction in CPB and aortic cross clamp times and improved surgical techniques and myocardial protection. And we think that the optimal treatment of patients with left ventricular dysfunction associated with congestive heart failure and the extended application of IABP, especially have contributed to the reduction of operative mortality and morbidity.

Effect of Boswellia serrata Extracts on Degenerative Osteoarthritis in vitro and in vivo Models (보스웰리아 추출물의 골관절염 억제 효과 연구)

  • Nam, Da-Eun;Kim, Ok Kyung;Shim, Tae Jin;Kim, Ji Hoon;Lee, Jeongmin
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.43 no.5
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    • pp.631-640
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    • 2014
  • The inhibitory effects of Boswellia serrata (BW) extracts on degenerative osteoarthritis were investigated in primary-cultured rat cartilage cells and a monosodium-iodoacetate (MIA)-induced osteoarthritis rat model. To identify the protective effects of BW extract against $H_2O_2$ ($800{\mu}M$, 2 hr) in vitro, cell survival was measured by MTT assay. Cell survival after $H_2O_2$ treatment was elevated by BW extract at a concentration of $20{\mu}g/mL$. In addition, BW extract treatment significantly reduced and normalized the productions of pro-inflammatory factors, nuclear transcription factor ${\kappa}B$, cyclooxygenase-2, tumor necrosis factor-${\alpha}$, and interleukin-6 at a concentration of $20{\mu}g/mL$. Treatment of chondrocytes with BW extract significantly reduced 5-lipoxygenase activity and production of prostaglandin E2, especially at a concentration of $10{\sim}20{\mu}g/mL$. For the in vivo animal study, osteoarthritis was induced by intra-articular injection of MIA into knee joints of rats. Consumption of a diet containing BW extract (100 and 200 mg/kg) for 35 days significantly inhibited the development and severity of osteoarthritis in rats. To determine the genetic expression of arthritic factors in articular cartilage, real-time PCR was applied to measure matrix metalloproteinases (MMP-3, MMP-9, and MMP-13), collagen type I, collagen type II, and aggrecan, and BW extract had protective effects at a concentration of 200 mg/kg. In conclusion, BW extract was able to inhibit articular cartilage degeneration by preventing extracellular matrix degradation and chondrocyte injury. One can consider that BW extract may be a potential therapeutic treatment for degenerative osteoarthritis.

Early Results of Aortic Valve-sparing Procedures in Patients with Annuloaortic Ectasia (대동맥륜대동맥확장(Annuloaortic Ectasia) 환자에서 대동맥판막을 보존하면서 시행된 대동맥근부 및 상행대동맥 치환술의 단기 성적)

  • Sung Kiick;Park Kay-Hyun;Lee Young Tak;Jun Tae-Gook;Yang Ji-Hyuk;Kim Su Wan;Kim Jin Sun;Cho Sung Woo;Kim Si Wook;Choi Jin Ho;Park Pyo Won
    • Journal of Chest Surgery
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    • v.38 no.7 s.252
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    • pp.483-488
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    • 2005
  • Aortic valve-sparing procedures could reduce valve-related morbidity, but may increase operative risks; therefore, these procedures could not be performed routinely. We attempted to find out the early results while focusing on the operative risks associated with these procedures in our hospital. Material and Method: From May 1996 to July 2003, 26 patients underwent these procedures including 15 patients with Marfan syndrome and 1 patient with Behcet disease. There were 17 men and 9 women with mean age of $37.9\pm19.2$ years (range: 6 months-74 years). Ten patients had ascending aortic dissection, 18 patients had more than moderate degree of aortic valve insufficiency (AI). Two types of valve-sparing procedures were performed: valve reimplantation in 14 and root remodeling in 12 patients. Associated procedures were performed as follows: aortic valve plasty in 6, mitral valve plasty in 5, hemi-arch replacement in 4, total arch replacement in 2, coronary artery bypass surgery in 1 and Maze procedure in 1 patient(s). Result: In four patients, valve-sparing procedures were converted to Bentall procedures during operation. Including these patients, there was no operative deaths, 3 patients underwent re-operation due to bleeding, 1 patient had permanent pacemaker. The median duration of ICU stay was 45.5 hours, the median duration of hospital stay was 10.5 days. In 22 patients excluding 4 converted patients, intraoperative transesophageal echocardiogram (TEE) showed less than mild degree of AI in all except one who had not received intra-operative TEE in the beginning and showed moderate degree of AI at discharge. The mean duration of follow-up was $21.2\pm27.4$ months. All patients were alive except one who died during other departmental surgery. In 3 patients, more than moderate degree of AI was recurred, but there were no reoperation. Conclusion: Aortic valve-sparing procedures could be performed relatively safely in selected patients who had annuloaortic ectasia.

Early and Mid-term Results of Operation for Infective Endocarditis on Mitral Valve (감염성 승모판 심내막염의 중단기 수술 성적)

  • Ahn, Byong-Hee;Chun, Joon-Kyung;Yu, Ung;Ryu, Sang-Wan;Choi, Yong-Sun;Kim, Byong-Pyo;Hong, Sung-Bum;Bum, Min-Sun;Na, Kook-Ju;Park, Jong-Chun;Kim, Sang-Hyung
    • Journal of Chest Surgery
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    • v.37 no.1
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    • pp.27-34
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    • 2004
  • Background: Infective endocarditis shows higher operative morbidity and mortality rates than other cardiac diseases. The vast majority of studies on infective endocarditis have been made on aortic endocarditis, with little attention having been paid to infective endocarditis on the mitral valve. This study attempts to investigate the clinical aspects and operative results of infective endocarditis on the mitral valve. Meterial and Method: The subjects of this study consist of 23 patients who underwent operations for infective endocariditis on the mitral valve from June 1995 to May 2003. Among them, 2 patients suffered from prosthetic valvular endocarditis and the other 21 from native valvular endocarditis. The subjects were evenly distributed age-wise with an average age of 44.8$\pm$15.7 (11∼66) years. Emergency operations were performed on seventeen patients (73.9%) due to large vegetation or instable hemodynamic status. In preoperative examinations, twelve patients exhibited congestive heart failure, four patients renal failure, two patients spleen and renal infarction, and two patients temporary neurological defects, while one patient had a brain abscess. Based on the NYHA functional classification, seven patients were determined to be at Grade II, 9 patients at Grade III, and 6 patients at Grade IV. Vegetations were detected in 20 patients while mitral regurgitation was dominant in 19 patients with 4 patients showing up as mitral stenosis dominant on the preoperative echocardiogram. Blood cultures for causative organisms were performed on all patients, and positive results were obtained from ten patients, with five cases of Streptococcus viridance, two cases of methicillin-sensitive Staphylococcus aureus, and one case each of Corynebacteriurn, Haemophillis, and Gernella. Operations were decided according to the AA/AHA guidelines (1988). The mean follow-up period was 27.6 $\pm$23.3 (1 ∼ 97) months. Result: Mitral valve replacements were performed on 43 patients, with mechanical valves being used on 9 patients and tissue valves on the other 4. Several kinds of mitral valve repair or mitral valvuloplasty were carried out on the remaining 10 patients. Associated procedures included six aortic valve replacements, two tricuspid annuloplasty, one modified Maze operation, and one direct closure of a ventricular septal defect. Postoperative complications included two cases of bleeding and one case each of mediastinitis, low cardiac output syndrome, and pneumonia. There were no cases of early deaths, or death within 30 days following the operation. No patient died in the hospital or experienced valve related complications. One patient, however, underwent mitral valvuloplasty 3 months after the operation. Another patient died from intra-cranial hemorrhage in the 31st month after the operation. Therefore, the valve-related death rate was 4.3%, and the valve-related complication rate 8.6% on mid-term follow-up. 1, 3-, and 5-year valve- related event free rates were 90.8%, 79.5%, and 79.5%, respectively, while 1, follow-up. 1, 3-, and 5-year valve- related event free rates were 90.8%, 79.5%, and 79.5%, respectively, while 1, 3-, and 5-year survival rates were 100%, 88.8%, and 88.8%, respectively. Conclusion: The findings suggest that a complete removal of infected tissues is essential in the operative treatment of infectious endocarditis of the mitral valve. It is also suggested that when infected tissues are completely removed, neither type of material nor method of operation has a significant effect on the operation result. The postoperative results also suggest the need for a close follow-up observation of the patients suspected of having brain damage, which is caused by preoperative blood contamination or emboli from vegetation, for a possible cerebral vascular injury such as mycotic aneurysm.

Myocardial Tracer Uptake in SPECT Images after Direct Intracoronary Injection Of TI-201: Comparison with Stress-Reinjection Images (관동맥내 주사 TI-201 SPECT에서 심근 분절의 섭취: 부하-재주사 TI-201 영상과의 비교)

  • Seo, Ji-Hyoung;Kang, Seong-Min;Bae, Jin-Ho;Lee, Yong-Jin;Lee, Sang-Woo;Yoo, Jeong-Soo;Ahn, Byeong-Cheol;Cho, Yong-Geun;Lee, Jae-Tae
    • Nuclear Medicine and Molecular Imaging
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    • v.41 no.4
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    • pp.291-298
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    • 2007
  • Purpose: To investigate the feasibility of TI-201 SPECT with intra coronary injection (lC-I) in the detection of viable myocardium, we have performed SPECT imaging after direct intracoronary injection of TI-201 and images were compared with those of stress-reinjection (Re-I) SPECT. Methods: Fourteen coronary artery disease patients (male 11, mean age 54 years) who had myocardial infarction or demonstrated left ventricular wall motion abnormality on echocardiography were enrolled. Three mCi of TI-201 was injected into both coronary arteries during angiography and images were acquired between 6- and 24-hour after injection. Reinjection imaging with 1 mCi of TI-201 was performed at 4-hour after adenosine stress imaging with 3 mCi of TI-201. Images were interpreted according to 4-grade visual scoring system (grade 0-3). Segments with mild to moderated uptake (${\leq}$grade 1), and upgraded more than one score with reinjection, and were defined as viable myocardium. Results: Image quality was poor in two cases with IC-I. Numbers of non-viable segments were 60 (23.8%) with IC-I, and 38 (15.1%) with Re-I, respectively. Overall agreement for perfusion grade per myocardial segment in each IC-I and Re-I was 76.5%. Overall agreement for viable segment between IC-I and Re-I was 90.5%. Only one out of 38 segments interpreted as non-viable with Re-I were interpretated as viable with IC-I. And 23 out of 214 segments interpreted as viable with Re-I were interpreted as non-viable with IC-I. Conclusion: Intracoronary TI-201 SPECT seemed to be not advantageous over stress-rest reinjection imaging in the assessment of myocardial viability, mainly due to low count statistics at 6-hour or 24-hour delayed time points. The feasibility of intracoronary TI- 201 SPECT is considered to be limited.

An Analysis of the Psychiatric Characteristics of the Alopecia Areata in Female (여성 탈모증의 정신의학적 특성 분석)

  • Lee, Kil-Hong;Na, Chul;Lee, Young-Sik;Lee, Chang-Hoon;No, Byung-In;Hong, Chang-Kwon
    • Korean Journal of Psychosomatic Medicine
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    • v.8 no.1
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    • pp.31-45
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    • 2000
  • Objectives : The present study was performed to reveal differences between female and male cases of alopecia in their alopecia related variables such as patterns of hair loss, psychiatric characteristics, associate illnesses, and methods of treatment, and to use them as basic materials for proper management and early prevention of the alopecia prone cases. Methods : In order to analysis the gender difference in hair losses, the subjects were divided into two subgroups as the 51 cases of female alopecia and the 42 cases of male alopecia, who had visited to the department of psychiatry consulted from the department of dermatology, Yongsan hopital, ChungAng University, Seoul, Korea, from January 1998 to December 1998. In data analysis, the subjects were statistically assesed by chi-squre test and analysis of varaiance, through SPSS-$PC^+$ 9.0V. Results : 1) Female subjects were more likely showed lower socio-economical level including lower eonomical level, lower educational level, or lower occupational level in their parent's job, were more likely to have larger number of siblings and to have many sisters comparison to the male cases. 2) Female subjects were more likely visited to the department of dermatology, more history of alopecia in their female family members, lesser history of alopecia in their male family members, more loss of hairs in vertex or frontal region of scalp, lesser loss of hairs in occipital region, and lesser nail changes in comparison to the male cases. 3) Female subjects were more suffered from intra-familial conflicts and economical changes, or their introverted personality makeup, lesser likely suffered from changes of business and health changes, and showed lesser conflicts related with poorer adaptaion in their job life. 4) Female subjects were more likely diagnosed as depression or conversion disorders, more frequently complaint anxiety symptoms or depressive symptoms, higher level of anxiety index, lesser complaint somatization or obsessive compulsive symptoms, and lesser diagnosed as anxiety disorder in comparison to the male cases. 5) Female subjects were more likely tended to show personality makeup such as the introverted, the lie, the repressed, or the feminine trends than the male cases. 6) Female subjects were more significantly treated by antianxiety drug such as etizolam and dermatological therapies include tretinoin, and lesser treated by clotiazepam and prednicarbonate in comparison to the male cases. Conclusion : From the facts that The most important factors in developing hair loss in the female subjects in comparison to the male cases seems to be closely correlated with the serious psychopathology such as the presence of mental disorders including depression, the presence of complaining anxiety or depressive symptomatology, the presence of stressful life events such as intrafamilial life changes, and the presence of personality makeup such as the introverted, the lie, the repressed, or the feminine trends, the authors confirmed that dermatologists act as the primary care physician are in a unique position to recognize psychiatric comorbidity and execute meaningful intervention for female patients with the alopecia with psychiatrists.

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