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Complications Following Transradial Cerebral Angiography : An Ultrasound Follow-Up Study

  • Yoon, Wonki;Kwon, Woo-Keun;Choudhri, Omar;Ahn, Jaegeun;Huh, Hanyong;Ji, Choel;Do, Huy M.;Mantha, Aditya;Jeun, Sin-Soo
    • Journal of Korean Neurosurgical Society
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    • v.61 no.1
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    • pp.51-59
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    • 2018
  • Objective : The feasibility and usefulness of transradial catheterization for coronary and neuro-intervention are well known. However, the anatomical change in the catheterized radial artery (RA) is not well understood. Herein, we present the results of ultrasonographic observation of the RA after routine transradial cerebral angiography (TRCA). Methods : Patients who underwent routine TRCA with pre- and post-procedure Doppler ultrasonography (DUS) of the catheterized RA were enrolled. We then recorded and retrospectively reviewed the diameter and any complicated features of the RA observed on DUS, and the factors associated with the diameter and complications were analyzed. Results : A total of 223 TRCAs across 181 patients were enrolled in the current study. The mean RA diameter was 2.48 mm and was positively correlated with male gender (p<0.001) and hypertension (p<0.002). The median change in diameter after TRCA was less than 0.1 mm (range, -1.3 to 1.2 mm) and 90% of changes were between -0.8 and +0.7 mm. Across 228 procedures, there were 12 cases (5.3%) of intimal hyperplasia and 22 cases (9.6%) of asymptomatic local vascular complications found on DUS. Patients with abnormal findings on the first procedure had a smaller pre-procedural RA diameter than that of patients without findings (2.26 vs. 2.53 mm, p=0.0028). There was no significant difference in the incidence of abnormal findings for the first versus subsequent procedures (p=0.68). Conclusion : DUS identified the pre- and post-procedural diameter and local complications of RA. Routine TRCA seems to be acceptable with regard to identifying local complications and changes in RA diameter.

Influences of Moral Sensitivity and Safety Environment on Compliance with Standard Precautions among Nurses (간호사의 도덕적 민감성과 안전 환경이 감염 표준주의 이행도에 미치는 영향)

  • Han, Dallong;Seo, Kyoungsan;Kim, Eun-sook;Kim, Hae-Eun
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.19 no.3
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    • pp.364-375
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    • 2018
  • This study was a descriptive investigation to identify the influence of nurses' moral sensitivity and safety of their environment on compliance with standard precautions. Participants consisted of 214 nurses in one general hospital and data were collected using a questionnaire that consisted of moral sensitivity, safety of environment and compliance with standard precautions from 1-15 August 2017. Data were evaluated by the independent t-test, ANOVA, Pearson's correlation coefficient, and multiple regression analysis. The mean scores of moral sensitivity, safety of environment and compliance with standard precautions were 5.05, 5.76 and 4.50, respectively. Moreover, compliance with standard precautions was significantly positively correlated with moral sensitivity and safety of environment. Additionally, multiple regression revealed an $R^2$ of 0.253 with the department (ER, ICU), age and safety environment serving as the major predictor variables for compliance with standard precautions. However, the influence of moral sensitivity on compliance was not identified. Therefore, to increase compliance with standard precautions among nurses, it is necessary to provide continuous educational programs for new nurses, customized programs considering departmental characteristics and administrative support of institutions to enhance safety of the environment.

A Study of Teacher's Satisfaction Regarding Oriental Medical Doctor's Student Health and Wellness Program (한의학 교의사업 시범시행 후 교사들의 교의만족도에 관한 연구 - 성남시 중고등학교를 대상으로)

  • Kim, Dong-Su;Park, Jang-Kyung;Yang, Na-Rae;Lee, Ju-Ah;Lee, Hye-Lim;Ko, Jae-Un;Park, Jae-Man;Kim, Hyo-Sun;Choi, Suk-Hoon;Go, Ho-Yeon;Sung, Hyun-Kyung
    • The Journal of Pediatrics of Korean Medicine
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    • v.31 no.4
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    • pp.71-77
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    • 2017
  • Objectives This study aims to build the baseline data for school health care program by analyzing the questionnaires about satisfaction regarding Oriental Medical Doctor's (Korean Medicine) student health and wellness program. Methods The association of Korean medicine doctor in Sung-nam city conducted Oriental Medical Doctor's student health and wellness program for 12 middle schools and 8 high schools in Sung-nam from August to December, 2015. The participating Oriental Medical Doctor visited each school for 8 times during 5 months period, and conducted health consultations, health education classes and Korean medicine treatment for the school students and school employees. Teachers and administrators from the participating schools answered the self-reported satisfaction questionnaires and the satisfaction questionnaires results were analyzed. Results 85 people responded the program satisfaction questionnaires; 69% responders were very satisfied and 28% were satisfied about the program specifically about the student's health check-ups, informatory brochures for the parents, good participation enrollment process. Responders were pleased about doctor's consultations regarding 'Advising students about their general health', 'Ways to cure sick students fast', 'Providing students with useful information about health', and 'Teaching students how to manage their health in a good shape'. 92.94% of participants agreed to the needs of the school health and wellness program. Conclusions One of the fundamental national health policies is to provide students opportunities to maintain their good health. We have developed a successful pilot program called, "Oriental Medical Doctor's student health and wellness program". We got positive feedback from the participating school teachers regarding our program. Further studies based on this study are needed to show the benefit of the program to broaden its use.

Immune reconstitution after allogeneic hematopoietic stem cell transplantation in children: a single institution study of 59 patients

  • Kim, Hyun O;Oh, Hyun Jin;Lee, Jae Wook;Jang, Pil-Sang;Chung, Nack-Gyun;Cho, Bin;Kim, Hack-Ki
    • Clinical and Experimental Pediatrics
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    • v.56 no.1
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    • pp.26-31
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    • 2013
  • Purpose: Lymphocyte subset recovery is an important factor that determines the success of hematopoietic stem cell transplantation (HSCT). Temporal differences in the recovery of lymphocyte subsets and the factors influencing this recovery are important variables that affect a patient's posttransplant immune reconstitution, and therefore require investigation. Methods: The time taken to achieve lymphocyte subset recovery and the factors influencing this recovery were investigated in 59 children who had undergone HSCT at the Department of Pediatrics, The Catholic University of Korea Seoul St. Mary's Hospital, and who had an uneventful follow-up period of at least 1 year. Analyses were carried out at 3 and 12 months post-transplant. An additional study was performed 1 month post-transplant to evaluate natural killer (NK) cell recovery. The impact of pre- and post-transplant variables, including diagnosis of Epstein-Barr virus (EBV) DNAemia posttransplant, on lymphocyte recovery was evaluated. Results: The lymphocyte subsets recovered in the following order: NK cells, cytotoxic T cells, B cells, and helper T cells. At 1 month post-transplant, acute graft-versus-host disease was found to contribute significantly to the delay of $CD16^+/56^+$ cell recovery. Younger patients showed delayed recovery of both $CD3^+/CD8^+$ and $CD19^+$ cells. EBV DNAemia had a deleterious impact on the recovery of both $CD3^+$ and $CD3^+/CD4^+$ lymphocytes at 1 year post-transplant. Conclusion: In our pediatric allogeneic HSCT cohort, helper T cells were the last subset to recover. Younger age and EBV DNAemia had a negative impact on the post-transplant recovery of T cells and B cells.

Comparison Study on CNR and SNR of Thoracic Spine Lateral Radiography (흉추 측면검사 영상의 CNR과 SNR 측정의 비교 연구)

  • Kim, Ki-Won;Min, Jung-Whan;Lyu, Kwang-Yeul;Kim, Jung-Min;Jeong, Hoi-Woun;Lee, Joo-Ah;Jung, Jae-Hong;Sung, Dong-Chan;Park, Soon-Cheol
    • Journal of radiological science and technology
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    • v.36 no.4
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    • pp.273-280
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    • 2013
  • This study was proven for the T-spine breathing technique in lateral projection, using computer radiography (CR), charge coupled device (CCD), indirect digital radiography (IDR) and direct digital radiography (DDR). All images were evaluated and compared with CNR and SNR measured with the mean pixels and the standard deviation as setting ROI of spinous process, pedicle, vertebral body, intervertebral foramen and intervertebral disk using Image J. In experiment results of 4 type detectors, T-spine breathing technique was indicated as excellent in ROI of spinous process, pedicle, vertebral body, intervertebral foramen and intervertebral disk. As T-spine breathing technique indicated excellent images compared to the existing T-spine lateral radiography, this method would be useful for elderly patients who have difficulty in deep exhalation. This study was indicated the application possibility of T-spine breathing technique by presenting contrast to noise ratio (CNR) and signal to noise ratio (SNR) with quantitative value in 4 type detectors.

Optimal Localization through DSA Distortion Correction for SRS

  • Shin, Dong-Hoon;Suh, Tae-Suk;Huh, Soon-Nyung;Son, Byung-Chul;Lee, Hyung-Koo;Choe, Bo-Young;Shinn, Kyung-Sub
    • Progress in Medical Physics
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    • v.11 no.1
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    • pp.39-47
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    • 2000
  • In Stereotactic Radiosurgery (SRS), there are three imaging methods of target localization, such as digital subtraction Angiography (DSA), computed tomography (CT), magnetic resonance imaging (MRI). Especially, DSA and MR images have a distortion effect generated by each modality. In this research, image properties of DSA were studied. A first essential condition in SRS is an accurate information of target locations, since high dose used to treat a patient may give a complication on critical organ and normal tissue. Hut previous localization program did not consider distortion effect which was caused by image intensifier (II) of DSA. A neurosurgeon could not have an accurate information of target locations to operate a patient. In this research, through distortion correction, we tried to calculate accurate target locations. We made a grid phantom to correct distortion, and a target phantom to evaluate localization algorithm. The grid phantom was set on the front of II, and DSA images were obtained. Distortion correction methods consist of two parts: 1. Bilinear transform for geometrical correction and bilinear interpolation for gray level correction. 2. Automatic detection method for calculating locations of grid crosses, fiducial markers, and target balls. Distortion was corrected by applying bilinear transform and bilinear interpolation to anterior-posterior and left-right image, and locations of target and fiducial markers were calculated by the program developed in this study. Localization errors were estimated by comparing target locations calculated in DSA images with absolute locations of target phantom. In the result, the error in average with and without distortion correction is $\pm$0.34 mm and $\pm$0.41 mm respectively. In conclusion, it could be verified that our localization algorithm has an improved accuracy and acceptability to patient treatment.

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Arrangement and analysis of multi-isocenter based on 3-D spatial unit in stereotactic radiosurgery (정위적 방사선 수술시 3차원적 공간상의 체적소에 기반한 회전중심점들(Multi-isocenter)의 표적내 자동적 배치 및 분석)

  • Choi, Kyoung-Sik;Oh, Seung-Jong;Lee, Jeong-Woo;Suh, Tae-Suk;Choe, Bo-Young;Kim, Moon-Chan
    • Proceedings of the Korean Society of Medical Physics Conference
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    • 2004.11a
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    • pp.75-77
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    • 2004
  • Stereotactic radiosurgery(SRS) is a technique to deliver a high dose to a particular target region and a low dose to the critical organ using only one or a few irradiations while the patient is fixed with a stereotactic frame. The optimized plan is decided by repetitive work to combine the beam parameters and identify prescribed doses level in a tumor, which is usually called a trial and error method. This requires a great deal of time, effort, and experience. Therefore, we developed the automatic arrangement of multi-isocenter within irregularly shaped tumor. At the arbitrary targets, which is this method based on the voxel unit of the space, well satisfies the dose conformity and dose homogeneity to the targets relative to the RTOG radiosurgery plan guidelines

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A New Method of Liver Size Estimation on Hepatic Scintigram -Hepato-abdominal Ratio (간신티그램상 간크기의 새로운 평가방법 -간.복부횡경비-)

  • Yang, Il-Kwon;Yoon, Sung-Do;Park, Seog-Hee;Bahk, Yong-Whee
    • The Korean Journal of Nuclear Medicine
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    • v.16 no.2
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    • pp.25-28
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    • 1982
  • Estimation of liver size is essential in the diagnosis of liver disease, Many approaches have been attempted in evaluation of liver size such as the measurement of length, area and volume. Among these, area and volume measurements are accurate but complicated, so we commonly use formerly introduced various linear measurements, but in scintigraphy one must calculate the actual liver size using rate of reduction, which is time consuming. Because of these reasons, we carried out present study to represent liver size by means of a simple liver measurement like we express the cardiac size by cardiothoracic ratio. Our cases consisted of 100 clinically normal subjects as the normal group and 50 patients suffering from liver disease and diagnosed to have hepatomegaly on abdominal palpation and scintigram at Dept, of Radiology of St. Mary's Hospital, Catholic Medical College during the period of 8 months from Jan. 1980. We measured the liver size using 4 linear diameters(Fig. 1). And as the reference measurement, the distance from the right margin of the liver to the left margin of the spleen was measured. We called this "abdominal transverse diameter(ATD)". The results were as follows; 1) The smallest value was recorded in the midline vertical diameter (MVD). It was $4.2{\pm}0.4cm$ in normal group and $5.0{\pm}0.6cm$ in the hepatomegaly group. 2) The diameter using other methods ranged from 5.6 to 7.2 cm in the normal group and from 6.3 to 7.5cm in the hepatomegaly group. 3) There was significant difference in the ratio of each diameter to ATD between the normal and hepatomegaly group (<0.01). We called this "hepato-abdominal ratio". 4) The "hepato-abdominal ratio" using MVD is $0.43{\pm}0.06$ in the normal group and $0.53{\pm}0.07$ in the hepatomegaly group. The "hepato-abdominal ratio" of MVD was most significantly different between normal and hepatomegaly group. 5) The tolerance limits(99%) of "hepato-abdominal ratio" using MVD is from 0.41 to 0.45 in the normal group and from 0.51 to 0.55 in the hepatomegaly group. Therefore, by reasons of error during measurement and convenience of memory, it was warranted to suggest hepatomegaly when "hepato-abdominal ratio" using MVD is more than 0.5 in the interpretation of hepatic scintigram.

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Tc-99m EHIDA Scintigraphic Demonstrability of Biliary Elements and Liver Function Tests in Hepatobiliary Diseases (몇가지 간담도질환에서 간기능에 따른 Tc-99m EHIDA의 담도영상능)

  • Kim, Choon-Yul;Lee, Myung-Hee;Bahk, Yong-Whee
    • The Korean Journal of Nuclear Medicine
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    • v.16 no.2
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    • pp.71-80
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    • 1982
  • In the present communication, the results will be reported on a clinical study of how well scintigraphic visualization of the hepatobiliary elements and several commonly used clinical liver function tests correlate each other in various diseases oft hepatobiliary system. The demonstrability of the biliary tract, gallbladder (GB) and duodenum was rather closely paralleled to serum bilirubin level and less closely to alkaline phosphatase and rather poorly to SGOT and SGPT. The biliary tree could not be visualized scintigraphically when bilirubin exceeded 10.5mg/dl. The usefulness of Tc-99m EHIDA [N-(2,6-diethylacetanilido) iminodiacetic acid, made by Amersham, England] hepatobiliary scintigraphy (Tc EHIDA HBS) in settling diagnostic controversy and ambiguity raised by oral cholecystography, intravenous cholangiography and ultrasonography in many hepatobiliary diseases is well known. The purpose of this investigation was to semiquantitatively evaluate the scintigraphic demonstrability of the hepatobiliary tract, GB and duodenum following intravenous injection of Tc-99m EHIDA in normal subjects and in patients with a disturbed liver function from various hepatobiliary diseases. The hepatobiliary scintigraphy was performed in 10 normal subjects and 39 patients with various hepatobiliary diseases (Table 1) at the Dept. of Radiology, St. Mary's Hospital Catholic Medical College, Seoul, Korea during 2 years period from September 1979. Scintigraphic examination was started at end of 3 minutes after intravenous injection of Tc-99m EHIDA in the amount of $50{\mu}Ci/kg$ and was continued until after 30 minutes at 5 minutes interval. The imaging was usually terminated when the tracer could be seen in the duodenum. Late scintigrams were obatained at 1 1/2, 3, 4 and 6 hours when reeded. Scintigrams were analyzed in terms of promptness and clarity of visualization of the biliary tree, GB and duodenum and demonstrability of these anatomical landmarks was correlated with the values of liver function tests. The demonstrability of the common hepatic duct, common bile duct, GB and duodenum was closely paralleled to the level of serum bilirubin when it is less than 10.5 mg/dl as shown in figure 1. However when the bilirubin exceeded 10.5 mg/dl the time of visualization between protracted reaching a flat curve or plateau around 10.5 mg/dl. The biliary tract could not be visualized when the bilirubin was higher than 10.5 mg/dl. The correlability between scintigraphic demonstration and serum alkaline phosphatase was less strong and between scintigraphic demonstration and SGOT and SGPT was rather poor. The present clinical study confirmed the usefulness and limitation of Tc-99m EHIDA hepatobiliary scintigraphy in visulizing and diagnosing the biliary system and duodenum when radiogrpahy and ultrasonography failed to provide useful informations. Scintigraphy was very helpful in the diagnosis of neonatal hepatitis, biliary atresia, cholecystitis and extrahepatic biliary obstruction. The hepatobiliary system and duodenum were visualized when serum bilirubin level was less than 10.5 mg/dl, SGOT 135 units, SGPT 114 units and alkaline phosphatase 52.2 KAU.

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Clinical Manifestations, Management, and Natural Course of Infants with Recurrent Bronchiolitis or Reactive Airways Disease (반복적인 모세기관지염, 과반응 기관지염을 보인 영유아의 임상양상, 치료와 자연경과)

  • Park, Hyoun Jin;Kim, Joo Hyun;Chun, Yoon Hong;Lee, Soo Young;Kim, Sang Yong;Kang, Jin Han
    • Pediatric Infection and Vaccine
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    • v.21 no.1
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    • pp.37-42
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    • 2014
  • Purpose: The purpose of this study was to investigate the clinical manifestations and 5-year natural course of recurrent bronchiolitis or reactive airways disease (RAD) in infants. Methods: We reviewed the medical records of infants with recurrent bronchiolitis from January 2007 to December 2007 at The Catholic University of Korea St. Mary's Hospital in Incheon, South Korea. Additionally, we telephoned their parents to confirm their present medical statuses. Results: Sixty-three subjects with recurrent bronchiolitis were identified. The mean age at admission was 8.1 months and the number of males was 44 (69.8%). Of the 63 infants with recurrent bronchiolitis, inhaled corticosteroids, bronchodilators, and antibiotics were given to 62 (98.4%), 53 (84.1%), and 40 (63.5%), respectively. Among the total 63 subjects, we were able to contact the parents of 45 children by telephone. None of these children had been hospitalized during the previous one year period due to respiratory infections or for other medical reasons. Of the 45 subjects we were able to contact, 38 (84.4%) had not experienced any further respiratory difficulties at all. Five (11.1%) had been diagnosed with allergic rhinitis while two (4.4%) were being managed for asthma. Conclusion: Most children who presented with recurrent episodes of bronchiolitis in infancy did not show any further respiratory difficulties after five years of age.