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Detection of TNF-alpha in Serum as the Effect of Corticosteroid to the Myocardial Protection in Cardiopulmonary Bypass (체외순환시 스테로이드의 심근보호효과에 관한 혈청내 TNF-alpha 측정의 의의)

  • 최영호;김욱진;김태식;조원민;김학제
    • Journal of Chest Surgery
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    • v.31 no.5
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    • pp.502-508
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    • 1998
  • Proinflammatory cytokines such as tumor necrosis factor-$\alpha$(TNF-$\alpha$) have been implicated in myocardial and organ dysfunction associated with postperfusion syndrome. We tested the hypothesis that cytokine productions are depressed by preoperative cortiosteroid injection for cardiopulmonary bypass(CPB) and the postoperative courses will be better than without steriod pretreated cases. Cardiac surgery was performed in randomized blind fashion for 20 patients from June 1996 to September 1996. In the steroid group(n=10), corticosteroid(dexamethasone 1 mg/kg) was injected 1 hour before anesthetic induction, but in the control group(n=10), nothing was injected. Each of groups were sampled 11 times as scheduled for TNF-$\alpha$ bioassays. We have checked EKG, cardiac enzymes(CPK, LDH with isoenzyme), WBC count preoperative day, one day and three days after operation. Viatal signs were continuously monitored for three postoperaive days. In the postoperative period three patients in the control group had elevated body temperature and four patients had hypotension that required considerable intravenous fluid administration. But steroid injected patients showed normal body temperture and acceptable blood pressures without supportive treatment. CPK enzymes rose in control group higher than steroid group at postoperative 1st and 3rd day(CPK; 1122$\pm$465 vs 567$\pm$271, 864$\pm$42 vs 325$\pm$87), and CPK-MB enzymes rose in control group higher than steroid group at postoperative 1st day(106.4$\pm$115.1 vs 29.5$\pm$22.4)(P=0.02). Arterial tumor necrosis factor-$\alpha$ rose during cardiopulmonary bypass, peaking at 5 minutes before the end of aortic cross clamping(ACC-5min) in steroid group(11.9$\pm$4.7 pg/ml), and 5 minutes before the end of cardiopulmonary bypass(CPB-5min) in control group(22.3$\pm$6.8 pg/ml). The steroid pretreated patients had a shorter period of time in respirator suport time, ICU stay day, hospital admission day. We conclude that corticosteroid suppress cytokine production during and after cardiopulmonary bypass, and may improve the postoperative course through inhibition of reperfusion injury such as myocardial stunning and hemodynamic instability.

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Efficiency of Staging Work-Ups in the Evaluation of Carcinoma of the Uterine Cervix (자궁경부암에 있어서 병기결정을 위한 검사의 효용성)

  • Kim, Jae-Sung;Ha, Sung-Whan
    • Radiation Oncology Journal
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    • v.9 no.2
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    • pp.271-276
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    • 1991
  • A series of 510 patients with carcinoma of the uterine cervix given the curative radiation therapy from March 1979 through December 1986 was evaluated to determine the value of intravenous pyelography (IVP), cystoscopy, sigmoidoscopy, and abdomino-pelvic CT as staging work-up prior to treatment. On IVP and cystoscopy, $10.7\%$(49/456) and $5.3\%$(24/452) showed abnormality, respectively, but only $0.7\%$(3/413) did on sigmoidoscopy. As a result of these work-ups prerequisite to FIGO staging, twenty six ($5.1\%$) out of 510 patients were upstaged from the stage determined by the findings of physical examination alone. The proportions of upstaging in each stage were as follows; none in stage IB (35), IIA (89) and IIIA (8), $7.9\%$(20/252) in stage IIB (14 patients to FIGO stage IIIB, 6 patients to FIGO stage IVA), and $4.8\%$(6/126) in stage IIIB (all to FIGO stage IVA). Positive findings of staging work-ups were found only in patients with advanced stages of stage IIB or over determined by physical examination alone but not in those with earlier stages. CT was performed in 337 patients. CT detected pelvic lymph node (LN) enlargement in $25.2\%$ (85/337) and paraaortic LN enlargement in $7.4\%$(25/337). Pelvic LN positivity was well correlated with increasing stage but paraaortic LN positivity was not. In the evaluation of parametrial involvement, CT findings were in accordance with those of physical examination only in $65.6\%$ (442/674). When compared with endoscopic studeies, CT had much lower positive predictive value than negative predicitive value in the evaluation of adjacent organ invasion. The staging work-ups should be individualized by the disease extent of each patient, and then the efficiency of work-uus may be increased without compromising the appropriate FIGO staging and treatment.

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Hypofractionated Radiotherapy for Small-sized Hepatocellular Carcinoma as Salvage Therapy: Sustained Local Control and Safety (작은 크기의 재발성 간세포암에 대한 구제치료로 소분할 방사선치료: 국소 제어율과 안전성)

  • Bae, Sun-Hyun;Park, Hee-Chul;Lim, Do-Hoon;Lee, Jung-Ae;Choi, Moon-Seok;Lee, Joon-Hyoek;Koh, Kwang-Cheol;Paik, Seung-Woon;Yoo, Byung-Chul
    • Radiation Oncology Journal
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    • v.28 no.2
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    • pp.85-90
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    • 2010
  • Purpose: To evaluate the rate of tumor response, local control, and treatment-related complications after hypofractionated radiotherapy for recurrent hepatocelluar carcinoma (HCC) less than 5 cm in size. Materials and Methods: Among the HCC patients who were treated by radiotherapy (RT) between 2006 and 2007 after the failure of previous treatment, a total of 12 patients were treated with hypofractionated RT. The criteria for hypofractionated RT was as follows: 1) HCC less than 5 cm, 2) HCC not adjacent to a critical organ, 3) HCC without portal vein tumor thrombosis, and 4) less than 15% of normal liver volume that irradiated 50% of the prescribed dose. Hypofractionated RT was performed with 50 Gy delivered in 10 fractions, at a rate of 5 fractions per week. The evaluation of tumor response was determined by CT scans performed at 3 months after the cessation of RT, followed by the evaluation of toxicity by Common Terminology Criteria for Adverse Events version 3.0. The median follow-up period after radiotherapy was 18 months. Results: A complete response (CR) was achieved in 5 of 12 lesions (41.7%) at CT performed at 3 months after the cessation, whereas the overall complete response was observed in 7 of 12 cases (58.3%). In-field local control rate was sustained in 83.3% of patients. All patients developed intra-hepatic metastases except for 2 patients. The overall survival rate was 90.0% at 1 year and 67.5% at 2 years, respectively. Three patients developed Grade 1 nausea during RT and 1 patient showed a progression of ascites after RT. There was no grade 3 or greater treatment-related toxicities. Conclusion: Hypofractionated RT for small-sized HCC as a salvage therapy showed a 58.3% CR rate and 83.3% of local control. Fifty Gy administered in 10 fractions of partial liver irradiation is considered as a tolerable dose that does not cause severe complications.

Studies of the egg drop laying diseases from the mass zone layer (산란계 밀집지역의 산란저하성 질병에 관한 연구)

  • Lee Jeoung-Won;Eum Sung-Shim;Park In-Gyu;Bea Joung-Jun;Joung Dong-Suk;Song Hee-Jong
    • Korean Journal of Veterinary Service
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    • v.28 no.2
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    • pp.121-146
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    • 2005
  • Newcastle disease (ND), infectious bronchitis (IB), low pathogenic avian Influenza (LPAI) and fowl typhoid (FT) have been known as egg drop laying diseases because of the serious layer damage from mass zone layer. In this study, such egg drop laying diseases were investigated. To access this study, we peformed to evaluate antibody titers in serum and isolated bacteria and virus from organs and feces on May, July and September in 2003. The distribution of ND from January to May, IB and LPAI from October to February of the next year, and FT from March to September were inspected by the question survey in 21 farms. ND revealed to be positive rates of 490 to 474 $(96.7\%)$ in May, 510 to 506 $(99.2\%)$ in July and 510 to 510 $(100\%)$ in September with hemagglutination inhibition (HI) test. The mean antibody titers were 10.2, 9.9 and 10.2, respectively. With regard to IB, 484 out of 490 samples $(98.7\%)$ in May, 508 of 510 $(99.6\%)$ in July and 509 of 510 $(99.8\%)$ in September showed positive results and the mean antibody titers were gradually increased with 8.2, 9.0 and 9.4, respectively. According to HI test of LPAI, the positive results were shown in 442 of 480 $(92.1\%)$, 394 of 494 $(79.8\%)$ and 402 of 483 $(83.2\%)$ in May, July and September, respectively The mean antibody titers were decreased with 4.6, 4.3 and 4.0. The distribution of LPAI also elicited the positive rates of 480 to 475 $(99.0\%)$ in May, 494 to 485$(98.2\%)$ in July, 483 to 472 $(97.7\%)$ in September as determined by ELISA and the mean S/P ratio were 2.319, 2.557 and 2.380, respectively. Compared ELISA results with HI test of LPAI the positive results were 480 to 422 $(92.1\%),\;475(99.0\%),\;494\;to\;394 (79.8\%),\;485 (98.2\%)\;and\;483\;to\;402(83.2\%),\;472(97.7\%)$. Therefore, the positive rate determined by ELISA was higher than that of HI test with 6.9, 18.4 and $14.5\%$, respectively. When performed RT-PCR for ND using organ and feces samples, the pathotypes were detected $5(15.6\%)\;in\;May,\; 2(5.3\%) in\;July,\;2(7.1\%)$ in September but there is no samples showing positive band for LPAI. In attempt to isolate Salmonella gallinarum, bacteria were obtained from 4 cases (12.5%) in May, 9 (23.6%) in July, 5 (17.8%) in September. Thus the highest rate for isolation revealed to be shown in July When evaluated the antimicrobial susceptibility to 18 isolated strains of 5. gallinarum, bacteria were sensitive to trimethoprim/sulfamethox$(61.1\%),\;kanamycin\;(55.5\%),\;ampicillin\;(55.5\%)$ and amoxacillin/clavulanic acid $(55.5\%)$, cephalothin $(50.0\%)$, but resistant to penicillin $(88.9\%)$, streptomycin $(88.9\%)$, erythromycin $(83_4\%)$ and tetracycline $(61.1\%)$. According to HI test of ND and LPAI using captured 164 wild Korean tree sparrows (Passer nontanus), the positive rates were $47.6\%\;and\;57.3\%$, and the mean HI titers were 5.32 and 4.02, respectively. 71 $(43.2\%)\;and\;58(35.3\%)$ in captured sparrows also showed more than 4 titers for HI test to ND and LPAI, respectively However, the attempt for isolation of viruses failed in all samples.

Morphological study on abdominal organs of healthy cats using omnidirectional radiography and fluoroscopy (다각도 방사선촬영 및 투시법을 이용한 정상 고양이 장기의 형태학적 연구)

  • Shin, Sa-kyeng;Hirose, Tsuneo;Sato, Motoyoshi;Miyahara, Kazuro
    • Korean Journal of Veterinary Research
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    • v.36 no.4
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    • pp.949-966
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    • 1996
  • To establish the method for the most effective radiography and fluoroscopy, the abdominal organs of cats were investigeted using omnidirectional angles with the center of the body as the axis using an omnidirectional protective shielding X-ray system and a $360^{\circ}$ rotary restraint unit for use in small animals. The organs examined were the diaphragm, liver, stomach, colon, spleen and kidney. The results obtained in the present study were as follows: 1. Regardless of gas in the stomach present or not, it was feasible to distinguish the left and right crura in the lumbar portion of diaphragm in the oblique projection inclined over $30^{\circ}$ and under $90^{\circ}$ from the lateral projection. 2. Outlines of the exterior left lobe and the interior right lobe of the liver were observed in the oblique image inclined up to $60^{\circ}$ from the lateral image, while that of the exterior right lobe was noted in the oblique image inclined up to $60^{\circ}$ from the ventrodorsal-dorsoventral images. 3. It was necessary to have gas present in the stomach for detailed morphological observations of the stomach. It was most clearly observed in the right $30^{\circ}$ ventral-left dorsal oblique projection($120^{\circ}$ image) and the left $60^{\circ}$ dorsal-right ventral oblique projection($300^{\circ}$ image). 4. Morphology of the colon was observable in detail by the oblique projection inclined over $30^{\circ}$ from the lateral projection. 5. To observe the whole spleen it was required to have images from the ventrodorsal projection ($90^{\circ}$ image) to the right $60^{\circ}$ ventral-left dorsal oblique projection ($150^{\circ}$ image) as well as those from the dorsoventral projection ($270^{\circ}$ image) to the left-right lateral projection $0^{\circ}$ image). 6. Dorsal and ventral sides of the kidney were observable in the oblique images inclined $30^{\circ}$ from the lateral image. 7. Considering above findings collectively, it was thought that the results of present study might be useful for the analysis of abnormalies in each organ of cat.

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Analysis of Productivity in Rice Plant -IV. Sink-filling rate and sink-source relation (벼의 생산력 분석(分析) -IV. 수기(受器)의 충전속도(充塡速度)와 수기(受器)-급기(給器) 관계(關係))

  • Park, Hoon
    • Korean Journal of Soil Science and Fertilizer
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    • v.6 no.2
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    • pp.95-105
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    • 1973
  • Sink (grain)-filling rates of IR667 line (Suwon 213 and 214) and local leading varieties (Jinheung and Paldal) were investigated in relation to sink-source ratio, sink-source distance, forms of photosynthates, and weather factors. The results are as follows. 1. IR667 line have higher maximum filling rate (g. grain/day. ear) and shorter duration to reach maximum filling rate than local varieties. The curve pattern of sink-filling rate was high and steep type in IR667 line and low and broad type in local varieties. 2. Weather factors seem to give little effect on the curve pattern of sink-filling rate. 3. The functional sink-source distance (actual sink-source distance multiplied by the contribution rate of leaf for grain production) was shorter in upper leaves (flag and 2nd leaf) for IR667 line, the upper leaf-dependent type in grain production, and was longer in lower leaves (3rd and 4th) for local varieties, the lower leaf-dependent type. Specially short first internode from top may contribute to the upper leaf depencency of IR667 line. 4. According to free sugar-starch ratio (sugar/starch) in the culm and leaf sheath IR667 line could be classified as the high sugar type and the local varieties as the high starch type. The ratio of transportable form (sugar) to non transportable photosynthate (starch) seems to relate with sink-filling rate. And high sugar type is expected to have higher efficiency for grain production in view of energy balance. 5. A hypothesis that the higher in the uniformity within the series of productive structure the more efficient in grain production is proposed and discussed in relation to productivity. 6. According to the pattern of percent nutrient retention of each leaf blade IR667 showed the central retention type and Jinheung showed the apical retention type and each retention type appears to be a cause of each canopy conservation pattern. 7. From the content and percent distribution of nutrient in various organ IR667 could be classified as the leaf sheath dominant type and Jinheung as the leaf blade dominant type. 8. The fact that the greater the percent translocation of nutrient into grain the greater the percent nutrient retention in leaf blade was held between nitrogen and phosphorus within a variety and between varieties within a nutrient (N, P or K).

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Legislative Study on the Mitigation of the Burden of Proof in Hospital Infection Cases - Focusing on the revised Bürgerliches Gesetzbuch - (병원감염 사건에서 증명책임 완화에 관한 입법적 고찰 - 개정 독일민법을 중심으로 -)

  • Yoo, Hyun Jung
    • The Korean Society of Law and Medicine
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    • v.16 no.2
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    • pp.159-193
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    • 2015
  • Owing to causes such as population aging, increased use of various medical devices, long-term hospitalization of various patients with reduced immune function such as cancer, diabetes, and organ transplant patients, and the growing size of hospitals, hospital infections are continuing to increase. As seen in the MERS crisis of 2015, hospital infections have become a social and national problem. In order to prevent damage due to such hospital infections, it is necessary to first strictly implement measures to prevent hospital infections, while, on the other hand, providing proper relief of damage suffered due to hospital infections. However, the mainstream attitude of judicial precedents relating to hospital infection cases has been judged to in fact shift responsibility over damages due to hospital infections on the patient. In light of the philosophy of the damage compensation system, whose guiding principle if the fair and proper apportionment of damages, there is a need to seek means of drastically relaxing the burden of proof on the patient's side relative to conventional legal principles for relaxing the burden of proof, or the theory of de facto estimation. In relation to such need, the German civil code (Burgerliches Gesetzbuch), which defines contracts of medical treatment as typical contracts under the civil code, and has presumption of negligence provisions stipulating that, in cases such as hospital infections which were completely under the control of the medical care providers, if risks in general medical treatment have been realized which cause violations of the life, body, or health of patients, error on the part of the person providing medical care is presumed, was examined. Contracts of medical treatment are entered into very frequently and broadly in the everyday lives of the general public, with various disputes owing thereto arising. Therefore, it is necessary to, by defining contracts of medical treatment as typical contracts under the civil code, regulate the content of said contracts, as well as the proof of burden when disputes arise. If stipulations in the civil code are premature as of yet, an option may be to regulate through a special act, as is the case with France. In the case of hospital infection cases, it is thought that 'legal presumption of negligence' relating to 'negligence in the occurrence of hospital infections,' which will create a state close to equality of arms, will aid the resolution of the realistic issue of the de facto impossibility of remedying damages occurring due to negligence in the process of occurrence of hospital infections. Also, even if negligence is presumed by law, as the patient side is burdened with proving the causal relationships, such drastic confusion as would occur if the medical care provider side is found fully liable if a hospital infection occurs may be avoided. It is thought that, alongside such efforts, social insurance policy must be improved so as to cover the expenses of medical institutions having strictly implemented efforts to prevent hospital infections in the event that they have suffered damages due to a hospital infection accident, and that close future research and examination into this matter will be required.

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Elementary School in Gwangju Gwangsan Radon gas Density Measurement (광주광역시 광산구 소재 초등학교 라돈가스 농도 계측)

  • Ahn, Byungju;Oh, Jihoon
    • Journal of the Korean Society of Radiology
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    • v.8 no.4
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    • pp.211-216
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    • 2014
  • Radium is rock or soil of crust or uranium of building materials after radioactivity collapse process are created colorless and odorless inert gas that accrue well in sealed space like basement. It inflow to lung circulate respiratory organ and caused lung cancer because of deposition of lung or bronchial tubes. In this study, the air in the elementary school classroom nongdoeul tonkatsu place of measured values were compared using the calculated annual internal radiation exposure. La tonkatsu exposure measured in primary school classroom at least five schools when you close the windows in the average floor 0.56mSv 2 floors ground floor windows when opened 0.384mSv 048mSv 3 floors, 2 floor levels of the same three layers 0.31mSv 0.296mSv the human exposure to radon and radiation on the first floor of 3 floors above ground in a lot of exposure was moderate. When you close the window from the first floor up 0.384mSv 056mSv 3 floors with a minimum annual radiation exposure due to natural radiation in the 16 to 23.3 percent minimum 2.4mSv accounted for. When I opened the window to the maximum annual radiation exposure 2.4mSv 0.296mSv 0.31mSv least a minimum of 12.3 to 12.91% accounted for Results suggest that more than five chodeunghakgyoeun La tonkatsu domestic radon measurements conducted below regulatory requirements and internal exposure has also fall within the normal range. People The less the radiation exposure to the human body because it reduces the impact in the classroom in elementary school vent windows often reduced to the maximum radon concentration in the air, if called tonkatsu be able to reduce radiation exposure for the immune system is weak and elementary will be helpful to experiment more in the future for the school authorities called tonkatsu investigation is done to him if the action to establish a more secure school building facilities is thought would be helpful.

A Study on Exposure to radiation of the patient who visited an emergency room at a University Hospital (한 대학병원 응급실에 방문한 환자의 방사선 피폭에 관한 연구)

  • Ahn, Buyung-Ju;Lee, Sang-Bock;Lee, Jun-Haeng
    • Journal of the Korean Society of Radiology
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    • v.1 no.3
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    • pp.23-34
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    • 2007
  • To find how much radiation was exposed the patients who visit emergency room, a measurement study was made for radiation amount toward 200 patients selected randomly among visitors to an emergency room in a university hospital from March 16 to 31st, 2006. The results are as follows ; 1. Among the subjects 50 person(25.0%) were transferred from other hospitals, 24 persons(8.3) come after traffic accident, 50 persons for other accident and 76 persons for general medical care. 2. The average frequency of X-ray taking was calculated as 6.4 time per person among transferred patients, 14.5 times per person among patients with traffic accident and 2.6 times per person among general medical care. 3. The radiation exposure amount by kind of X-ray showed 28.9mGyfor general X-ray diagnosis, 84.2mGy for CT scanning and 1.02mGy for other special radiation study. 4. Average radiation exposure amount was calculated as 24.6mGy by transferred patients, 55.2mGy by patients with traffic accident, 17.1mGy by patients with other accidents and 17.0mGy by general patients. 5. Through the comparison of radiation exposure amount among to subject with maximum allowance threshold by International Commission on X-ray Radium Protection, transferred patients exceeded 6 times than allowance in whole body except extremities and joints, blood forming organ, reproductive system, vitreous body of eye, bone, thyroid gland, skin and etc, Patient suffered from traffic accidents were exposed 10 times more than allowance. In conclusion, the radiation exposure amount during X-rat diagnosis re too much and exceeded allowance standard by International Commission on X-ray Radium Protection. So further study and preventive measure to decrease radiation exposure by patients who visit emergency room.

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Histopathological and Serological Observations on Experimental Anisakiasis of Rabbits (실험적 토끼 아니사키스증에서의 조직학적 병변과 혈청 항체가의 경시적 변동 양상)

  • 홍성태;이손형
    • Parasites, Hosts and Diseases
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    • v.25 no.2
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    • pp.168-180
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    • 1987
  • This study was performed to observe histopathological changes and serological reactions in chronic anisakiasis of rabbits. Each rabbit was infected per os with 30 larvae of Anisakis type I. Their sera were collected chronologically and the rabbits were killed for histopathological examination, 3, 13, 20, 30, 60, 90 and 150 days after the infection. The results were summarized as below. 1. Most of the larvae were recovered from the stomach, but a few from the omentum, intestine, mesentery and abdominal wall. The recovery rates and distribution of worms by organ were not differed by duration of infection. 2. Histologically the lesion was abscess type on 13 days, i.e., the dead worms were surrounded by fibrinous exudate, histiocytes and thick zone of numerous inflammatory cells. After 30 days, histiocytes were found to invade the worms and the lesion was changing into abscessgranulomatous type. Also a calcified worm was found on the 30th day. After then the worms were observed to be dissolved slowly until 90 days. On 150 day, only one calcified worm was observed. 3. The levels of serum IgG antibody by ELISA reached their maximum 30 days after the infection. After then, it decreased slowly until 150 days after the infection. Above serological and histopathological findings indicated that antigenic stimulation from degenerating Anisakis larvae was the greatest during the first 30 days after infection. This period was corresponding with the beginning of worm resolution or calcification. Serologic test by ELISA would be a valuable tool for confirming chronic anisakiasis.

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