• Journal of the korean academy of Pediatric Dentistry
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• v.29 no.2
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• pp.168-179
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• 2002

The purpose of this study was to find a method for improving the children's behavior during dental treatment in relation with dentist's attire. For this study 150 children, visiting a dental clinic, were asked to participate in a survey on the attire of the dentist. The results of the survey were as follows: 1. In the survey for the preference between gown and ordinary clothes according to sex(P<0.05), age(P<0.05), residence (P<0.05) and number of visits(P<0.05), there was more preference for gown(65.3%). 2. The preference for the type of gown and attire under the gown was a long gown and white shirt (30.7%), followed by a suit-like gown (18.7%) and white shirt, and long gown and polo shirt(17.3%). 3. The preference for the color of gown was white(34.7%), followed by pink (18.7%), green(18.0%), blue(15.3%) and yellow(13.3%). 4. The preference for the pattern on the gown was cartoon characters(49.3%), followed by hospital logo(28.7%) and no pattern(14.7%). 5. The preference for ordinary clothes of female dentists was polo shirt(37.3%), followed by striped shirt(28.7%), round T-shirt(18.7%), and everyday Korean traditional dress(15.3%). 6. The preference for ordinary clothes of male dentists was pattern necktie and no pattern Y-shirt(28.0%), followed by no pattern necktie and Y-shirt(21.3%) or pattern shirt with no necktie, and no pattern Y-shirt with no necktie(14.7%). 7. The preference on the protective equipment worn was mask and glove(28.7%), followed by no protective equipment(26.7%), mask, glove and protective glasses(22.7%) at)d only mask(22.0%). Based on the above results, it seems that parting with the traditional white gown and wearing multi-color and pattern attire will provide psychological stability and help improve children's behavior during treatment.

• Journal of the korean academy of Pediatric Dentistry
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• v.32 no.2
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• pp.370-376
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• 2005

In children, dental anxiety of dental treatment has been recognized as a source of problems in patient man agement for many years. Dental anxiety can be causes of negative cooperation, cancel and avoid of dental treatment. Therefore, dentist and dental team should recognize of child's dental anxiety as early as possible and manage appropriately. In previous studies, it is reported that parental dental anxiety affect dental anxiety and cooperation of their child. And it is parental decision which results in a child's visit to the dentist, rather than a child's decision in most cases. Therefore, it is important to identify the relationship of dental anxiety between child and parent. We estimated child's dental anxiety before dental treatment using Venham Picture Scale that is useful even a very young child and parental dental anxiety using Corah's dental anxiety scale. Then, two values above were compared. Child's cooperation, temperament, sex, age, parental education were estimated and compared with dental anxiety, too. The results were as follows: 1. There are positive relationship of dental anxiety between child and parent with the correlation analysis(P<0.02). 2. There are negative relationship of child's dental anxiety and child's cooperation with the correlation and regression analysis(P<0.001). 3. Low anxiety group has lower mean value of four temperament item with the Student's t-test. But, there is no statistical differences(P>0.1). 4. Girl and younger group have higher mean value of dental anxiety than boy and older group with the Student's t-test(P<0.001). 5. Low educated parents have higher mean value of dental anxiety than high educated parents with the Student's t-test(P>0.1).

• Advances in pediatric surgery
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• v.6 no.2
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• pp.106-123
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• 2000

The purpose of the survey was to clarify the clinical features and management of the anorectal malformations (ARM) in Korea. Twenty-seven members of the Korean Association of Pediatric Surgeons were surveyed. The members completed a case registration form for each patient during the two years period of 1996-1997, and a questionnaire that contained their management preferences for primary and complicated patients. Twenty-four members of the 22 institutions registered 295 cases of the ARM, and 27 out of 34 members (77.1 %) responded to the questionnaire. The patients were classified by the Wingspread classification of ARM(1984). The case registration form was a modification of Wingspread workshop for the postoperative assessment and case registration. The male to female ratio was 1.7 : 1. The average number of patients per surgeon was 6.1 cases per year. Prematurity(< 36 weeks) was present in 1.9 % of cases and low birth weight (< 2.6 Kg) in 12.1 %. Among 187 male patients, 62 were high(H) type, 29 intermediate(l) type, 88 low(L), and 8 unclassified. In female, there were 2 cases of cloacal anomalies(C), 4 H type, 30 I type, 66 L type and 6 unclass ified. For male, 87.9 % of H and I type were operated by the Pena procedure, but only 7.9 % in L types. In female, all of C, H and I types, and 40.9 % of L type were done by the Pena procedure. One case expired (MR; 0.003%) as a result of surgical complication. Over-all complication rate was 12.5 %. Among 6 cases of reoperation, 4 were failed Pena procedures. Among 140 colostomies sigmoid colon was utilized in 75.7%, and loop colostomy was commonly used. Ten surgeons prefered primary maturation of the stoma. In conclusion, posterior sagittal anorectoplasty is popular for high types of ARM in this country, but considerable number of patients are still suffering from failed operations. For better understanding and analysis, necessity of prospective study by new classification was discussed.

• Advances in pediatric surgery
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• v.19 no.1
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• pp.1-13
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• 2013

The Korean Association of Pediatric Surgeons (KAPS) performed the second nationwide survey on biliary atresia in 2011. It was a follow-up study to the first survey, which was performed in 2001 for the retrospective analysis of biliary atresia between 1980 and 2000. In the second survey, the authors reviewed and analyzed the clinical data of patients who were treated for biliary atresia by the members of KAPS from 2001 to 2010. A total of 459 patients were registered. Among them, 435 patients primarily underwent the Kasai operation. The mean age of patients who underwent the Kasai operation was $66.2{\pm}28.7$ days, and 89.7% of those patients had type III biliary atresia. Only five patients (1.4%) had complications related to the Kasai operation. After the Kasai operation, 269 (61.8%) of the patients were re-admitted because of cholangitis (79.9%) and varices (20.4%). One hundred and fifty-nine (36.6%) of the patients who underwent the Kasai operation subsequently underwent liver transplantation. The most common cause of subsequent liver transplantation was persistent hyperbilirubinemia. The mean interval between the Kasai operation and liver transplantation was $1.1{\pm}1.3$ years. Overall the 10-year survival rate after the Kasai operation was 92.9% and the 10-year native liver survival rate was 59.8%. We had 23 patients for primary liver transplantation without the Kasai operation. The mean age patients who underwent primary liver transplantation was $8.6{\pm}2.9$ months. In summary, among the 458 Kasai-operation and liver-transplantation patients, 373 lived, 31 died, and 54 were unavailable for follow up. One-third of the patient who survived have had complications correlated with biliary atresia. In comparison with the first survey, this study showed a higher survival rate and a greater number of liver transplantation.

• Journal of Radiation Protection and Research
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• v.39 no.4
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• pp.168-175
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• 2014

This study was designed to assess whether the conventional tangential technique, using a multileaf collimator (MLC), allows a reduced dose to the organs at risk (OAR) in breast radiation therapy. A total of forty right and left 20 for each breast cancer patients that underwent radiation therapy after breast conserving surgery were included in this study. For each patient, the planning target volume (PTV) and OAR (heart, left anterior descending artery (LAD), liver and lung) were defined and dose distribution were produced for conventional tangential beams using 6 MV photons. The treatment plans were made using the following two techniques for all patients. For the first plan (P1), MLC was designed to shield as much of OAR as possible without compromising the coverage of PTV. In the second plan (P2), the treatment plan was created without using MLC. Dose-volume histograms for OARs were calculated for all plans. For left breast cancer, the percentage of maximum dose ($D_{max%}$) and mean dose ($D_{mean%}$) of OARs (heart and LAD) were calculated, and for right breast cancer, the percentage of the mean dose ($D_{mean%}$) of the liver was calculated. The $D_{mean%}$ of the lung was calculated in all patients. The mean values of $D_{max%}$ of the heart ($86.9{\pm}19.5%$ range, 35.1-100.6%) in P1 were significantly lower than in P2 ($98.3{\pm}3.4%$ range, 91.7-105.2%) (p=0.001). The mean values of $D_{max%}$ of LAD ($78.4{\pm}22.5%$ range, 26.5-99.7%) in P1 was significantly lower than in P2 ($93.3{\pm}8.1%$ range, 67.9-102.1%) (p<0.001). In P1, the mean values of $D_{mean%}$ of the liver ($4.8{\pm}2.0%$) were significantly lower than in P2 ($6.2{\pm}2.5%$) (p<0.001). The mean values of $D_{mean%}$ of the lung were significantly lower in P1 ($9.3{\pm}2.3%$) than in P2 ($9.7{\pm}2.4%$) (p<0.001). P1, by using MLC, allows a significantly reduced dose to OAR compared with P2. We can suggest that it is reasonable to routinely use MLC in the conventional tangential technique for breast radiation therapy considering the primary tumor location.

• Journal of Radiation Protection and Research
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• v.38 no.4
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• pp.214-227
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• 2013

Computed tomographic scan as a screening procedures in asymptomatic individuals has seen a steady increase with the introduction of multiple-raw detector CT scanners. This report provides a brief review of the current controversy surrounding CT cancer screening, with a focus on the radiation induced cancer risks and clinical efficacy. 1. A large study of patients at high risk of lung cancer(the National Lung Screening Trial[NLST]) showed that CT screening reduced cancer deaths by 20%(1.33% in those screened compared with 1.67% in those not screened). The rate of positive screening tests was 24.2% and 96.4% of the positive screening results in the low-dose CT group were false-positive. Radiation induced lung cancer risk was estimated the most important in screening population because ERR of radiation induced lung cancer does not show the decrease with increasing age and synergistic connection between smoking and radiation risk. Therefore, the radiation risk may be on the same order of magnitude as the benefit observed in the NLST. Optimal screening strategy remain uncertain, CT lung cancer screening is not yet ready for implementation. 2. Computed tomographic colonography is as good as colonoscopy for detecting colon cancer and is almost as good as colonoscopy for detecting advanced adenomas, but significantly less sensitive and specific for smaller lesions and disadvantageous for subsequent therapeutic optical colonoscopy if polyps are detected. The average effective dose from CT colonography was estimated 8-10 $mS{\nu}$, which could be a significant dose if administered routinely within the population over many years. CT colonography should a) achieve at least 90% sensitivity and specificity in the size category from 6 and 10 mm, b) offer non-cathartic bowl preparation and c) be optimized and standardized CT parameters if it is to be used for mass screening. 3. There is little evidence that demonstrates, for whole-body scanning, the benefit outweighs the detriment. This test found large portion of patient(86~90.8%) had at least one abnormal finding, whereas only 2% were estimated to have clinically significant disease. Annual scans from ages 45 to 75 years would accrue an estimated lifetime cancer mortality risk of 1.9%. There is no group within the medical community that recommends whole-body CT. No good studies indicate the accuracy of screening CT, at this time. The benefit/risk balance for any of the commonly suggested CT screening techniques has yet to be established. These areas need further research. Therefore wild screening should be avoided.

• Sleep Medicine and Psychophysiology
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• v.3 no.1
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• pp.68-78
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• 1996

Objective : The Mini-Mental State Examination(MMSE) and Brief Cognitive Rating Scale(BCRS) are frequently using screening tests fur evaluating the cognitive function in clinical practice and research. The authors tried to evaluate the clinical usefulness of these tests for the patients with non-traumatic subcortical cerebrovascular disease. Method : We administered the MMSE and BCRS to 85 patients and 195 normal control group. In order to compare the test results according to the lesion site, we divided patients into left sided lesion group(21 patients), right sided lesion group(31 patients) and both sided lesion group(13 patients). Their cognitive function was evaluated by the BNA and daily living functional activity was examined by the IADLs(Instrumental Activities of Daily Living Scale)and GERRI(Geriatric Evaluation by Relative's Rating Instrument). Results : The results are as follows : 1) In the BNA, the patients scored significantly lower than control group at all items(except Right-Left Orientation and Motor Impersistence), but there were no difference in the MMSE(total score and all 5 items), and only 2 items(recent memory and self-care) were significantly different between two groups in the BCRS. 2) In the comparison by lateralization, there were significant differences among three groups at 3 items(Left Tactile Form Perception, Left Finger Localization and Right Finger Localization) in the BNA. But, there were no difference in the MMSE and BCRS. 3) In the correlation between daily living functioning and the MMSE/BCRS, control group showed no relation(except item of cognitive functioning), but patient group was significantly correlated with 3 items(social functioning, instrumental activities of daily living and cognitive functioning). Conclusions : These findings suggest that MMSE and BCRS are not useful as the test for cognitive function and discrimination of lateralization in patients with non-traumatic subcortical cerebrovascular disease. However, scores of these tests may be related with the functional level(such as daily living function) of patients.

• Tuberculosis and Respiratory Diseases
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• v.46 no.1
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• pp.44-52
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• 1999

Background : Airway infiltration by inflammatory cells, particularly of eosinophils, is one of the characteristic features of asthma. Several mechanisms for the recruitment of eosinophil is focused on the CD4+ T lymphocyte for the preferential production of Th2-c1erived cytokines. Interleukin-10(IL-10) is identified cytokine with potent antiinflammatory activity. This molecule has been shown to inhibit the release of cytokine from inflammatory cells including Th2 cell, and also to inhibit eosinophil survival. We therefore attempted to determine whether decreased synthesis of IL-10 in the lung of bronchial asthma may contribute to inflammation that is characteristics of this dease. Method: Subjects were patients with bronchial asthma(n=23) and normal controls(n=11). IL-10 produced from peripheral mononuclear cell(PBMC) and in bronchoalveolar lavage(BAL) fluid was measured by ELISA method. Degree of bronchial inflammation was assessed by total cell counts and eosinophil percents in BAL fluid, eosinophil infiltration on bronchial biopsy tissue and $PC_{20}$ for methacholine. Results: The IL-10 level produced by PBMC and in BAL fluid from patient with bronchial asthma were not different with normal controls(respectively, $901.6\pm220.4$ pg/ml, $810.9\pm290.8$ pg/ml for PBMC, $24.5\pm9.5$ pg/mL $30.5\pm13.5$ pg/ml for BAL fluid p>0.05). There were significant negative correlation between IL-10 in BAL fluid and eosinophil percents in BAL fluid or degree of eosinophil infiltration in bronchial biopsy (respectively r=-0.522, r=-0.4486 p<0.05). However there was no difference of IL-10 level according to $PC_{20}$ for methacholine. There were no correlation between IL-10 production by PBMC and peripheral blood eosinophil counts or serum eosinophilic cationic protein levels(respectively r=0.1146, r=0.0769 p>0.05). Conclusion: These observation suggest that IL-10 may participate but not acts the crucial role in regulation of the airway inflammation in bronchial asthma.

• Tuberculosis and Respiratory Diseases
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• v.48 no.3
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• pp.357-364
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• 2000

Background : Complicated exudative pleural fluid collections have traditionally been treated by either closed tube thoracostomy drainage or by open surgical drainage. Complete drainage is important in order to control pleural sepsis, restore pulmonary function, and entrapment. Recently intracavitary fibrinolytic therapy has been advocated as a method to facillitate drainage of complicated exudative pleural effusion and to allow enzymatic debridemant of the restrictive fibrinous sheets covering the pleural surface. The purpose of this study is to prospectively evaluate the effects of image-guided catheter drainage with high dose urokinase(UK) instillation in the treatment of complicated pleural effusions. Patients : Twenty complicated pleural effusion patients that poorly respond to image-guided drainage were allocated to receive UK. There were 8 pneumonia and 12 tuberculosis. Methods : Drugs were diluted in 250 mL normal saline and were infused intrapleurally through the chest tube or pig-tail catheter in a daily dose of 250,000 IU of UK. Response was assessed by clinical outcome, fluid drainage, chest radiography, pleural ultrasound and/or computed tomography. Results : The mean UK instillation time was $1.63{\pm}0.10$. The mean volume drained UK instillation was $381.3{\pm}314.4\;mL$, and post-UK was $321.6{\pm}489.5\;mL$. The follow up duration after UK therapy was mean $212.9{\pm}194.5$ days. We had successful results in 19 cases (95.0%). There were 12 pleural thickenings (60.0%), 2 markedly decreased effusions (10.0%) and 5 cases of no thickening or effusion. There was recurrence after treatment in only one patient(5%) with complicated pleural effusiondue to tuberculosis. Conclusions : Image-guided drainage with high dose UK instillation (250,000 U/day) in complicated pleural effusion is a safe and more effective method than closed thoracostomy drainage. And this management, in turn, can obviate surgery in most cases.

• Tuberculosis and Respiratory Diseases
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• v.48 no.4
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• pp.420-427
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• 2000

Background : Isolated leukopenia is rare, but it has important clinical implications during antituberculosis treatment. Inadvertent discontinuation of short-course regimen drugs for fear of leukopenia inevitably will extend the duration of treatment, and the completion of treatment will be delayed. However no guidelines concerning proper management for leukopenia during antituberculosis treatment have been presented. Therefore, this study was performed to evaluate the possibility of continuing the same short-course regimen if a mild-to-moderate degree of isolated leukopenia was to develop during antituberculosis treatment. Method : Thirty-six patients who had been prescribed a short-course antituberculosis regimen between January 1997 and August 1999, had newly developed, mild-to-moderate degree, isolated leukopenia during medication, and had continued the same drug regimen despite leukopenia were enrolled. One patient was not available for the follow-up, so the remaining thirty-five (twenty-five prospectively and ten retrospectively) patients were analyzed. Patients who had other known causes of leukopenia were excluded. A mild-to-moderate degree of isolated leukopenia was arbitrarily defined as having a peripheral blood leukocyte count between 2,000 and $3,499/mm^3$ and no evidence of coexisting hematologic abnormalities. Results : 1) All thirty-five patients were able to complete short-course anti-tuberculosis treatment without complication or further decrease of leukocytes count to less than $2,000/mm^3$ despite continuous treatment with the same regimen. 2) The mean duration from start of antitituberculosis medication to detection of leukopenia was $64{\pm}65$ days. 3) The mean leukocyte count was $5,035{\pm}1,583/mm^3$ before treatment, and the its lowest count was $2,908{\pm}390/mm^3$ during treatment. Leukopenia recovered after completion of treatment ($4,283{\pm}1,269/mm^3$). 4) The main component of leukopenia was the decrease in neutrophil count ($3,361{\pm}1,732$ vs. $1,512{\pm}423/mm^3$, p<0.05). Conclusion : For mild-to-moderate degree of isolated leukopenia ($2,000/mm^3{\leq}$ WBC < $3,500/mm^3$), developing during short-course antituberculosis treatment, the short-course antituberculosis regimen may be continued without complications.