• Journal of the Korean Society of Radiology
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• v.17 no.4
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• pp.573-579
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• 2023

This study compares dose difference between the presence or absence of grid in Chest PA radiography using auto exposure control and compares image quality among presence, absence or virtual grid, and proposes a new clinically useful grid combination for chest radiography. The human body phantom was placed Chest PA position and the dosimeter was placed at T6. The same irradiation conditions and field size were applied. 30 images were obtained in the state in which grid was applied and in the state in which grid was not applied, and an additional 30 images in which the virtual grid was applied to the image without the grid were obtained. Radiation dose was presented to entrance surface dose. The image quality was analyzed by comparing the signal-to-noise and contrast-to-noise ratio. ESD decreased by 48% when the grid was not used, compared to when the grid was used. SNR and CNR increased by 32% and 30% compared to grid use when grid was not used, respectively. In the case of using the virtual grid, it increased by 18% and 16% respectively, compared to the case of using the grid. As a result of this study, it is believed that when using a virtual grid instead of a grid, the quality of the image can be maintained while reducing the patient dose.

• Journal of Korean Neurosurgical Society
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• v.29 no.12
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• pp.1673-1676
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• 2000

Anticonvulsant hypersensitivity syndrome is a rare but fatal complication. It manifests as fever, skin rash, lymphadenopathy, and hepatitis. Phenytoin, phenobarbital, and carbamazepine are the most frequently involved drugs. We here report a case of phenytoin-induced anticonvulsant hypersensitivity syndrome. A 37-year-old woman presented with fever and generalized skin rash, 3 weeks following commencement of phenytoin 400mg daily for treatment of seizure after superficial temporal artery-middle cerebral artery(STA-MCA) anastomosis for moyamoya disease. Her temperature was $39.3^{\circ}C$ and her face was edematous. Laboratory findings showed elevated hepatic enzymes and eosinophilia. Blood and urine culture were all negative. Initially, prednisolone was commenced at 30 mg daily. But fever and skin rash did not improved and hepatic function was more aggravated. After increasing dose of steroid(methylprednisolone 125mg/day), fever and skin rash disappeared and hepatic enzymes returned to normal range.

• Journal of Veterinary Clinics
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• v.41 no.1
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• pp.49-53
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• 2024

A two-year-old, spayed female, 22.5 kg Pungsan was referred with chronic crusts and erosion on the nose. A referring veterinarian prescribed an anti-inflammatory dose (0.5-1 mg/kg/day) of oral glucocorticoids for 5 months, but skin lesions showed no meaningful improvement. A dermatological evaluation revealed a crust, depigmentation, erosion, and erythematous lesion over the nasal planum with a loss of the normal cobblestone texture. Also, firm and multifocal plaques over the thigh, groin, axilla, and dorsum were detected. A cytology examination on the nose, thigh, groin, axilla, and dorsum revealed moderate neutrophilic inflammation and bacterial infection. Abdominal radiography and ultrasonography revealed subcutaneous calcified materials along the thigh, groin, axilla, and dorsum. Calcinosis cutis was suspected because of the adverse effect of previous prolonged corticosteroid therapy. A histopathology examination of the nose lesion revealed moderate to severe degenerative or apoptotic changes of the basal layer and lymphoplasmacytic interface dermatitis. Facial discoid lupus erythematosus (FDLE) was diagnosed based on the history and the clinical, cytological, and histopathological results. Minocycline (7 mg/kg PO q 12 h) and niacinamide (500 mg/dog PO q 12 h) were prescribed as initial treatment. Glucocorticoids were not administered due to the presence of calcinosis cutis induced by previous corticosteroid treatment. After 6 weeks of treatment, the clinical signs on the nose were mildly improved. At this time, topical 1% pimecrolimus cream (twice daily) was initiated, while minocycline and niacinamide were continued at the same dose. The nasal planum markedly improved after 6 weeks of additional treatment, hence minocycline and niacinamide were prescribed for an additional 2 weeks and stopped, and the patient was continued solely on topical pimecrolimus. The dog's skin lesion has been maintained in clinical remission with topical 1% pimecrolimus twice daily for more than 5 months.

• Journal of The Korean Society of Inherited Metabolic disease
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• v.10 no.1
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• pp.59-66
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• 2010

Enzyme replacement of therapy (ERT) is one of the most promising therapeutic strategies for the treatment of lysosomal storage disorders. ERT is available in three types of Mucopolysaccharidosis (MPS): for MPS I (Aludrazyme$^{(R)}$), MPS II (Elaprase$^{(R)}$) and MPS VI (Naglazyme$^{(R)}$) patients who are over 5 years old. But recently, early diagnosis can be done by expert clinicians and even in prenatal case. We describe the case of ERT under 5 years old MPS patients. Up to June, 2010 in Samsung Medical Center, there are 6patients who were diagnosed as MPS and started ERT under 5 years old. 3 patients were MPS I, 3 patients were MPS II. 2 patient who was diagnosed as MPS I was female and others were male. Their age at diagnosis were 4 to 37month-old (4, 13, 16, 25, 27, 37 month-old) and they are now 9 to 60 month-old (9, 39, 32, 81, 60 month-old). The youngest patient was started ERT at 4 month-old and others were started at their 13 to 49 month-old (13, 29, 27, 28, 49 month-old). First manifested symptoms of patients were macrocephaly, kyphosis and coarse face appearance. Especially, in 2 of them, one was MPS I and the other was MPS II had elder brother with same disease. And the youngest one was diagnosed by the iduronate-2-sulfatase (IDS) gene analysis from chorionic villi sampling. His mother knew that she was a heterozygous carrier of IDS gene mutation because her younger brother died from MPS II. All of them confirmed as MPS by the enzyme assay in leukocytes and fibroblast skin culture. We started ERT with ${\alpha}$-L-iduronidase(Aldurazyme$^{(R)}$) to MPS I and did recombinant human iduronate-2-sulfatase (Elaprase$^{(R)}$) to MPS II patients as recommended dose as over 5 years old. But for MPS II patient who was 4 month old, we started ERT by recombinant human IDS (Elaprase$^{(R)}$) with reduced dose 0.1 mg/kg and increased dose every 2 weeks by 0.1mg/kg up to 0.5mg/kg IV infusion. During ERT, all patients had no adverse effects and the excretion of GAGs were decreased. We have evaluated other clinical symptoms such as liver/ spleen volume, heart function and neurologic evaluation. We describe a successful ERT to MPS I and MPS II patient under 5 years old without any adverse event. It indicates that ERT in young children are well tolerated and that it has several effects which may confer clinical benefits with long-term therapy.

• Korean Journal of Clinical Pharmacy
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• v.7 no.2
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• pp.64-66
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• 1997

Zinc is employed in body cell growth and immune function. Zinc deficiency causes growth retardation, night blindness, delay of wound healing, skin disorders, alopecia, et al. Pharmacokinetic study of zinc in Korean has not yet been proceeded to apply to patient. In this study, we investigated to adjust zinc dosage for maintaining constant zinc optimum serum level. Five NPO inpatients (3 males, 2 females) in Seoul National University of Hospital were evaluated, retrospectively. Zinc was mixed with parenteral nutrition solution and administrated intravenously in 24 hour-continuous infusion, and zinc dosage range was 0.17-0.45 mg/kg/day. AUC to zinc dose (AUC/Dose) was $2.421\pm1.007\;kg{\cdot}min/ml.$ 0.5 mg/kg/day zinc administration may achieve the plasma zinc concentration of $120\;{\mu}g/dl.$(Kor. J. Clin. Pharm. 1997; 7: 64-66)

• Journal of Medicine and Life Science
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• v.20 no.2
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• pp.89-93
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• 2023

We present three cases of patients with breast cancer and psoriasis who received radiotherapy following breast-conserving surgery. One patient developed an extensive flare-up of psoriasis during chemotherapy. After discontinuing chemotherapy, she received conventional radiotherapy to the ipsilateral whole breast, axillary, and supraclavicular lymph nodes with 50.4 Gy in 28 fractions and boosted with 10 Gy in five fractions to the tumor bed. Two patients received hypofractionated whole-breast radiotherapy at a total dose of 40.05-42.4 Gy in 15-16 fractions. In all three cases, there was no flare-up of psoriatic events at least 6 months after the completion of radiotherapy. We hypothesized that there is a close relationship between psoriatic events and the extent of trauma rather than the daily dose of the fraction. Therefore, we confirmed that the effect of radiotherapy on psoriatic events is minimal if the radiation field size does not exceed that of the whole breast.

• Journal of Radiation Protection and Research
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• v.27 no.1
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• pp.1-10
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• 2002

High energy photon beams from medical linear accelerators produce large scattered radiation by various components of the treatment head, collimator and walls or objects in the treatment room including the patient. These scattered radiation do not provide therapeutic dose and are considered a hazard from the radiation safety perspective. Scattered dose of therapeutic high energy radiation beams are contributed significant unwanted dose to the patient. ICRP take the position that a dose of 500mGy may cause abortion at any stage of pregnancy and that radiation detriment to the fetus includes risk of mental retardation with a possible threshold in the dose response relationship around 100 mGy for the gestational period. The ICRP principle of as low as reasonably achievable (ALARA) was recommended for protection of occupation upon the linear no-threshold dose response hypothesis for cancer induction. We suggest this ALARA principle be applied to the fetus and testicle in therapeutic treatment. Radiation dose outside a photon treatment filed is mostly due to scattered photons. This scattered dose is a function of the distance from the beam edge, treatment geometry, primary photon energy, and depth in the patient. The need for effective shielding of the fetus and testicle is reinforced when young patients ate treated with external beam radiation therapy and then shielding designed to reduce the scattered photon dose to normal organs have to considered. Irradiation was performed in phantom using high energy photon beams produced by a Varian 2100C/D medical linear accelerator (Varian Oncology Systems, Palo Alto, CA) located at the Yonsei Cancer Center. The composite phantom used was comprised of a commercially available anthropomorphic Rando phantom (Phantom Laboratory Inc., Salem, YN) and a rectangular solid polystyrene phantom of dimensions $30cm{\times}30cm{\times}20cm$. the anthropomorphic Rando phantom represents an average man made from tissue equivalent materials that is transected into transverse 36 slices of 2.5cm thickness. Photon dose was measured using a Capintec PR-06C ionization chamber with Capintec 192 electrometer (Capintec Inc., Ramsey, NJ), TLD( VICTOREEN 5000. LiF) and film dosimetry V-Omat, Kodak). In case of fetus, the dosimeter was placed at a depth of loom in this phantom at 100cm source to axis distance and located centrally 15cm from the inferior edge of the $30cm{\times}30cm^2$ x-ray beam irradiating the Rando phantom chest wall. A acryl bridge of size $40cm{\times}40cm^2$ and a clear space of about 20 cm was fabricated and placed on top of the rectangular polystyrene phantom representing the abdomen of the patient. The leaf pot for testicle shielding was made as various shape, sizes, thickness and supporting stand. The scattered photon with and without shielding were measured at the representative position of the fetus and testicle. Measurement of radiation scattered dose outside fields and critical organs, like fetus position and testicle region, from chest or pelvic irradiation by large fie]d of high energy radiation beam was performed using an ionization chamber and film dosimetry. The scattered doses outside field were measured 5 - 10% of maximum doses in fields and exponentially decrease from field margins. The scattered photon dose received the fetus and testicle from thorax field irradiation was measured about 1 mGy/Gy of photon treatment dose. Shielding construction to reduce this scattered dose was investigated using lead sheet and blocks. Lead pot shield for testicle reduced the scatter dose under 10 mGy when photon beam of 60 Gy was irradiated in abdomen region. The scattered photon dose is reduced when the lead shield was used while the no significant reduction of scattered photon dose was observed and 2-3 mm lead sheets refuted the skin dose under 80% and almost electron contamination. The results indicate that it was possible to improve shielding to reduce scattered photon for fetus and testicle when a young patients were treated with a high energy photon beam.

• Journal of Korean Neurosurgical Society
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• v.50 no.1
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• pp.68-71
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• 2011

We present a case of Neuro-Behçet's disease with an unpredictable clinical course. A 47-year-old man was admitted to the neurosurgery department of our hospital with a mild headache. Three days after admission, his consciousness suddenly decreased and respiratory distress progressed rapidly. A brain MRI revealed that the previously observed abnormal signal had extended markedly to both the thalamic areas and the entire brain stem, and the surrounding brain parenchyma were compressed by cerebral edema. Based on the patient's symptoms of recurrent oral and genital ulcers, skin lesions, and uveitis, a rheumatologist made a diagnosis of Behçet's disease with CNS involvement. The patient was treated with high-dose methylprednisolone with respiratory assistance in the intensive care unit for 9 days and his neurologic symptoms improved remarkably. Neuro-Behçet's disease must be considered in the differential diagnosis in rapidly deteriorated young neurological patients along with a stroke, low-grade glioma, multiple sclerosis, and occlusive venous disease.

• The Korean Journal of Pain
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• v.8 no.1
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• pp.124-126
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• 1995

Atopic allergy implies a familial tendency to manifest alone or in combination such as asthma, rhinitis, urticaria and atopic dermatitis. The patient with atopic dermatitis shows a variety of humoral and cell-mediated immune dysfunction, including an elevation of serum IgE level, multiple positive immediate skin tests to a variety of antigen. A 30 year old female patient suffering from an atopic dermatitis on face, has been administered a stellate ganglion block(SGB) with a 1% mepivacaine 5cc. She complained of bronchial hyperresponsivness such as cough, soreness, and inspiration difficulty for 5 days following the treatment, so we have reduced 1% mepivacaine dose from 5cc to 3cc. She had no complain of bronchial hyperresponsivenss and the lesion of atopic dermatitis was improved. From our result we conclude that SGB appears to be a good choice for the treatment of the atopic dermatitis and only 1% mepivacaine 3cc is possible in complete SGB.

• Progress in Medical Physics
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• v.13 no.2
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• pp.74-78
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• 2002

The individual (customized) immobilization has been used to reproduce the patients' set-up on daily base. There are many various devices available commercially. To evaluate dosimetric characteristics of vacuum cushion, we analysed the surface dose and transmission factor for d$_{max}$ when patient is immobilized with vacuum cushion. Experiments were performed with 4 MV (Varian 4/100, USA), 6 MV, 15 MV (Varian CL2100C/D, USA) photon beams and five field sizes (5$\times$5, 10$\times$10, 20$\times$20, 30$\times$30, 40$\times$40 $\textrm{cm}^2$) on each occasion. Outputs were measured from surface of polysterene phantom to d$_{max}$ with four different thicknesses of cushion, which is 12, 32, 48 mm and only vinyl without styroforms. As results, the transmission factor for thicknesses of vacuum cushion was ranged from 0.9953 to 1.0043. The more the thickness of vacuum cushion is thick, the more surface dose delivered to patient is increased. The surface dose vary with the thickness of vacuum cushion for energy and field size. The skin reactions may result. But the variation is not serious in the clinic.