• Journal of Chest Surgery
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• v.40 no.7 s.276
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• pp.480-484
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• 2007

Background: Major vascular injuries can jeopardize a patient's life or imperil limb survival. We performed this study to establish an optimal management plan for vascular injuries. Material and Method: We retrospectively reviewed 26 cases of vascular injury that were treated at Pusan National University Hospital from May, 1999 to September, 2004. The age and sex distribution, the locations and causes of vascular injury, the diagnostic tools, the degree of injuries, clinical manifestations, the treatment modality and complications were reviewed. Result: The mean age was 39.5 years (range: $12{\sim}86$) and the male to female ratio was 22 : 4. The injuries were in 6 descending thoracic aortas, 4 femoral arteries, 4 popliteal veins and so on. The causes of injury were iatrogenic in 8 cases, traffic accident in 7, stab injury in 6 and industrial accident in 5. The most commonly used diagnostic tools were CT and angiography. The degrees of arterial injury were pseudoaneurysm in 10 cases, partial severance in 5, complete severance in 3 and thrombosis in 3. The degrees of venous injury were partial severance in 6 cases, complete severance in 2 and arteriovenous fistula in 2. The clinical manifestations were absence of pulse in 8 cases, coldness in 7, chest pain in 6, swelling in 5, bleeding in 5 and so on. The most frequently used type of revascularization was graft interposition in 11 cases. Two arteriovenous fistulae were repaired by endovascular procedure. There was one case of mortality due to multi-organ failure after hemorrhagic shock, There were three major amputations, and two of them were due to delayed diagnosis and treatment. Conclusion: A system for the early diagnosis and treatment is essential for improving limb salvage and patient mortality. As a consequence of the widespread application of endovascular procedures, the incidence of iatrogenic injuries has recently increased. Educating physicians is important for the prevention of iatrogenic injury. Easy communication and cooperation for earlier involvement of a vascular surgeon is also an important factor.

• Radiation Oncology Journal
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• v.21 no.1
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• pp.75-81
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• 2003

Purpose : This study quantitatively evaluated the apoptosis In human peripheral blood lymphocytes using flow cytometry, and investigated the possibility of using this method, with a small amount of blood, and the time and dose dependence of radiation-induced apoptosls. Materials and Methods : Peripheral blood lymphocyes were isolated from the heparinized venous blood of 11 healthy volunteers, 8 men and 3 women, with each 10 ml of blood being divided Into IS samples. The blood lymphocytes were Irradiated using a linear accelerator at a dose rate of 2.4 Gy/min, to deliver doses of 0.5, 1, 2 and S Gy. The control samples, and Irradiated cells, were maintained in culture medium for 24, 48 and 72 hours fellowing the Irradiation. The number of apoptotic cells after the in vitro X-irradiation was measured by flow cytometry after Incubation periods of 24, 48 and 72 hours. We also observed the apoptotic cells using a DNA fragmentation assay and electron microscopy. Results : The rate oi spontaneous apoptosis increased in relation to the time interval following irradiation (1.761 ${\pm}$0.161, 3.563${\pm}$0.554, 11.098${\pm}$2.849, at 24, 48, and 72 hours). The apoptotli cells also increased In the samples irradiated with 0.5, 1, 2 and 5 Gy, In a radiation dose and time interval after Irradiation manner, with the apoptosls being too great at 72 hours after Irradiation. The dose-response curves were characterized by an Initial steep Increase In the number of apoptotic cells for Irradiation doses below 2 Gy, with a flattening of the curves as the dose approached towards 5 Gy. Conclusion :The flow cytometric assay technique yielded adequate data, and required less than 1 mL of blood. The time and dose dependence of the radiation-induced apoptosis, was also shown. It is suggested that the adequate time Interval required for the evaluation of apoptosis would be 24 to 48 hours after blood sampling.

• Tuberculosis and Respiratory Diseases
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• v.39 no.1
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• pp.42-54
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• 1992

Background:It has been suggested that the cyclooxygenase metabolites play an important role in changes of early hemodynamic parameters in the endotoxin-induced acute lung injury. But there have been many debates about their role in the late increase of alveolar-capillary permeability, and it is not known whether they act directly or indirectly through oxygen free radicals which have been known to be produced during the metabolic process of cyclooxygenase pathway. So we performed this study to identify the pathogenetic role of cyclooxygenase metabolites in the endotoxin-induced acute lung injury in domestic pigs. Method: We infused endotoxin into 8 domestic pigs; endotoxin only (n=3), and pretreatment with indomethacin (n=5). We observed the sequential changes in hemodynamic parameters, the concentration of plasma oxidized glutathione (GSSG) in pulmonary arterial and venous blood, and albumin content in bronchoalveolar lavage fluid (BALF). Results: 1) While cardiac output decreased, mean pulmonary arterial pressure, pulmonary vascular resistance, and alveolar-arterial oxygen difference increased over phase 1 (0-2hr) and phase 2 (2-4.5hr) by endotoxin, indomethacin attenuated the decrease in cardiac output during phase 1 and increase in mean pulmonary arterial pressure, pulmonary vascular resistance, and alveolar-arterial oxygen difference during both phases. 2) The increase in plasma GSSG content during phase 2 was not attenuated by indomethacin. 3) The content of BALF albumin was significantly lower in indomethacin groups than that of endotoxin group. Conclusion: These results suggest that it is likely that cyclooxygenase metabolites have an effect on endotoxin-induced acute lung injury during both phases probably through direct action.

• Journal of Gastric Cancer
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• v.8 no.1
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• pp.9-19
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• 2008

Purpose: Gastric cancer is the most common malignant tumor in Korea. We reviewed the cases at our institution to identify the survival rates and clarify the prognostic factors of patients with gastric cancer. Materials and Methods: We conducted a retrospective study of 6,918 patients who had received a diagnosis of gastric cancer, and they underwent surgery at Korea Cancer Center Hospital during a 15-year period from 1991 to 2005. Results: The overall 5-year survival rate was 66.8%. The univariate analysis revealed that age, location of tumor, gross type of tumor, the histology according to the WHO classification, the Lauren classification, depth of invasion (T stage), lymph node metastasis (N stage), distant metastasis (M stage), the type of surgery, the UICC TNM stage, postoperative complications, adjuvant chemotherapy, lymphatic invasion, venous invasion and perineural invasion were the significantly different factors of the survival rates. The multivariate analysis revealed that age, Borrmann type 4, the histology according to the WHO classification, depth of invasion (T stage), lymph node metastasis (N stage), distant metastasis (M stage), the type of surgery, UICC TNM stage, postoperative complications, adjuvant chemotherapy and lymphatic invasion were the independent prognostic factors. Conclusion: We have shown a statistically significant association between the survival rates after operation for gastric cancer and the clinicopathologic factors. Early diagnosis of gastric cancer, appropriate surgeryand adjuvant therapy might improve the quality of life and the survival rates of gastric cancer patients.

• Journal of Preventive Medicine and Public Health
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• v.18 no.1
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• pp.129-136
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• 1985

This paper is carried out to determine the venous blood gas components and heavy metals, such as lead, cadmium and copper, in blood between urban and rural teenager. The subjects were 34 in urban, Taegu city and 37 in rural, Euisung-Gun. But smokers were excluded. The specimens were sampled in May, 1985. The heavy metals were analyzed by atomic absorption spectrophotometry (IL. 551) and carboxy-Hb, Met-Hb, Hb, $O_2\;and\;CO_2$, blood gas analyzer (IL. 1301) and CO-oximeter (IL. 282). In urban group, $PO_2\;and\;O_2-Hb$ were significantly lower than in rural (p<0.01, p<0.03, respectively), and ${HCO_3}^{-}\;and\;TCO_2$ were significantly higher than in rural (p<0.01, p<0.01, respectively). CO-Hb concentration was rather higher in the rural group than the urban (p<0.03), other Met-Hb was higher in urban group than in the rural (p<0.01). Lead and cadmium were also significantly higher in the urban group (p<0.03, p<0.02, respectively).

• Journal of Preventive Medicine and Public Health
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• v.31 no.2 s.61
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• pp.275-284
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• 1998

Activities of enzymes involved in the metabolism of various carcinogenic xenobiotics is one of the most important host factors for cancer occurrence. N-acetyltransferase (NAT) and glutathione S-transferases (GST) are enzymes which .educe the toxicity of activated carcinogenic metabolites. Slow N-acetylation and lack of GST mu (GSTMI) were reported as risk factors of bladder cancer. GST theta (GSTT1), which is another type of GST, was reported to be deleted at higher proportion among Koreans. Since cause of bladder cancer is not fully explained by single risk factor, many kinds of enzymes would be involved in the metabolism of carcinogens excreted in urine. This study was performed to investigate whether the polymorphisms of NAT2, GSTM1 and GSTT1 are risk factors of bladder cancer and to evaluate the effects of their interaction on bladder cancer development. Sixty-seven bladder cancer and 67 age- and sex-matched non-cancer patients hospitalized in Chungbuk National University Hospital from March to December 1996, are the subjects of this case-control study. Questionnaire interview was done and the genotypes of NAT2, GSTM1 and GSTT1 were identified using PCR methods with DNA extracted from venous blood. The effects of the polymorphism of NAT2 and GSTM1 and their interaction on bladder cancer were statistically tested after controlling the other risk factors. The frequencies of slow, intermediate, and rapid acetylators were 3.0%, 38.8%, and 58.2% to. the cases, and 7.6%, 40.9%, and 51.5% for the controls, respectively. The risk of bladder cancer was not associated with the increase of NAT2 activity($\chi^2_{trend}=1.18$, P-value>0.05). GSTM1 was deleted in 68.7% of the cases and 49.3% of the controls ($\chi^2=5.21$, P-value<0.05), and the odds ratio (95% CI) was 2.23 (1.12 - 4.56). GSTT1 deletion, the .ate of which were 26.9% for the bladder cancer patients and 43.3% for the controls, was a significant protective factor against bladder cancer. Smoking history turned out to be insignificant as a risk factor of bladder cancer (OR=1.85, 95% CI: 0.85 - 4.03), and occupation could not be tested because of the extremely small number of occupational history related to the increase of bladder cancer. In multiple logistic analysis controlling the effects of other risk factors, GSTM1 deletion was the only significant risk factor for bladder cancer (OR: 2.56, 95% CI: 1.22-5.36, P-value<0.05), but slow acetylation and GSTT1 deletion were not. These results suggest that GSTM1 deletion may be a significant risk factor of bladder cancer. Since there have been much debates on causal relationship between slow acetylation and GSTT1 deletion, and bladder cancer, further studies are needed.

• Investigative Magnetic Resonance Imaging
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• v.5 no.2
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• pp.138-148
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• 2001

Purpose : Within a clinically acceptable time frame, we obtained the high resolution MR images of the human brain, knee, foot and wrist from 3T whole-body MRI system which was equipped with the world first 37 active shield magnet. Materials and Methods : Spin echo (SE) and Fast Spin Echo (FSE) images were obtained from the human brain, knee, foot and wrist of normal subjects using a homemade birdcage and transverse electromagnetic (TEM) resonators operating in quadrature and tuned to 128 MHz. For acquisition of MR images of knee, foot and wrist, we employed a homemade saddle shaped RF coil. Topical common acquisition parameters were as follows: matrix=$512{\times}512$, field of view (FOV) =20 cm, slice thickness = 3 mm, number of excitations (NEX)=1. For T1-weighted MR images, we used TR = 500 ms, TE = 10 or 17.4 ms. For T2-weighted MR images, we used TR=4000 ms, TE = 108 ms. Results : Signal to noise ratio (SNR) of 3T system was measured 2.7 times greater than that of prevalent 1.5T system. MR images obtained from 3T system revealed numerous small venous structures throughout the image plane and provided reasonable delineation between gray and white matter. Conclusion The present results demonstrate that the MR images from 3T system could provide better diagnostic quali\ulcorner of resolution and sensitivity than those of 1.5T system. The elevated SNR observed in the 3T high field magnetic resonance imaging can be utilized to acquire images with a level of resolution approaching the microscopic structural level under in vivo conditions. These images represent a significant advance in our ability to examine small anatomical features with noninvasive imaging methods.

• Journal of radiological science and technology
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• v.31 no.3
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• pp.267-276
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• 2008

The 25 healthy male volunteers aged from 20 to 50years old have been employed in this study. 2D-PC MRA was performed to measure the velocity of the blood flow in the internal carotid artery and internal jugular veins using 3.0T MRI Whole body (signa VH/i GE). ECTRICKS-CEMRA was performed to evaluate the pattern of blood circulation from internal carotid artery to internal jugular vein. Using 2D-PC MRA, the cross-section of the 4th and 5th cervical discs was scanned with 24cm FOV. Then the speed of blood flow was measured for internal carotid artery and internal jugular vein when the subject wears a necktie tightly and no tie. The average of maximum velocity of internal carotid arteries without a necktie was 72.13cm/sec in the right side and 74.96cm/sec in the left side(average 73.54cm/sec in both sides) while the average of maximum velocity of internal jugular veins without a necktie was -34.45cm/sec in the right side and -24.99cm/sec in the left side (-29.72cm/sec in both sides). However, when wearing a necktie tightly, the average of maximum velocity of internal carotid arteries was 61.35cm/sec in the right side and 65.19cm/sec in the left side(average 63.27cm/sec in both sides) while the average of maximum velocity of internal jugular veins was -22.14cm/sec in the right side and -17.93cm/sec in the left side(-20.03cm/sec in both sides). With the necktie tightly knotted, the average blood flow speed of both internal carotid arteries slightly decreased to 86% (63.27/73.54cm/sec) compared to no tie case in which both internal jugularveins significantly went down to 67% (-20.03/-29.72 cm/sec). Thus it is suggested that wearing a necktie affects the circulation of internal jugular veins(33% decrease in blood flow speed) more significantly than that of internal carotid artery(14% decrease in blood flow speed). Without a necktie, ECTRICKS-CEMRA showed natural blood circulation patterns of internal carotid arteries and internal jugular veins without any disturbances or compressions. However, when wearing a necktie tightly, ECTRICKS-CEMRA showed severe compression onto both internal jugular veins in all 25 volunteers. In conclusion, the result of the study showed that the tightly worn necktie instantly presses more internal jugular veins than internal carotid arteries, thereby significantly reducing the blood flow speed and leading to the temporary occlusion. Thus, the defecation or washing the face under the tightly tied necktie situations can cause the unexpected and temporary compression or occlusion of the internal jugular veins, subsequently leading to the occurrences of the stroke due to the secondary intracranial venous hypertension.

• Pediatric Infection and Vaccine
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• v.17 no.1
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• pp.1-8
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• 2010

Purpose : Recently, vancomycin-resistant enterococci (VRE) have become one of the major nosocomial pathogens in Korea. However, there have been few studies on the epidemiology of VRE colonization among neonates. In this study, we investigated the prevalence of VRE colonization, risk factors for VRE, and how to control the spread of VRE infection in the Neonatal Intensive Care Unit (NICU) of Pusan National University Hospital (PNUH). Methods : We retrospectively reviewed medical records of 192 neonates who were admitted to the NICU of PNUH from March 2006 to March 2007. Surveillance cultures from rectal swabs for detecting VRE were obtained weekly during the study period. We analyzed the prevalence of VRE and various risk factors. Results : The rate of VRE colonization among NICU patients was 25% (48/192). Thirty five of these VRE colonized patients were transferred to the NICU from other local hospitals. Compared with the non-VRE group, the risk factors associated with VRE colonization were lower birth weight, congenital heart disease, applied mechanical ventilation, use of a central venous catheter, chest tubing, a history of surgery, and use of antibiotics. Conclusion : VRE colonization among patients admitted to the NICU is rapidly increasing. Monitoring and managing premature neonates from the beginning of the birth process, avoiding many invasive procedures, avoiding antibiotics such as vancomycin and third generation cephalosporin are important for preventing the emergence and spread of VRE colonization in the NICU.

• Pediatric Infection and Vaccine
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• v.17 no.1
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• pp.36-48
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• 2010

Purpose : In children on anticancer chemotherapy, bloodstream infections (BSIs) are a major cause of morbidity and mortality. We investigated febrile episodes and bloodstream infections in pediatric cancer patients to guide proper selection of empiric antibiotics for febrile pediatric hemato-oncologic patients. Methods : All febrile episodes treated in the division of hematology-oncology, the department of pediatrics, Hanyang University Hospital, between July 2005 and June 2008 were reviewed. Episodes with and without bloodstream infections were compared. Results : Forty cases (18.9%, 25 patients) of BSI occurred in 212 febrile episodes (63 patients). Thirty-seven cases (23.6%, 22 patients) of BSI occurred in 157 febrile episodes with neutropenia (54 patients). Microorganisms identified in BSI corresponded to 23 gram-positive bacteria (51.2%), 20 gram-negative bacteria (44.5%), and 2 fungi (4.4%). Rates of BSI between those who had received umbilical cord blood transplantation and those who had received transplantation from other source were significantly different (55.0% vs. 7.7%, P =0.001). No differences in mortality rate were observed among organisms in BSI patients. For febrile episodes the rate of BSI was higher among those with Chemoport than those with Hickman catheter (P =0.029) and gram-positive pathogens were more likely to be associated with Chemoport (P =0.001). Conclusion : The study showed the rate of BSI, distribution of pathogens with regard to neutropenia, transplantation, central venous catheters, and antimicrobial susceptibility of pathogens in order to help guide in the choice of optimal empiric antibiotics in pediatric febrile neutropenic hemato-oncologic patients.