• Journal of Yeungnam Medical Science
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• v.18 no.2
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• pp.239-245
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• 2001

Background: Acute idiopathic thrombocytopenic purpura(ITF) is one of the common hematologic disorders in children. Bone marrow aspiration (BMA) is often performed in children with acute ITP to rule out leukemia, aplastic anemia or other hematologic diseases. However, whether BMA is needed in children with typical clinical and hematological features of acute ITP have been questioned. This study was performed to examine the proper indication of BMA in acute childhood ITF. Materials and Methods: The medical records and BMA reports of children with the provisional diagnosis of acute ITP were reviewed from January 1984 to December 2000. Patients were divided into two groups, one with typical and another with atypical clinical and hematological features of acute ITP. Typical acute ITP group was characterized by the history of previous viral infection, well being appearance, no hepatosplenomegaly, no lymphadenopathy, normal Hb, WEC, neutrophil count and peripheral blood smear except thrombocytopenia. A platelet count of $50{\times}l0^9/L$ or lower was the cutoff level. Results: Total 120 children with the provisional diagnosis of acute ITP were included. One hundred eighteen of them were confirmed to have acute ITP by BMAs. Of these, 66 had typical and 54 had atypical features. All of typical features and 52 of 54 with atypical features of acute ITP were confirmed to have acute ITP by BMAs. Two patients with atypical features of acute ITP were diagnosed as aplastic anemia and myelodyspalstic syndrome, respectively, by BMAs. Conclusion: This study concludes that BMA is not needed for the children with typical features of acute ITP but it is needed for the children with atypical features of acute ITP to rule out other hematologic disorders.

• Tuberculosis and Respiratory Diseases
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• v.45 no.2
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• pp.280-289
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• 1998

Background: It is sometimes difficult to differentiate tuberculous pleural effusion from malignant pleural effusion by clinical symptoms, signs, by routine tests of pleural fluid, and by pathologic studies. And recently, it was discovered that cytokines such as IL-2, IFN-$\gamma$, TNF-$\alpha$ are elevated in tuberculous pleural fluid, and there have been several attempts to diagnose tuberculous pleural effusion by using these immunological mediators. There are several studies regarding the diagnostic value of IFN-$\gamma$, and there are two studies in Korea. But the diagnostic values of IFN-$\gamma$ in these studies were slightly lower than those in other countries. To compare the diagnostic value of IFN-$\gamma$ with those of CEA and ADA, and to determine the sensitivity and specificity of IFN-$\gamma$ in Korean, we mesured IFN-$\gamma$, CEA level and ADA activity in pleural effusions. Methods: ADA activity, IFN-$\gamma$ level and CEA level as well as cell count, differential count, and biochemical assays such as protein content and lactate dehydrogenase were measured in 40 cases of tuberculous pleuritis and 42 cases of malignant pleural effusion. Results: Tuberculous pleural fluid showed higher levels of IFN-$\gamma$ and ADA ($832.6{\pm}357.2$ pg/ml and $82.5{\pm}25.9$ U/L, respectively) than those of malignant pleural effusion ($2.6{\pm}8.0$ pg/ml and $19.2{\pm}10.9$ U/L, respectively) (p<0.01). Malignant pleural effusions showed higher median value (102.2 ng/ml) than tubercalous pleural effusions (1.8 ng/ml) (p<0.01). The sensitivities of IFN-$\gamma$, ADA, CEA were 0.97, 0.87, 0.67 and the specificities of IFN-$\gamma$, ADA, CEA were 1.0, 0.97, 1.0, respectively. There was no significant correlation between ADA activity and IFN-$\gamma$ level. Conclusion: This study showed that IFN-$\gamma$ test would be a very useful clinical test for differential diagnosis of tuberculous pleuritis and malignant pleural effusion because it is very sensitive and specific, although it is an expensive test.

• Tuberculosis and Respiratory Diseases
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• v.61 no.5
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• pp.456-462
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• 2006

Background: Differential diagnosis is very important in patients with pleural effusions. A few studies on the etiologies of massive pleural effusions have been reported, but these were conducted in different decades and locations. In the present study, the etiologic spectrum of massive pleural effusions in Korea, were evaluated through an investigation at one university hospital. Methods: Retrospective chart reviews were performed in patients having undergone thoracentesis between July 2002 and July 2005. Pleural effusions were deemed to be massive if they occurred in two thirds or more of one hemithorax. The etiologies of massive pleural effusions, pleural fluid findings, serum laboratory findings, and sputum and pleural fluid cytologies were compared. Results: Of 298 pleural effusions cases, 41 (13.8%) had massive pleural effusions. The most frequent causes of massive pleural effusions were malignancy (19; 46.3%) followed by tuberculosis (15; 36.6%), parapneumonic effusion (4; 9.8%) and transudate (3; 7.3%). Compared with massive benign effusions, patients with massive malignant pleural effusions were more likely to have lower adenosine deaminase (ADA) activity, a higher amylase level and higher RBC count in their pleural fluids. Also, compared with non-tuberculosis effusions, patients with massive tuberculous pleural effusions were more likely to have lower RBC and neutrophil counts, but a higher lymphocyte count, adenosine deaminase (ADA) activity and protein level. Conclusion: The most common etiologies of massive pleural effusions in Korea are malignancy and tuberculosis. A high ADA content favors a tuberculous condition, while bloody effusions with a relatively lower ADA content. favors malignancy. The proportion of tuberculosis in massive pleural effusions was higher than in previous reports.

• Journal of Chest Surgery
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• v.34 no.6
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• pp.454-464
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• 2001

Background: It has been recognized that systemic inflammatory reaction and oxygen free radical formed by activated leukocyte in the procedure of cardiopulmonary bypass(CPB) frequently produce postoperative cardiac and pulmonary dysfunction. The purpose of this study was to evaluate the efficacy of leukocyte-depleting filters in the cardiopulmonary bypass circuit for patients undergoing open heart surgery(OHS). Material and method: The study involved 15 patients who underwent OHS with a Leukoguard-6 leukocyte filter placed in the arterial limbs of the bypass circuit(filter group, n=15) and 15 patients who did not have the filter(control group, n=15). We analyzed the differences between the groups in intraoperative changes of peripheral blood leukocyte and platelet counts, pre- and postbypass changes of malondialdehyde(MDA), troponin-T(TnT), 5'-nucleotidase(5'-NT) in coronary sinus blood, spontaneous recovery rate of heart beat after CPB, pre-and postoperative cardiac index(Cl) and pulmonary vascular resistance(PVR), and the amounts of postoperative bleeding and sternal wound complication. Result: During CPB, total leukocyte count of the filter group(9,567$\pm$ 842/㎣) was significantly less than that of the control group(13,573+1,167/㎣) (p<0.01), but there was no significant difference in platelet count between the groups. Postoperative levels of MDA(3.78+0.32 $\mu$mol/L vs 5.86+0.65 $\mu$mo1/L, p<0.01), TnT(0.40$\pm$0.04 ng/mL vs 0.59$\pm$0.08 ng/mL, p<0.05) and 5'-NT(3.88$\pm$0.61 U/L vs 5.80$\pm$0.90 U/L, p<0.05) were all significantly lower in the filter group than the control group. Postoperative Cl was higher in the filter group than the control group(3.26$\pm$0.18 L/$m^2$min vs 2.75$\pm$0.17 L/$m^2$/min, p=0.05). PVR of the filter group was lower than that of the control group(65.87$\pm$7.59 dyne/sec/cm$^{5}$ vs 110.80+12.22 dyne/sec/cm$^{5}$ , p<0.01). Spontaneous recovery rate of heart beat in the filter group was higher than that in the control group(12 patients vs 8 patients, p<0.05). Postoperative wound infection occurred in one case in the filter group and 4 case in the control group(p<0.05). Postoperative 24 hour blood loss of the filter group was more than that of the control group (614$\pm$107 mL vs 380+71 mL, p=0.05).

• The Korean Journal of Nuclear Medicine
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• v.33 no.4
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• pp.422-429
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• 1999

Purpose: The measurement of radiation absorbed dose is useful to predict the response after I-131 labeled metaiodobenzylguanidine (MIBG) therapy and determine therapy dose in patients with unresectable or malignant pheochromocytoma. We estimated the absorbed dose in tumor tissue after high dose I-131 MIBG in a patient with pheochromocytoma using a gamma camera and Medical Internal Radiation Dose (MIRD) formula. Materials and Methods: A 64-year old female patient with pheochromocytoma who had multiple metastases of mediastinum, right kidney and periaortic lymph nodes, received 74 GBq (200 mCi) of I-131 MIBG. We obtained anterior and posterior images at 0.5, 16, 24, 64 and 145 hours after treatment. Two standard sources of 37 and 74 MBq of I-131 were imaged simultaneously. Cummulated I-131 MIBG uptake in tumor tissue was calculated after the correction of background activity, attenuation, system sensitivity and count loss at a high count rate. Results: The calculated absorbed radiation dose was 32-63 Gy/ 74 GBq, which was lower than the known dose for tumor remission (150-200 Gy). follow-up studies at 1 month showed minimally reduced tumor size on computed tomography, and mildly reduced I-131 MIBG uptake. Conclusion: We estimated radiation absorbed dose after therapeutic I-131 MIBG using a gamma camera and MIRD formula, which can be peformed in a clinical nuclear medicine laboratory. Our results suggest that the measurement of radiation absorbed dose in I-131 MIBG therapy is feasible as a routine clinical practice that can guide further treatment plan. The accuracy of dose measurement and correlation with clinical outcome should be evaluated further.

• Journal of Trauma and Injury
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• v.18 no.2
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• pp.161-171
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• 2005

Background: The management of hepatic injuries has changed dramatically during the past two decade after the technologic breakthroughs in radiologic imaging techniques. Recently, the non-operative management of blunt hepatic trauma has become the standard of care in hemodynamically stable patients. We reviewed our experience of the non-operative management of blunt hepatic trauma. And the purpose of this study was to examine the prognostic factors and indicators affecting the decision for treatment modality of emergent hepatic trauma. Methods: The medical records of 84 patients who were treated for blunt hepatic injury at Masan Samsung Hospital from January 2002 to December 2003. The patients were divided two groups, non-operative(Non-OP) and operative(OP), according to the treatment modality. The two groups were compares for age, sex, mechanism of injury, grade of liver injury scale, combined injury, systolic blood pressure, pulse rate, hemoglobin, hematocrit, WBC count, S-GOT, S-GPT, ALP, transfusion amount during initial 24 hours, amount of infused crystalloid fluid, length of ICU stay, length of ward care, morbidity and mortality. The grade of the liver injury were determined by using the organ injury scale(OSI). Results: Among the 84 patients, 46 cases(54.8%) were managed non-surgically, and 3 cases of Non-OP group were treated by transarterial embolization. Between the two groups, there were significant difference in age, injury grade, combined injury, hemoglobin, hematocrit, initial systolic blood pressure, amount of infused crystalloid fluid, amount of transfusion during the first 24 hours, and length of ICU care, morbidity and mortality.(p<0.05) The overall mortality rate was 8.3%, but 2.2% mortality in the non-operative group. Conclusion: Non-operative management may be considered as a first choice in hemodynamic stable patients with blunt liver trauma. The reliable indicators affecting the treatment modality of blunt hepatic trauma were systolic BP, Hb, Hct, amount of infused crystalloid fluid, amount of transfusion during the first 24 hours, liver injury grade and combined injury. Strict selection of treatment madality and aggresive monitoring with intensive care unit were more important.

• Journal of Biomedical Engineering Research
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• v.37 no.1
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• pp.7-14
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• 2016

Radiopharmaceutical agents for positron emission tomography (PET), such as $^{18}F$-FDG and $^{68}Ga$, have been used not only for whole-body PET imaging but also for intraoperative radionuclide-guided surgery due to their quantitative and sensitive imaging characteristics. Current intraoperative probes detect gamma or beta particles, but not both of them. Gamma probes have low sensitivities since a collimator has to be used to reduce backgrounds. Positron probes have a high tumor-to-background ratio, but they have a 1-2 mm depth limitation from the body surface. Most of current intraoperative probes produce only audible sounds proportional to count rates without providing tumor images. This research aims to detect both positrons and annihilation photons from $^{18}F$ using plastic scintillators and a GAGG scintillation crystal attached to silicon photomultiplier (SiPM). The depth-of-interaction (DOI) along the plastic scintillator can be used to obtain the 2-D images of tumors near the body surface. The front and rear part of the intraoperative probe consists of $4{\times}1$ plastic scintillators ($2.9{\times}2.0{\times}12.0mm^3$) for positron detection and a Ce:GAGG scintillation crystal ($12.0{\times}12.0{\times}9.0mm^3$) for annihilation photon detection, respectively. The DOI resolution of $4.4{\pm}1.6mm$ along the plastic scintillator was obtained by using the 3M enhanced specular reflector (ESR) with rectangular holes between the plastic scintillators, which showed the feasibility of a 2-D image pixel size of $2.9{\times}4.4mm^2$ (X-direction ${\times}$ Y-direction).

• The Korean Journal of Emergency Medical Services
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• v.3 no.1
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• pp.7-19
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• 1999

Background : We are in the edge of some human made disasters such as hazardous materials and air pollution, for example, the world news reported that the city of Bhopal, India had serious victims related with a leaking out of the chemical materials, Methyl Isocyanate and many people in India were killed by. These situations many people who live in this world are world are worrying about are not others, but just ours and people consider about that kind of the disasters are the possible situation to happen to all the people. Therefore, we performed this basic study to recognize the risk of Methyl Isocyanate leak accident and to prepare local disaster plan with EMS system. Method : Trace 8.0, a simulation software made by the U.S. company Safer System was used as a tool to estimate the diffusion distance, area and its victims at the concentrations of 0.02ppm, 0.2ppm 5ppm respectively for an assumed B-city of 2 hundred thousands population count in which was presumed 500kg Methyl Isocyanate gas to leak out. Results : 1. During 1 hour, maximum diffusion distances of 0.02ppm 0.2ppm and 5ppm were 5.41km, 1.61km and 0.29km respectively on the plume impact. 2. Maximum population counts influenced by Methyl Isocyanate gas at the concentrations of 0.02ppm 0.2ppm and 5ppm were 40838, 4346 and 222 on the plume impact, while those were 138238, 17261 and 1588 on the vulnerability impact, respectively. 3. Therefore, 17261 persons must put on respiratory device and 138283 persons must be evacuated to safety place within 1 hour. Conclusions : Only small amount leak of Methyl Isocyanate may cause tremendous chemical disaster in urban area, so its disaster plan must be prepared with an accident simulation program and Material Safety Data Sheets(MSDS). Especially, nearby emergency center of an industrial complex must have a strong position about preparation of chemical disaster plan and perform a disaster dill of hazardous material accident annually.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.6
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• pp.3903-3907
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• 2013

Background: Patients with colorectal cancer are usually treated with chemotherapy, which reduces the number of blood cells, especially white blood cells, and consequently increases the risk of infections. Some research studies have reported that aromatherapy massage affects the immune system and improves immune function by, for example, increasing the numbers of natural killer cells and peripheral blood lymphocytes. However, there has been no report of any study which provided good evidence as to whether aromatherapy with Thai massage could improve the immune system in patients with colorectal cancer. The objectives of this study were to determine whether the use of aromatherapy with light Thai massage in patients with colorectal cancer, who have received chemotherapy, can result in improvement of the cellular immunity and reduce the severity of the common symptoms of side effects. Materials and Methods: Sixty-six patients with colorectal cancer in Phichit Hospital, Thailand, were enrolled in a single-blind, randomised-controlled trial. The intervention consisted of three massage sessions with ginger and coconut oil over a 1-week period. The control group received standard supportive care only. Assessments were conducted at pre-assessment and at the end of one week of massage or standard care. Changes from pre-assessment to the end of treatment were measured in terms of white blood cells, neutrophils, lymphocytes, CD4 and CD8 cells and the CD4/CD8 ratio and also the severity of self-rated symptom scores. Results: The main finding was that after adjusting for pre-assessment values the mean lymphocyte count at the post-assessment was significantly higher (P=0.04) in the treatment group than in the controls. The size of this difference suggested that aromatherapy with Thai massage could boost lymphocyte numbers by 11%. The secondary outcomes were that at the post assessment the symptom severity scores for fatigue, presenting symptom, pain and stress were significantly lower in the massage group than in the standard care controls. Conclusions: Aromatherapy with light Thai massage can be beneficial for the immune systems of cancer patients who are undergoing chemotherapy by increasing the number of lymphocytes and can help to reduce the severity of common symptoms.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.10
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• pp.4647-4653
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• 2016

Background: The discovery of somatic acquired mutations of JAK2 (V617F) in Philadelphia-negative myeloproliferative neoplasms (Ph-negative MPNs) including polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF) has not only improved rational disease classification and prognostication but also brings new understanding insight into the pathogenesis of diseases. Dosage effects of the JAK2 (V617F) allelic burden in Ph-negative MPNs may partially influence clinical presentation, disease progression, and treatment outcome. Material and Methods: Pyrosequencing was performed to detect JAK2 (V617F) and MPL (W515K/L) and capillary electrophoresis to identify CALR exon 9 mutations in 100 samples of Ph-negative MPNs (38.0 PV, 55 ET, 4 PMF, and 3 MPN-U). Results: The results showed somatic mutations of JAK2 (V617F) in 94.7% of PV, 74.5% of ET, 25.0% of PMF, and all MPN-U. A high proportion of JAK2 (V617F) mutant allele burden (mutational load > 50.0%) was predominantly observed in PV when compared with ET. Although a high level of JAK2 (V617F) allele burden was strongly associated with high WBC counts in both PV and ET, several hematological parameters (hemoglobin, hematocrit, and platelet count) were independent of JAK2 (V617F) mutational load. MPL (W515K/L) mutations could not be detected whereas CALR exon 9 mutations were identified in 35.7% of patients with JAK2 negative ET and 33.3% with JAK2 negative PMF. Conclusions: The JAK2 (V617F) allele burden may be involved in progression of MPNs. Furthermore, a high level of JAK2 (V617F) mutant allele appears strongly associated with leukocytosis in both PV and ET.