• Journal of Korean Orthopaedic Sports Medicine
• /
• v.6 no.2
• /
• pp.110-114
• /
• 2007

Purpose: This study evaluate clinical findings & management of rhabdomyolysis after strenuous activities in military police recruit. Materials and Methods: This study was carried out from June $1^{st}$, 2004 and May $23^{nd}$, 2005. The study subjects were 13 military police recruit patients who were admitted to our hospital with intractable muscle pain and swelling, and had suspicions of Rhabdomyolysis. The patients were given various blood tests (CPK, CK-MB, AST, BUN/Cr, and Electrolyte) and clinically observed. The patients were all males, and their average age was 20 $(19\sim21)$ years. Seven cases were due to push-up exercises, 5 was due to a soccer game, and 1 was due to riot control activities. The patients complained of swelling and tenderness in various parts of the extremities. Four complained of swelling and tenderness in forearm, 3 in upper arm, 1 in shoulder, and 5 in lower extremity. The diagnosis of rhabdomyolysis was made if the patient complained clinical symptom and had a blood CPK level of above 1,000 IU/L at the time of admission. Patients who took medication or had medical problem were excluded from this study. Bone scans were taken of all patients 4 hours after giving 99mTc-MDP 20mCi intravenously. Treatment was bed rest and fluid therapy. Patients who complained of excessive pain were given splint immobilization. Results: The average hospitalization day for the 13 patients was 20 days ($14\sim42$ days). Excluding one patient who exhibited ARF at time of admission, all patients showed a decrease of blood CPK below 1000 IU/L at an average hospitalization time of 8 days ($2\sim11$ days). The patient with ARF recovered after hemodialysis and fluid therapy. Conclusion: Patients complaining of swelling and severe muscle pain after excessive exercise or training should be suspicious of exercise induced rhabdomyolysis, and should be given blood tests and fluid therapy immediately.

• The Korean Journal of Nuclear Medicine
• /
• v.29 no.1
• /
• pp.79-83
• /
• 1995

Purpose : We analysed $^{99m}Tc-MAG_3$ renal scans to evaluate renal function of transplanted kidney and to detect various renal transplant complications, measuring the ratio of renal radioactivity at three minutes to that at 20 minutes(elimination index). Material and Methods : The fifty seven renal transplantation recipients were studied. There were 50 normal functioning transplanted kidneys as group I and 7 abnormal function-ing transplanted kidney, including 5 cases of acute renal rejection, 2 cases of acute tubular necrosis as group IIl. The protocol consisted of: (1) $^{99m}Tc-MAG_3$ 740MBq injection intravenously : (2) sequential imaging for 2min(60two-second images) followed by 30min(30 sixty-second images) : (3) drawing of region of interest(ROI) on renal imaging; (4) time-activity corves were generated from renal ROI after background subtraction, and time of maximum activity($T_{max}$) and half time of maximal peak radioactivity($T_{1/2}$) were produced in the renogram curve. (5) EI through Bischof-Delaloye method as determined on the renogram curve. Results : Normal group( I ) shows mean EI of 2.21(95.0% Confidence limit of 2.01-2.87), $T_{max}$ of 154 sec, $T_{1/2}$ of 1,139 sec. Abnormal group(II) shows mean EI of 0.74, $T_{max}$ of 1,466 sec, $T_{1/2}$ of 19,224 sec. The EI, $T_{max}$, $T_{1/2}$, BUN and serum creatinine values are significantly different between normal group(I) and abnormal group(II) (p<0.0001). Conclusion : By measuring EI with $^{99m}Tc-MAG_3$, renal function of transplanted kidney could be easily evaluated and various complications could be detected early.

• The Journal of Korean Society for Radiation Therapy
• /
• v.27 no.2
• /
• pp.131-143
• /
• 2015

Purpose : By comparing a CT fusion plan based on MRI with a plan based on only MRI without CT, we intended to study usefulness of a plan based on only MRI. And furthermore, we intended to realize a realtime MR-IGRT by MRI image without CT scan during the course of simulation, treatment planning, and radiation treatment. Materials and Methods : BBB CT (Brilliance Big Bore CT, 16slice, Philips), Viewray MRIdian system (Viewray, USA) were used for CT & MR simulation and Treatment plan of 11 patients (1 Head and Neck, 5 Breast, 1 Lung, 3 Liver, 1 Prostate). When scanning for treatment, Free Breathing was enacted for Head&Neck, Breast, Prostate and Inhalation Breathing Holding for Lung and Liver. Considering the difference of size between CT and Viewray, the patient's position and devices were in the same condition. Using Viewray MRIdian system, two treatment plans were established. The one was CT fusion treatment plan based on MR image. Another was MR treatment plan including electron density that [ICRU 46] recommend for Lung, Air and Bone. For Head&Neck, Breast and Prostate, IMRT was established and for Lung and Liver, Gating treatment plan was established. PTV's Homogeneity Index(HI) and Conformity Index(CI) were use to estimate the treatment plan. And DVH and dose difference of each PTV and OAR were compared to estimate the treatment plan. Results : Between the two treatment plan, each difference of PTV's HI value is 0.089% (Head&Neck), 0.26% (Breast), 0.67% (Lung), 0.2% (Liver), 0.4% (Prostate) and in case of CI, 0.043% (Head&Neck), 0.84% (Breast), 0.68% (Lung), 0.46% (Liver), 0.3% (Prostate). As showed above, it is on Head&Neck that HI and CI's difference value is smallest. Each difference of average dose on PTV is 0.07 Gy (Head&Neck), 0.29 Gy (Breast), 0.18 Gy (Lung), 0.3 Gy (Liver), 0.18 Gy (Prostate). And by percentage, it is 0.06% (Head&Neck), 0.7% (Breast), 0.29% (Lung), 0.69% (Liver), 0.44% (Prostate). Likewise, All is under 1%. In Head&Neck, average dose difference of each OAR is 0.01~0.12 Gy, 0.04~0.06 Gy in Breast, 0.01~0.21 Gy in Lung, 0.06~0.27 Gy in Liver and 0.02~0.23 Gy in Prostate. Conclusion : PTV's HI, CI dose difference on the Treatment plan using MR image is under 1% and OAR's dose difference is maximum 0.89 Gy as heterogeneous tissue increases when comparing with that fused CT image. Besides, It characterizes excellent contrast in soft tissue. So, radiation therapy using only MR image without CT scan is useful in the part like Head&Neck, partial breast and prostate cancer which has a little difference of heterogeneity.

• Radiation Oncology Journal
• /
• v.26 no.2
• /
• pp.83-90
• /
• 2008

Purpose: For the first time, a nationwide survey of the Patterns of Care Study(PCS) for the various radiotherapy treatments of esophageal cancer was carried out in South Korea. In order to observe the different parameters, as well as offer a solid cooperative system, we compared the Korean results with those observed in the United States(US) and Japan. Materials and Methods: Two hundreds forty-six esophageal cancer patients from 21 institutions were enrolled in the South Korean study. The patients received radiation theraphy(RT) from 1998 to 1999. In order to compare these results with those from the United States, a published study by Suntharalingam, which included 414 patients[treated by Radiotherapy(RT)] from 59 institutions between 1996 and 1999 was chosen. In order to compare the South Korean with the Japanese data, we choose two different studies. The results published by Gomi were selected as the surgery group, in which 220 esophageal cancer patients were analyzed from 76 facilities. The patients underwent surgery and received RT with or without chemotherapy between 1998 and 2001. The non-surgery group originated from a study by Murakami, in which 385 patients were treated either by RT alone or RT with chemotherapy, but no surgery, between 1999 and 2001. Results: The median age of enrolled patients was highest in the Japanese non-surgery group(71 years old). The gender ratio was approximately 9:1(male:female) in both the Korean and Japanese studies, whereas females made up 23.1% of the study population in the US study. Adenocarcinoma outnumbered squamous cell carcinoma in the US study, whereas squamous cell carcinoma was more prevalent both the Korean and Japanese studies(Korea 96.3%, Japan 98%). An esophagogram, endoscopy, and chest CT scan were the main modalities of diagnostic evaluation used in all three countries. The US and Japan used the abdominal CT scan more frequently than the abdominal ultrasonography. Radiotherapy alone treatment was most rarely used in the US study(9.5%), compared to the Korean(23.2%) and Japanese(39%) studies. The combination of the three modalities(Surgery+RT+Chemotherapy) was performed least often in Korea(11.8%) compared to the Japanese(49.5%) and US(32.8%) studies. Chemotherapy(89%) and chemotherapy with concurrent chemoradiotherapy(97%) was most frequently used in the US study. Fluorouracil(5-FU) and Cisplatin were the most preferred drug treatments used in all three countries. The median radiation dose was 50.4 Gy in the US study, as compared to 55.8 Gy in the Korean study regardless of whether an operation was performed. However, in Japan, different median doses were delivered for the surgery(48 Gy) and non-surgery groups(60 Gy). Conclusion: Although some aspects of the evaluation of esophageal cancer and its various treatment modalities were heterogeneous among the three countries surveyed, we found no remarkable differences in the RT dose or technique, which includes the number of portals and energy beams.

• The Korean Journal of Nuclear Medicine Technology
• /
• v.14 no.2
• /
• pp.122-127
• /
• 2010

Purpose: The Xpress3.$cardiac^{TM}$ which is a kind of wide beam reconstruction (WBR) method developed by UltraSPECT (Haifa, Israel) enables the acquisition of at quarter time while maintaining image quality. The purpose of this study is to investigate the usefulness of WBR method for decreasing scan times and to compare to it with filtered back projection (FBP), which is the method routinely used. Materials and Methods: Phantom and clinical studies were performed. The anthropomorphic torso phantom was made on an equality with counts from patient's body. The Tl-201 concentrations in the compartments were 74 kBq (2 ${\mu}Ci$)/cc in myocardium, 11.1 kBq (0.3 ${\mu}Ci$)/cc in soft tissue, and 2.59 kBq (0.07 ${\mu}Ci$)/cc in lung. The non-gated Tl-201 myocardial perfusion SPECT data were acquired with the phantom. The former study was scanned for 50 seconds per frame with FBP method, and the latter study was acquired for 13 seconds per frame with WBR method. Using the Xeleris ver. 2.0551, full width at half maximum (FWHM) and average image contrast were compared. In clinical studies, we analyzed the 30 patients who were examined by Tl-201 gated myocardial perfusion SPECT in department of nuclear medicine at Asan Medical Center from January to April 2010. The patients were imaged at full time (50 second per frame) with FBP algorithm and again quarter-time (13 second per frame) with the WBR algorithm. Using the 4D MSPECT (4DM), Quantitative Perfusion SPECT (QPS), and Quantitative Gated SPECT (QGS) software, the summed stress score (SSS), summed rest score (SRS), summed difference score, end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (EF) were analyzed for their correlations and statistical comparison by paired t-test. Results: As a result of the phantom study, the WBR method improved FWHM more than about 30% compared with FBP method (WBR data 5.47 mm, FBP data 7.07 mm). And the WBR method's average image contrast was also higher than FBP method's. However, in result of quantitative indices, SSS, SDS, SRS, EDV, ESV, EF, there were statistically significant differences from WBR and FBP(p<0.01). In the correlation of SSS, SDS, SRS, there were significant differences for WBR and FBP (0.18, 0.34, 0.08). But EDV, ESV, EF showed good correlation with WBR and FBP (0.88, 0.89, 0.71). Conclusion: From phantom study results, we confirmed that the WBR method reduces an acquisition time while improving an image quality compared with FBP method. However, we should consider significant differences in quantitative indices. And it needs to take an evaluation test to apply clinical study to find a cause of differences out between phantom and clinical results.

• Investigative Magnetic Resonance Imaging
• /
• v.13 no.2
• /
• pp.161-170
• /
• 2009

Purpose : A parallel imaging method provides us to improve temporal resolution to obtain three-dimensional (3D) MR images. The objective of this study was to optimize three 3D MRI techniques by adjusting 2D SESNE factors of the parallel imaging method in phantom and human brain. Materials and Methods : With a 3 Tesla MRI system and an 8-channel phase-array sensitivity-encoding (SENSE) coil, three 3D MRI techniques of 3D T1-weighted imaging (3D T1WI), 3D T2-weighted imaging (3D T2WI) and 3D fluid attenuated inversion recovery (3D FLAIR) imaging were optimized with adjusting SESNE factors in a water phantom and three human brains. The 2D SENSE factor was applied on the phase-encoding and the slice-encoding directions. Signal-to-noise ratio(SNR), percent signal reduction rate(%R), and contrast-to-noise ratio(CNR) were calculated by using signal intensities obtained in specific regions-of-interest (ROI). Results : In the phantom study, SENSE factor = 3 was provided in 0.2% reduction of signals against without using SENSE with imaging within 5 minutes for 3D T1WI. SENSE factor = 2 was provided in 0.98% signal reduction against without using SENSE with imaging within 5 minutes for 3D T2WI. SENSE factor = 4 was provided in 0.2% signal reduction against without using SENSE with imaging around 6 minutes for 3D FLAIR. In the human brain study, SNR and CNR were higher with SENSE factors = 3 than 4 for all three imaging techniques. Conclusion : This study was performed to optimize 2D SENSE factors in the three 3D MRI techniques that can be scanned in clinical time limitations with minimizing SNR reductions. Without compromising SNR and CNR, the optimum 2D SENSE factors were 3 and 4, yielding the scan time of about 5 to 6 minutes. Further studies are necessary to optimize 3D MRI techniques in other areas in human body.

• Tuberculosis and Respiratory Diseases
• /
• v.44 no.4
• /
• pp.766-775
• /
• 1997

Background : Primary malignant tumors of the trachea are extremely rare entities and account for a mere 0.1 per cent of all malignancies of the respiratory tract. Because of vague localizing signs, symptoms and a usually negative routine chest film, the patients with tracheal tumors are often treated for asthma or chronic obstructive pulmonary disease for considerable period of time before correct diagnosis. Method : We have made a review of the 17 cases of primary tracheal tumors in recent 15 years. We reviewed the clinical features including history of smoking and respiratory symptoms, the official readings of initial routine chest film, the cytologic examination of sputum, the time of delay in diagnosis, and the response according to the therapeutic modalities. Results : Eight out of 9 patients with squamous cell carcinoma(SCC) were above 50 years old, five out of 6 patients with adenoid cystic carcinoma(ACC) were below 50 years old. The most common location of primary tracheal tumors was the upper one-third of trachea in 8 cases(47%). The most frequent symptoms were dyspnea in 13/17 cases(76%) and then stridor or wheezing, cough. and sputum in order. The routine chest roentgenographic examinations were not helpful to diagnose tracheal carcinoma and the cytologic examinations of sputums were helpful to diagnose tracheal carcinoma in only one case with adenocarcinoma. The mean times of delay in diagnosis of patients with sec and ACC were 5 months and 24.9 months respectively. We had bronchial asthma in 8 cases(47%) and tracheal tumors in 4 cases(23%) as initial clinical impression. Conclusion : We would like to perform more comprehensive diagnostic tools(high KVP technique, the fibroptic bronchoscopic examination, chest CT scan etc.) in patients who had the suggestive points for the tracheal tumorse(1. unexplained hemoptysis or hoarsness, 2. inspiratory wheezing or stridor, 3. wax and waning of dyspnea according to changes of position, 4. progressive asthmatics unresponsive to antiasthmatic therapy) and radical resection of tumor or external radiation therapy with curative aim as possible.

• Childhood Kidney Diseases
• /
• v.3 no.2
• /
• pp.180-186
• /
• 1999

Purpose : It has been well known that urinary tract infection(UTI) in infants and children is frequently associated with vesicoureteral reflux(VUR). However, the publishied papers dealing with congenital anomalies associated with UTI emphasized the importance of VUR only. The aim of our study was to evaluate the type, incidence and spectrum of urologic anomalies associated with UTI. Methods : Medical records of clinical, bacteriologic and radiologic study were assessed retrospectively in 65 infants or children with documented UTI who were admitted to the Department of Pediatrics, Samsung Seoul Hospital from March 1996 to February 1998. Results : Spectrum of anomalies were associated with UTI as follows: VUR(n=23), both ectopic kidney(n=1), ureterovesical junction(UVJ) obstruction(n=1), multicystic dysplastic kidney(n=1), ureteropelvic junction(UPJ) obstruction with hydronephrosis(n=1), hutch diverticulum(n=1), UPJ stenosis(n=1), posterior urethral valve(n=1), urachal remnant(n=1) and bladder diverticula(n=1). Congenital urinary anomalies other than VUR were detected in 9 children among 65 patients with UTI(13.8%). 4 children among 9 congenital urinary anomalies other than VUR were combined with VUR. Sex distribution with congenital urinary anomalies other than VUR was more prevalent in male than female (7 males : 2 females). Age distribution at the time of UTI was less than 5 years in most patient (under 1 year in 1 patient, 1-2 year in 5 patients, 3-5 year in 1 patient, and above 5 year in 2 patients). And age distribution at the time of UTl associated with VUR was less than 5 years in most patient (under 1 year in 6 patients, 1-2 year in 8 patients, 3-5 year in 5 patients, and above 5 year in 4 patients), too Conclusion : Because congenital urinary anomalies other than VUR are seen in as high as 13.8% of patients, more careful evaluation of all possible congenital urinary anomalies as well as VUR is mandatory in pediatric patient with UTI.

• The Journal of Internal Korean Medicine
• /
• v.14 no.2
• /
• pp.50-70
• /
• 1993

Clinical observation was done on 92 cases of Occlusive CVD, Cerebral hemorrhage (Subarachnoid hemorrhage) which were confirmed by Brain CT scan and observed for over 4 weeks, among the 121 cases which were more than 65 years of age. they admitted to the Dept. of Internal Medicine, Oriental Medical Hospital in Dong Guk Univ. from July 1992 to June 1993. The result were as follows; 1. In this study, Occlusive CVD was 74 cases, Cerebral hemorrhage (Subarachnoid hemorrhage was 2 cases) was 18 cases. 2. The ratio of male to female was 1.09:1. The age distribution showed the large number in the 65-69 year group(52.2%), 7th decade was 44.5% over 8th decade was 3.3% in ratio. 3. The site of Occlusive CVD was most common at MCA. the site of Cb-hemorrhage was most common at Basal ganglia. 4. The most common preceding disease was hypertension(47.8%) and the next were diabetes mellitus(14.1%), heart desease(14.1%). 5. Recurrence rate was 33.7% and 2nd attack was 20.7%, 3rd attack was 8.7%, 4th attack was 4.3% 6. Predisposing factors in Occlusive CVD were initiated usually during resting and sleeping, and that in Cb-hemorrhage were represented chiefly exercising(66.6%). 7. The smoker was 52.2%, the drinker was 32.6% in whole group. the drinker was 61.1% by the Cb-hemorrhage. 8. The ratio of the season distribution was as follow, fall 35.8%, winter 29.3%, spring 19.6%, summer 15.3%, that of the month distribution was november 15.2%. 9. Duration from on set in Occlusive CVD, 60.8% was within 5 days, that in Cb-hemorrhage, 77.8% was within 5 days. 10. Level of consciousness on attack was clear 42.2%, lethargy and mental change(dull, stupid etc.) 41.3%. The common symptoms were motor disturbance(90.2%), verbal disturbance(65.2%), headache(43.5%). 11. The physical theraphy of Occlusive CVD has been performed 75.7% in whole group and the average beginning time was 6.4 days, and that of Cb-hemorrhage has been performed 61.1% in whole group and the average beginning time was 13 days. 12. Duration of hospitalization was noted 11-20 days was 31.5%, over 21 days was 46.8%, and the average admission was 22.7 day(Occlusive CVD), 32days (Cb-hemorrhage). 13. The main complication were observed in the studies; urinary tract infection and pneumonia were noted in 6.5%, bed sore in 5.4%. 14. The ratio of systolic blood pressures in admission and discharge decreased from 58.7% to 28.3% in over 160 mmHg, that of diastolic blood pressures in admission and discharge decreased from 72.8% to 51.1% in over 90 mmHg. In 31(33.7%) of the 92 cases it showed the glucose levels of more than normal. 15. The patients have done family history of hypertension and C.V.A were 32.6% of all 16. Occlusive CVD In 83.8% and Cb-hernorrhage in 72.2% were improved 17. The herb medications were various Sunghyanggeonggisan, Sopungtang, CHunmagudeungeum were used most frequently and Gamidaebotang, Boyangwhanotang, Gagamyunjotang, Mangeumtang etc. were used as discharge.

• Proceedings of the Materials Research Society of Korea Conference
• /
• 2011.05a
• /
• pp.5-5
• /
• 2011

The research and development of hybrid electric vehicle (HEV), plug-in hybrid electric vehicle (PHEV) and electric vehicle (EV) are intensified due to the energy crisis and environmental concerns. In order to meet the challenging requirements of powering HEV, PHEV and EV, the current lithium battery technology needs to be significantly improved in terms of the cost, safety, power and energy density, as well as the calendar and cycle life. One new technology being developed is the utilization of composite cathode by mixing two different types of insertion compounds [e.g., spinel $LiMn_2O_4$ and layered $LiMO_2$ (M=Ni, Co, and Mn)]. Recently, some studies on mixing two different types of cathode materials to make a composite cathode have been reported, which were aimed at reducing cost and improving self-discharge. Numata et al. reported that when stored in a sealed can together with electrolyte at $80^{\circ}C$ for 10 days, the concentrations of both HF and $Mn^{2+}$ were lower in the can containing $LiMn_2O_4$ blended with $LiNi_{0.8}Co_{0.2}O_2$ than that containing $LiMn_2O_4$ only. That reports clearly showed that this blending technique can prevent the decline in capacity caused by cycling or storage at elevated temperatures. However, not much work has been reported on the charge-discharge characteristics and related structural phase transitions for these composite cathodes. In this presentation, we will report our in situ x-ray diffraction studies on this mixed composite cathode material during charge-discharge cycling. The mixed cathodes were incorporated into in situ XRD cells with a Li foil anode, a Celgard separator, and a 1M $LiPF_6$ electrolyte in a 1 : 1 EC : DMC solvent (LP 30 from EM Industries, Inc.). For in situ XRD cell, Mylar windows were used as has been described in detail elsewhere. All of these in situ XRD spectra were collected on beam line X18A at National Synchrotron Light Source (NSLS) at Brookhaven National Laboratory using two different detectors. One is a conventional scintillation detector with data collection at 0.02 degree in two theta angle for each step. The other is a wide angle position sensitive detector (PSD). The wavelengths used were 1.1950 ${\AA}$ for the scintillation detector and 0.9999 A for the PSD. The newly installed PSD at beam line X18A of NSLS can collect XRD patterns as short as a few minutes covering $90^{\circ}$ of two theta angles simultaneously with good signal to noise ratio. It significantly reduced the data collection time for each scan, giving us a great advantage in studying the phase transition in real time. The two theta angles of all the XRD spectra presented in this paper have been recalculated and converted to corresponding angles for ${\lambda}=1.54\;{\AA}$, which is the wavelength of conventional x-ray tube source with Cu-$k{\alpha}$ radiation, for easy comparison with data in other literatures. The structural changes of the composite cathode made by mixing spinel $LiMn_2O_4$ and layered $Li-Ni_{1/3}Co_{1/3}Mn_{1/3}O_2$ in 1 : 1 wt% in both Li-half and Li-ion cells during charge/discharge are studied by in situ XRD. During the first charge up to ~5.2 V vs. $Li/Li^+$, the in situ XRD spectra for the composite cathode in the Li-half cell track the structural changes of each component. At the early stage of charge, the lithium extraction takes place in the $LiNi_{1/3}Co_{1/3}Mn_{1/3}O_2$ component only. When the cell voltage reaches at ~4.0 V vs. $Li/Li^+$, lithium extraction from the spinel $LiMn_2O_4$ component starts and becomes the major contributor for the cell capacity due to the higher rate capability of $LiMn_2O_4$. When the voltage passed 4.3 V, the major structural changes are from the $LiNi_{1/3}Co_{1/3}Mn_{1/3}O_2$ component, while the $LiMn_2O_4$ component is almost unchanged. In the Li-ion cell using a MCMB anode and a composite cathode cycled between 2.5 V and 4.2 V, the structural changes are dominated by the spinel $LiMn_2O_4$ component, with much less changes in the layered $LiNi_{1/3}Co_{1/3}Mn_{1/3}O_2$ component, comparing with the Li-half cell results. These results give us valuable information about the structural changes relating to the contributions of each individual component to the cell capacity at certain charge/discharge state, which are helpful in designing and optimizing the composite cathode using spinel- and layered-type materials for Li-ion battery research. More detailed discussion will be presented at the meeting.