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Clinical Usefulness of D-dimer Test with Semiquantitative Latex Agglutination Method in Pulmonary Embolism (폐색전증에서 반정량적 Latex 응집법으로 시행한 D-dimer 검사의 유용성에 관한 연구)

  • Kim, Dong Kyun;Chun, Kang Il;Kim, Yang-Ki;Lee, Young-Mok;Kim, Ki Up;Uh, Soo-taek;Kim, Yong Hoon;Park, Choon Sik;Park, No Jin;Choi, Tae Youn
    • Tuberculosis and Respiratory Diseases
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    • v.59 no.6
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    • pp.651-655
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    • 2005
  • Background : Diagnosing a pulmonary embolism is difficult because its presenting symptoms are nonspecific and there are limitations with all of the objective tests. The D-dimer is known to be a marker of the lysis of intravascular cross-linked fibrin as a result of the activation of the endogenous fibrinolytic pathways, and the D-dimer assay is these an objective method for diagnosing a pulmonary embolism. This study assessed the benefits of the D-dimer test for diagnosing a pulmonary embolism using semiquantitative latex agglutination. Methods : The latex agglutination results of 185 patients were retrospectively reviewed. The D-dimer test was performed at the time a pulmonary embolism was suspected. Ninety patients(group I) were diagnosis with PE through spiral chest CT or a chest CT angiogram, perfusion/ventilation scans, and/or pulmonary angiogram. Ninety-five patients (group II) were found not to have a pulmonary embolism through the above tests. Results : The male to female ratio and mean age in groups I and II was 37:55, and 57 years old to 50:45 and 52 years old, respectively. When the cut off value for a positive D-dimer assay was set to $500{\mu}g$, the sensitivity, positive predictive value, negative predictive value and specificity was 86.7%, 61.4%, 79.3%, and 48.4%, respectively. Conclusion : The semiquantitative latex agglutination method in the D-dimer test has a lower sensitivity and negative predictive value than the well known ELISA test particularly for small emboli. Therefore, this test is not a suitable screening test for excluding a pulmonary embolism.

Sedimentary Facies and Evolution of the Cretaceous Deep-Sea Channel System in Magallanes Basin, Southern Chile (마젤란 분지의 백악기 심해저 하도 퇴적계의 퇴적상 및 진화)

  • Choe, Moon-Young;Sohn, Young-Kwan;Jo, Hyung-Rae;Kim, Yea-Dong
    • Ocean and Polar Research
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    • v.26 no.3
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    • pp.385-400
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    • 2004
  • The Lago Sofia Conglomerate encased in the 2km thick hemipelagic mudstones and thinbedded turbidites of the Cretaceous Cerro Toro Formation, southern Chile, is a deposit of a gigantic submarine channel developed along a foredeep trough. It is hundreds of meters thick kilometers wide, and extends for more than 120km from north to south, representing one of the largest ancient submarine channels in the world. The channel deposits consist of four major facies, including stratified conglomerates (Facies A), massive or graded conglomerates (Facies B), normally graded conglomerates with intraformational megaclasts (Facies C), and thick-bedded massive sandstones (Facies D). Conglomerates of Facies A and B show laterally inclined stratification, foreset stratification, and hollow-fill structures, reminiscent of terrestrial fluvial deposits and are suggestive of highly competent gravelly turbidity currents. Facies C conglomerates are interpreted as deposits of composite or multiphase debris flows associated with preceding hyperconcentrated flows. Facies D sandstones indicate rapidly dissipating, sand-rich turbidity currents. The Lago Sofia Conglomerate occurs as isolated channel-fill bodies in the northern part of the study area, generally less than 100m thick, composed mainly of Facies C conglomerates and intercalated between much thicker fine-grained deposits. Paleocurrent data indicate sediment transport to the east and southeast. They are interpreted to represent tributaries of a larger submarine channel system, which joined to form a trunk channel to the south. The conglomerate in the southern part is more than 300 m thick, composed of subequal proportions of Facies A, B, and C conglomerates, and overlain by hundreds of m-thick turbidite sandstones (Facies D) with scarce intervening fine-grained deposits. It is interpreted as vertically stacked and interconnected channel bodies formed by a trunk channel confined along the axis of the foredeep trough. The channel bodies in the southern part are classified into 5 architectural elements on the basis of large-scale bed geometry and sedimentary facies: (1) stacked sheets, indicative of bedload deposition by turbidity currents and typical of broad gravel bars in terrestrial gravelly braided rivers, (2) laterally-inclined strata, suggestive of lateral accretion with respect to paleocurrent direction and related to spiral flows in curved channel segments around bars, (3) foreset strata, interpreted as the deposits of targe gravel dunes that have migrated downstream under quasi-steady turbidity currents, (4) hollow fills, which are filling thalwegs, minor channels, and local scours, and (5) mass-flow deposits of Facies C. The stacked sheets, laterally inclined strata, and hollow fills are laterally transitional to one another, reflecting juxtaposed geomorphic units of deep-sea channel systems. It is noticeable that the channel bodies in the southern part are of feet stacked toward the east, indicating eastward migration of the channel thalwegs. The laterally inclined strata also dip dominantly to the east. These features suggest that the trunk channel of the Lago Sofia submarine channel system gradually migrated eastward. The eastward channel migration is Interpreted to be due to tectonic forcing imposed by the subduction of an oceanic plate beneath the Andean Cordillera just to the west of the Lago Sofia submarine channel.

CT Simulation Technique for Craniospinal Irradiation in Supine Position (전산화단층촬영모의치료장치를 이용한 배와위 두개척수 방사선치료 계획)

  • Lee, Suk;Kim, Yong-Bae;Kwon, Soo-Il;Chu, Sung-Sil;Suh, Chang-Ok
    • Radiation Oncology Journal
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    • v.20 no.2
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    • pp.165-171
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    • 2002
  • Purpose : In order to perform craniospinal irradiation (CSI) in the supine position on patients who are unable to lie in the prone position, a new simulation technique using a CT simulator was developed and its availability was evaluated. Materials and Method : A CT simulator and a 3-D conformal treatment planning system were used to develop CSI in the supine position. The head and neck were immobilized with a thermoplastic mask in the supine position and the entire body was immobilized with a Vac-Loc. A volumetrie image was then obtained using the CT simulator. In order to improve the reproducibility of the patients' setup, datum lines and points were marked on the head and the body. Virtual fluoroscopy was peformed with the removal of visual obstacles such as the treatment table or the immobilization devices. After the virtual simulation, the treatment isocenters of each field were marked on the body and the immobilization devices at the conventional simulation room. Each treatment field was confirmed by comparing the fluoroscopy images with the digitally reconstructed radiography (DRR)/digitally composite radiography (DCR) images from the virtual simulation. The port verification films from the first treatment were also compared with the DRR/DCR images for a geometrical verification. Results : CSI in the supine position was successfully peformed in 9 patients. It required less than 20 minutes to construct the immobilization device and to obtain the whole body volumetric images. This made it possible to not only reduce the patients' inconvenience, but also to eliminate the position change variables during the long conventional simulation process. In addition, by obtaining the CT volumetric image, critical organs, such as the eyeballs and spinal cord, were better defined, and the accuracy of the port designs and shielding was improved. The differences between the DRRs and the portal films were less than 3 mm in the vertebral contour. Conclusion : CSI in the supine position is feasible in patients who cannot lie on prone position, such as pediatric patienta under the age of 4 years, patients with a poor general condition, or patients with a tracheostomy.

Foundation Methods for the Soft Ground Reinforcement of Lightweight Greenhouse on Reclaimed Land: A review (간척지 온실 기초 연약지반 보강 방법에 대한 고찰)

  • Lee, Haksung;Kang, Bang Hun;Lee, Su Hwan
    • Journal of Bio-Environment Control
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    • v.29 no.4
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    • pp.440-447
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    • 2020
  • The demand for large-scale horticultural complexes utilizing reclaimed lands is increasing, and one of the pending issues for the construction of large-scale facilities is to establish foundation design criteria. In this paper, we tried to review previous studies on the method of reinforcing the foundation of soft ground. Target construction methods are spiral piles, wood piles, crushed stone piles and PF (point foundation) method. In order to evaluate the performance according to the basic construction method, pull-out resistance, bearing capacity, and settlement amount were measured. At the same diameter, pull-out resistance increased with increasing penetration depth. Simplified comparison is difficult due to the difference in reinforcement method, diameter, and penetration depth, but it showed high bearing capacity in the order of crushed stone pile, PF method, and wood pile foundation. In the case of wood piles, the increase in uplift resistance was different depending on the slenderness ratio. Wood, crushed stone pile and PF construction methods, which are foundation reinforcement works with a bearing capacity of 105 kN/㎡ to 826 kN/㎡, are considered sufficient methods to be applied to the greenhouse foundation. There was a limitation in grasping the consistent trend of each foundation reinforcement method through existing studies. If these data are supplemented through additional empirical tests, it is judged that a basic design guideline that can satisfy the structure and economic efficiency of the greenhouse can be presented.

A Pilot Study for the Remote Monitoring of IMRT Using a Head and Neck Phantom (원격 품질 보증 시스템을 사용한 세기변조 방사선치료의 예비 모니터링 결과)

  • Han, Young-Yih;Shin, Eun-Hyuk;Lim, Chun-Il;Kang, Se-Kwon;Park, Sung-Ho;Lah, Jeong-Eun;Suh, Tae-Suk;Yoon, Myong-Geun;Lee, Se-Byeong;Ju, Sang-Gyu;Ahn, Yong-Chan
    • Radiation Oncology Journal
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    • v.25 no.4
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    • pp.249-260
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    • 2007
  • Purpose: In order to enhance the quality of IMRT as employed in Korea, we developed a remote monitoring system. The feasibility of the system was evaluated by conducting a pilot study. Materials and Methods: The remote monitoring system consisted of a head and neck phantom and a user manual. The phantom contains a target and three OARs (organs at risk) that can be detected on CT images. TLD capsules were inserted at the center of the target and at the OARs. Two film slits for GafchromicEBT film were located on the axial and saggital planes. The user manual contained an IMRT planning guide and instructions for IMRT planning and the delivery process. After the manual and phantom were sent to four institutions, IMRT was planed and delivered. Predicted doses were compared with measured doses. Dose distribution along the two straight lines that intersected at the center of the axial film was measured and compared with the profiles predicted by the plan. Results: The measurements at the target agreed with the predicted dose within a 3% deviation. Doses at the OARs that represented the thyroid glands showed larger deviations (minimum 3.3% and maximum 19.8%). The deviation at OARs that represented the spiral cord was $0.7{\sim}1.4%$. The percentage of dose distributions that showed more than a 5% of deviation on the lines was $7{\sim}27%$ and $7{\sim}14%$ along the horizontal and vertical lines, respectively. Conculsion: Remote monitoring of IMRT using the developed system was feasible. With remote monitoring, the deviation at the target is expected to be small while the deviation at the OARs can be very large. Therefore, a method that is able to investigate the cause of a large deviation needs to be developed. In addition, a more clinically relevant measure for the two-dimensional dose comparison and pass/fail criteria need to be further developed.

Assessment of Computed Tomographic Lung Density in Beagle and Shihtzu Dogs : Influence of Position and Positive End Expiratory Pressure (비글과 시츄견에서 호기말 양압에 따른 전산화 단층촬영상의 폐밀도의 평가)

  • Kim, Tae-Hun;Chang, Jin-Hwa;Yun, Seok-Ju;Yoon, Jung-Hee;Chang, Dong-Woo
    • Journal of Veterinary Clinics
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    • v.27 no.3
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    • pp.273-283
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    • 2010
  • The objective of this study was to measure densities in various areas of the normal canine lung with computed tomography (CT) depending on influences of gravity and the degree of lung inflation and to determine optimal positions and positive end expiratory pressure of canine lung for CT scanning. In each eight normal Beagle and Shihtzu dogs, a respiratory breathhold maneuver without spontaenous breathing at different positive end expiratory pressure (PEEP) of 0 mmHg, 10 mmHg and 20 mmHg was applied with the position of right and left lateral recumbency, sternal recumbency, and dorsal recumbency and spiral-CT scans of the total lung were acquired. Slices were selected at three levels through the apex, middle and basal lung at the aortic arch, carina and just above the diaphragm and lung density was measured in the dorsal, ventral, and lateral portions of the peripheral lung field. Lung density in dependent areas was higher than in nondependent areas (p < 0.05) regardless of species, positions, anatomic locations at the PEEP of 0 mmHg and 10 mmHg. However, no significant difference of lung density was found at PEEP of 20 mmHg in both species except the dorsal recumbency in Shihtzu dogs. This density gradient in the dependent areas is strongly influenced by PEEP (p < 0.05). In the four positions on the CT gantry, the lung density at the dependent and nondependent location of the lung was greater at the aortic arch than at the base (p < 0.05). Lung density decreased on identical location according to increase of PEEP (p < 0.05). There was no significant difference between right and left lung density at sternal and dorsal recumbency and no significant difference of the dorsal, ventral, and lateral portions of lung density at the right and left recumbency under identical pressure. It is implied that during chest CT scan with 20 mmHg of positive end expiratory pressure with right or left lateral recumbency, canine lung density do not influenced by gravity or anatomic location.

Development and Usefulness of Acrylic Needle for Percutaneous Bone Biopsy (경피적 골생검용 아크릴 바늘의 제작과 유용성)

  • Kim, Tae-Hyung;Shin, Myung-Jin;Shin, Ji-Hoon;Lim, Jin-Oh;Ryu, Ji-Yeon;Oh, Jae-Seon;Woo, Chul-Woong;Nam, Jeung-Hee
    • Journal of radiological science and technology
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    • v.33 no.1
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    • pp.25-29
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    • 2010
  • To evaluate the usefulness of newly designed percutaneous bone biopsy needle for pumpkin's specimen collection. We manufactured three types of biopsy needle with different internal processing which were made of 10 mm-diameter acrylic material. We made the conventional type (Ct) similar to the clinical type then compared the test group. The type a (Ta) made 1 cm-length internal processing from the distal, type b (Tb) made taper, and type c (Tc) made internal processing like spiral configuration. We performed 20 times biopsy to get an 10 mm length specimen from pumpkin's surface and evaluated the success rate of the biopsy, length of the specimen, and determine internal processing type of the most suitable biopsy needle (ANOVA test). Success rates of Ct, Ta, Tb, and Tc were 55%, 80%, 90%, and 100%, respectively. The lengths of the specimen of Ct, Ta, Tb, and Tc were $5.6{\pm}1.1\;mm$, $5.9{\pm}0.87\;mm$, $3.9{\pm}0.77\;mm$, and $9.4{\pm}0.54\;mm$, respectively. All groups were statistically significant (p < 0.05) except the group between Ct and Ta (p = 0.28). Newly designed bone biopsy needle seems to be useful for obtaining enough specimen. Tc may be more effective than other types.

Development of the Trichomes in Floating Leaves of Salvinia Species (생이가래속(Salvinia) 부유엽 모용의 분화발달)

  • Seo, Ae-Ri;Kim, In-Sun
    • Applied Microscopy
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    • v.38 no.2
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    • pp.117-124
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    • 2008
  • Salvinia is an aquatic plant forming dimorphic leaves that have been modified into floating and submerged leaves. A air of floating leaves plays an important role for the floating and photosynthesis while the submerged leaves, which are lim and long, have the form and function of root. Many aquatic plants develop trichomes in the epidermis but in Salvinia, richomes grow densely in the epidermis of the dimorphic leaves. The present study examined the differentiation pattern of trichomes developing in the floating leaves of S. natans and S. molesta by scanning and transmission electron microscopy. Trichomes developing in the floating leaves of Salvinia showed very different patterns. In S. natans, they were arranged in a V-shape form, having 20${\sim}$25 rows at $18{\sim}25^{\circ}$ on both sides of the lamina divided by the midrib in the floating leaf. In each row, 8${\sim}$10 oval-shaped cells, $200{\sim}290{\mu}m$ in length, were arranged in a spiral fashion. Four trichomes of this form made a trichome unit, but their apical parts were separated from one another and developed into the so-called 'knuckle-crane' type. On the other hand, in S. molesta, trichomes differentiated in a unique pattern quite different from those of S. natans. At the early stage of differentiation, trichomes protruded from the epidermis and then 4${\sim}$6 cylindrical cells grew $400{\sim}600{\mu}m$ long and the four trichomes formed as an unit. The four grouped trichomes were interconnected through their apex and developed in the 'egg-beater' type. Then $300{\sim}600{\mu}m$ long multi-cellular stalk cells grew and protruded out of the epidermal surface from the basal part of the trichomes. Such a structural characteristic of trichomes is considered to play a very important role along with the aerenchyma tissue in the leaf mesophyll tissue for the floating of Salvinia on the water surface.

A CT Simulator Phantom for Geometrica1 Test (CT 시뮬레이터의 기하학적 성능평가용 팬톰)

  • Min, Chul-Kee;Yi, Byong-Yong;Ahn, Seung-Do;Choi, Eun-Kyung;Chang, Hye-Sook
    • Radiation Oncology Journal
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    • v.18 no.4
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    • pp.337-344
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    • 2000
  • Purpose :To design and test test CT simulator phantom for geometrical test. Materials and Methods : The PMMA phantom was designed as a cylinder which is 20 cm in diameter and 24 cm in length, along with a 25$\times25\times31cm^{3}$ rectangular parallelepiped. Radio-opaque wires of which diameter is 0.8 mm are attached on the other surface of the phantom as a spiral. The rectangular phantom was made of four 24$\times24\times0.5 cm^{3}$ square plates and each plate had a 24$\times24 cm^{2}$, 12$\times12cm^{2}$, 6$\times6 cm$^{2}$ square line. The squares were placed to face the cylinder at angles 0 $^{\circ}$ , 15 $^{\circ}$ , 30 $^{\circ}$ ,respectively. The rectangular phantom made it possible to measure the field size, couch angle, the collimator angle, the isocenter shift and the SSD, the measurements of the gantry angle from the cylindrical part. A virtual simulation software, AcOSim, offered various conditions to perform virtual simulations and these results were used to perform the geometrical Quality assurance of CT simulator. Results : A 0.3$\~$0.5 mm difference was found on the 24 cm field size which was created with the DRR measurements obtained by scanning of the rectangular phantom. The isocenter shift, the collimator rotation, the couch rotation, and the gantry rotation test showed 0.5$\~$1 mm, 0.5$\~$l$^{\circ}$ 0.5$\~$ 1$^{\circ}$ , and 0.5-1 $^{\circ}$ differences, respectively. We could not find any significant differences between the results from the two scanning methods. Conclusion :The geometrical test phantom developed in the study showed less than 1 mm (or 1 $^{\circ}$ ) differences. The phantom could be used as a routine geometrical QC/QA tools, since the differences are within clinically acceptable ranges.

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Clinical Study of Pulmonary Thromboembolism (폐혈전색전증의 임상적 연구)

  • Bak, Sang-Myeon;Lee, Sang-Hwa;Lee, Sin-Hyung;Sin, Cheol;Cho, Jae-Youn;Shim, Jae-Jeong;In, Kwang-Ho;Kang, Kyung-Ho;Yoo, Se-Hwa
    • Tuberculosis and Respiratory Diseases
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    • v.50 no.1
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    • pp.106-116
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    • 2001
  • Background : Pulmonary thromboembolism is relatively frequent and potentially fatal. However, it is commonly misdiagnosed. The incidence of pulmonary thromboembolism is not decreasing despite advances in diagnosis and effective prophylatic measures. Its potential for significant sequela necessitates a prompt diagnosis and treatment. Unfortunately, there are many difficulties and problems regarding accurate diagnosis. There is a low prevalence of deep vein thrombosis and pulmonary thromboembolism in Korea and only few reports on this subject are available. Method : The clinical features of 36 patients, who were diagnosed with pulmonary thromboembolism at the Korea University medical center, were reviewed. Results : 1) There was no significant difference in prevalence between men an women, and the mean age was 50.9 years in men 59.2 years in women. 2) The frequent causes of pulmonary thromboembolism were malignancies (22.2%), surgery (22.2%), and heart disease(8.2%). Specific causes were not identified in 33.3%. 3) The most common symptom was dyspnea(72.2%), and the most common sign was tachypnea(61.1%). 4) The EKG findings were normal in 28.6%, an S1Q3T3 pulmonale pattern in 25.7%, ST or QRS changes in others. 5) The chest X-ray findings indicated pulmonary infiltration in 37.5%, cardiomegaly in 15.6%, pleural effusion in 12.5%, and normal in 27.8%. The perfusion lung scan showed a high probability in 66.7%, and intermediate or low probability in 33.3%. 6) The pulmonary arterial pressure(PAP) in the high probability groups was 57.9mmHg with a higher mortality rate(35%). Conclusion : Pulmonary thromboembolism is not uncommon in Korea and its clinical features do not differ greatly from thase reported in the literature. When pulmonary thromboemblism of unknown causes are diagnosed, a search for an occult malignancy is recommended. Rapid diagnosis and treatment are achieved when thromboemblism is suspected.

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