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Assessment of Cerebral Hemodynamic Changes in Pediatric Patients with Moyamoya Disease Using Probabilistic Maps on Analysis of Basal/Acetazolamide Stress Brain Perfusion SPECT (소아 모야모야병에서 뇌확률지도를 이용한 수술전후 혈역학적 변화 분석)

  • Lee, Ho-Young;Lee, Jae-Sung;Kim, Seung-Ki;Wang, Kyu-Chang;Cho, Byung-Kyu;Chung, June-Key;Lee, Myung-Chul;Lee, Dong-Soo
    • Nuclear Medicine and Molecular Imaging
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    • v.42 no.3
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    • pp.192-200
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    • 2008
  • To evaluate the hemodynamic changes and the predictive factors of the clinical outcome in pediatric patients with moyamoya disease, we analyzed pre/post basal/acetazolamide stress brain perfusion SPECT with automated volume of interest (VOIs) method. Methods: Total fifty six (M:F = 33:24, age $6.7{\pm}3.2$ years) pediatric patients with moyamoya disease, who underwent basal/acetazolamide stress brain perfusion SPECT within 6 before and after revascularization surgery (encephalo-duro-arterio-synangiosis (EDAS) with frontal encephalo-galeo-synangiosis (EGS) and EDAS only followed on contralateral hemisphere), and followed-up more than 6 months after post-operative SPECT, were included. A mean follow-up period after post-operative SPECT was $33{\pm}21$ months. Each patient's SPECT image was spatially normalized to Korean template with the SPM2. For the regional count normalization, the count of pons was used as a reference region. The basal/acetazolamide-stressed cerebral blood flow (CBF), the cerebral vascular reserve index (CVRI), and the extent of area with significantly decreased basal/acetazolamide- stressed rCBF than age-matched normal control were evaluated on both medial frontal, frontal, parietal, occipital lobes, and whole brain in each patient's images. The post-operative clinical outcome was assigned as good, poor according to the presence of transient ischemic attacks and/or fixed neurological deficits by pediatric neurosurgeon. Results: In a paired t-test, basal/acetazolamide-stressed rCBF and the CVRI were significantly improved after revascularization (p<0.05). The significant difference in the pre-operative basal/acetazolamide-stressed rCBF and the CVRI between the hemispheres where EDAS with frontal EGS was performed and their contralateral counterparts where EDAS only was done disappeared after operation (p<0.05). In an independent student t-test, the pre-operative basal rCBF in the medial frontal gyrus, the post-operative CVRI in the frontal lobe and the parietal lobe of the hemispheres with EDAS and frontal EGS, the post-operative CVRI, and ${\Delta}CVRI$ showed a significant difference between patients with a good and poor clinical outcome (p<0.05). In a multivariate logistic regression analysis, the ${\Delta}CVRI$ and the post-operative CVRI of medial frontal gyrus on the hemispheres where EDAS with frontal EGS was performed were the significant predictive factors for the clinical outcome (p =0.002, p =0.015), Conclusion: With probabilistic map, we could objectively evaluate pre/post-operative hemodynamic changes of pediatric patients with moyamoya disease. Specifically the post-operative CVRI and the post-operative CVRI of medial frontal gyrus where EDAS with frontal EGS was done were the significant predictive factors for further clinical outcomes.

Morphological Characteristics, and Coefficient of Variation, Heritability and Genetic Advance of Major Cultivars of Spray Chrysanthemum (주요 스프레이 국화 품종의 형태적 특성과 변이계수, 유전율 및 유전자 전이율)

  • Shim, Sung-Im;Lim, Ki-Byung;Kim, Chang-Kil;Chung, Mi-Young;Kim, Kyung-Min;Chung, Jae-Dong
    • Horticultural Science & Technology
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    • v.34 no.2
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    • pp.269-281
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    • 2016
  • The statistical analyses of coefficient of variation, heritability, and genetic advance were carried out to identify differences in morphological characteristics, such as the stem and inflorescence length, of 10 major commercial cultivars of spray chrysanthemum (Chrysanthemum morifolium). For morphological characteristics, stem lengths ranged from 46.4 cm to 54.9 cm, the maximum diameter of stem was 5.6 to 8.5 mm, the hardness of the stem was 0.17 to $0.70kg{\cdot}m^{-2}$, the fresh weight of stem was 7.5 to 17.5 g, the dry weight of the stem was 1.6 to 3.3 g, the ratio of dry weight/fresh weight of stem was 15.9% to 23.1%. Also, the number of leaves on the stem was 8.4 to 12.2, the stem leaf area was 17.8 to $37.8m^2$, the fresh weight stem leaves was 5.3 to 18.6 g, the dry weight was 0.5 to 1.4 g and the ratio of dry weight /fresh weight of stem leaves was 7.6% to 11.5%. The inflorescence length ranged from 10.1 to 18.6 cm, the fresh weight of inflorescence was 7.3 to 26.7 g, the dry weight of inflorescence was 1.2 to 2.8 g, the ratio of dry weight /fresh weight of inflorescence was 10.4% to 17.1%. For flower, the diameter of the flower center was 8.2 to 13.3 mm, the petal width was 5.7 to 14.0 mm, the petal length was 12.9 to 33.1 mm, and the petal thickness was 157.8 to $354.4{\mu}m$. The mean values of each character in each cultivar were very different, and DMRT and LSD values based on morphological characteristics among 10 cultivars were highly significant. For variability and genetic parameters, the lowest CV (coefficient of variation), PCV (phenotypic coefficient of variation), and GCV (genotypic coefficient of variation) were 4.79% to 5.15% in stem length, and the highest variations were 62.97% to 65.21% in leaf area. ECV (error or environmental coefficient of variation) was the lowest for leaf area (1.71%) and it was the highest for leaf dry weight (19.30%). Heritability also significantly differed among the characteristics, ranging from 68.69% to 99.67%, the lowest value was shown in ratio of dry weight /fresh weight of stem and the highest value was for leaf area of stem. The value for genetic advance was the lowest in hardness of stem at 0.30 and the highest in leaf thickness at 156.65. The lowest genetic advance as percentage of mean of stem hardness was 9.17%, while the highest percentage of stem length was 134.27%. Thus the characters which had the highest values indicated above show the influence of additive gene action and may provide useful resources for selection programs for agronomic improvement.

The Study of Radiation Reducing Method during Injection Radiopharmaceuticals (방사성의약품 투여 시 피폭선량 저감에 대한 연구)

  • Cho, Seok-Won;Jung, Seok;Park, June-Young;Oh, Shin-Hyun;NamKoong, Hyuk;Oh, Ki-Beak;Kim, Jae-Sam;Lee, Chang-Ho
    • The Korean Journal of Nuclear Medicine Technology
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    • v.16 no.1
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    • pp.80-85
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    • 2012
  • Purpose: The whole body bone scan is an examination that visualizing physiological change of bones and using bone-congenial radiopharmaceutical. The patients are intravenous injected radiopharmaceutical which labeled with radioactive isotope ($^{99m}Tc$) emitting 140 keV gammarays and scanned after injection. The 3 principles of radiation protection from external exposureare time, distance and shielding. On the 3 principles of radiation protection basis, radiopharmaceutical might just as well be injected rapidly for reducing radiation because it might be the unopened radiation source. However the radiopharmaceuticals are injected into patient directly and there is a limitation of distance control. This study confirmed the change of radiation exposure as change of distance from radiopharmaceutical and observed the change of radiation exposure afte rsetting a shelter for help to control radio-technician's exposure. Materials & methods: For calculate the average of injection time, the trained injector measured the injection time for 50 times and calculated the average (2 minutes). We made a source as filled the 99mTc-HDP 925 MBq 0.2 mL in a 1 mL syringe and measured the radiation exposure from 50 cm,100 cm,150 cm and 200 cm by using Geiger-Mueller counter (FH-40, Thermo Scientific, USA). Then we settled a lead shielding (lead equivalent 6 mm) from the source 25 cm distance and measured the radiation exposure from 50 cm distance. For verify the reproducibility, the measurement was done among 20 times. The correlation between before and after shielding was verified by using SPSS (ver. 18) as paired t-test. Results: The radiation doses according to distance during 2 minutes from the source without shielding were $1.986{\pm}0.052{\mu}$ Sv in 50 cm, $0.515{\pm}0.022{\mu}$ Sv in 100 cm, $0.251{\pm}0.012{\mu}$ Sv in 150 cm, $0.148{\pm}0.006{\mu}$ Sv in 200 cm. After setting the shielding, the radiation dose was $0.035{\pm}0.003{\mu}$ Sv. Therefore, there was a statistical significant difference between the radiation doses with shielding and without shielding ($p$<0.001). Conclusion: Because the great importance of whole body bone scan in the nuclear medicine, we should make an effort to reduce radiation exposure during radiopharmaceutical injections by referring the principles of radiation protection from external exposure. However there is a limitation of distance for direct injection and time for patients having attenuated tubules. We confirmed the reduction of radiation exposure by increasing distance. In case of setting shield from source 25 cm away, we confirmed reducing of radiation exposure. Therefore it would be better for reducing of radiation exposure to using shield during radiopharmaceutical injection.

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The Consideration of the Region of Interest on $^{99m}Tc$-DMSA Renal Scan in Pediatric Hydronephrosis Patients (수신증을 진단 받은 소아 환자의 DMSA 신장 검사에서 정확한 관심영역 설정에 대한 고찰)

  • NamKoong, Hyuk;Lee, Dong-Hyuk;Oh, Shin-Hyun;Cho, Seok-Won;Park, Hoon-Hee;Kim, Jung-Yul;Kim, Jae-Sam;Lee, Chang-Ho
    • The Korean Journal of Nuclear Medicine Technology
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    • v.16 no.1
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    • pp.27-33
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    • 2012
  • Purpose: Most of diagnosis in the pediatric hydronephrosis patients have been performed $^{99m}Tc$-DMSA renal scan. Then the region of interest (ROI) is set for comparative analysis of uptake ratio in left-right kidney after acquiring the image. But if the equipment set an automatic ROI, the ROI could include expanded renal pelvis due to hydronephrosis and the uptake ratio of left-right kidney will be incorrect result. Therefore this study compared both ROIs including expanded renal pelvis and excluding renal pelvis through experiment using normal kidney phantom and expanded renal pelvis phantom and suggested setting method of improved ROI. In addition, this study have been helped by readout doctor for investigate distinction radiopharmaceutical uptake between renal cortex and remained urine by expanded renal pelvis. Materials and Methods: The both of renal phantoms were filled with water and shacked with $^{99m}TcO_4$ 111 MBq. In order to describe the expanded renal pelvis, the five latex balloon were all filled with 10 mL water and each of balloon was mixed with $^{99m}TcO_4$ 18.5, 37, 55.5, 74, 92.5 MBq. And we made phantom with fixed $^{99m}TcO_4$activity of 37 MBq and mixed water 5, 10, 15, 20, 25 mL in each balloon. The left kidney was fixed its shape and the right kidney was modified like as hydronephrosis kidney by attached the latex balloons. And the acquiring counts were 2 million. After acquisition, we compared the image of ROI with Expanded renal pelvis and the image of ROI without renal pelvis for analyzing difference in the uptake ratio of left-right kidney and for reproducibility, set the ROI 5 times in the same images. Patients were injected $^{99m}Tc$-DMSA 1.5~1.9 MBq/kg and scanned 3 to 4 hours after injection. The each of 3 skillful radio technologists performed the comparing estimation by setting ROI. To determine statistical significance between two data, SPSS (ver. 17) Wilcoxon Signed Ranks Test was used. Results: As a result of renal phantom's experiment, we compared with average of counts Background (BKG) ratios in the setting of ROI including expanded renal pelvis and setting of excluding expanded renal pelvis. Therefore, they can obtain changed counts and changed ratios. Patient also can obtain same results. In addition, the radiopharmaceutical uptake in expanded renal pelvis was come out the remained urine that couldn't descend to ureter by the help of readout doctor. Conclusion: As above results, the case of setting ROI including expanded renal pelvis was more abnormally increasing uptake ratio than the case of setting ROI excluding expanded renal pelvis in analysis the uptake ratio in left-right kidney of hydronephrosis. Because of the work convenience and prompted analysis, the automatic ROI is generally used. But in case of the hydronephrosis study, we should set the manual ROI without expanded renal pelvis for an accurate observation of the uptake ratio of left-right kidney since the radiopharmaceutical uptake in expanded renal pelvis is the remained urine.

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The Plan of Dose Reduction by Measuring and Evaluating Occupationally Exposed Dose in vivo Tests of Nuclear Medicine (핵의학 체내검사 업무 단계 별 피폭선량 측정 및 분석을 통한 피폭선량 감소 방안)

  • Kil, Sang-Hyeong;Lim, Yeong-Hyeon;Park, Kwang-Youl;Jo, Kyung-Nam;Kim, Jung-Hun;Oh, Ji-Eun;Lee, Sang-Hyup;Lee, Su-Jung;Jun, Ji-Tak;Jung, Eui-Ho
    • The Korean Journal of Nuclear Medicine Technology
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    • v.14 no.2
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    • pp.26-32
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    • 2010
  • Purpose: It is to find the way to minimize occupationally exposed dose for workers in vivo tests in each working stage within the range of the working environment which does not ruin the examination and the performance efficiency. Materials and Methods: The process of the nuclear tests in vivo using a radioactive isotope consists of radioisotope distribution, a radioisotope injection ($^{99m}Tc$, $^{18}F$-FDG), and scanning and guiding patients. Using a measuring instrument of RadEye-G10 gamma survey meter (Thermo SCIENTIFIC), the exposure doses in each working stage are measured and evaluated. Before the radioisotope injection the patients are explained about the examination and educated about matters that require attention. It is to reduce the meeting time with the patients. In addition, workers are also educated about the outside exposure and have to put on the protected devices. When the radioisotope is injected to the patients the exposure doses are measured due to whether they are in the protected devices or not. It is also measured due to whether there are the explanation about the examination and the education about matters that require attention or not. The total exposure dose is visualized into the graph in using Microsoft office excel 2007. The difference of this doses are analyzed by wilcoxon signed ranks test in using SPSS (statistical package for the social science) program 12.0. In this case of p<0.01, this study is reliable in the statistics. Results: It was reliable in the statistics that the exposure dose of injecting $^{99m}Tc$-DPD 20 mCi in wearing the protected devices showed 88% smaller than the dose of injecting it without the protected devices. However, it was not reliable in the statistics that the exposure dose of injecting $^{18}F$-FDG 10 mCi with wearing protected devices had 26% decrease than without them. Training before injecting $^{99m}Tc$-DPD 20 mCi to patient made the exposure dose drop to 63% comparing with training after the injection. The dose of training before injecting $^{18}F$-FDG 10 mCi had 52% less then the training after the injection. Both of them were reliable in the statistics. Conclusion: In the examination of using the radioisotope $^{99m}Tc$, wearing the protected devices are more effective to reduce the exposure dose than without wearing them. In the case of using $^{18}F$-FDG, reducing meeting time with patients is more effective to drop the exposure dose. Therefore if we try to protect workers from radioactivity according to each radioisotope characteristic it could be more effective and active radiation shield from radioactivity.

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The Comparison of Image Quality and Quantitative Indices by Wide Beam Reconstruction Method and Filtered Back Projection Method in Tl-201 Myocardial Perfusion SPECT (Tl-201 심근관류 SPECT 검사에서 광대역 재구성(Wide Beam Reconstruction: WBR) 방법과 여과 후 역투영법에 따른 영상의 질 및 정량적 지표 값 비교)

  • Yoon, Soon-Sang;Nam, Ki-Pyo;Shim, Dong-Oh;Kim, Dong-Seok
    • The Korean Journal of Nuclear Medicine Technology
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    • v.14 no.2
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    • pp.122-127
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    • 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.

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The Characteristics and Fates of Pulmonary Tuberculosis Patients Seen at Medical Department of A Medium Sized General Hospital (부산에 한 중형 종합 병원 내과에서의 폐결핵 환자의 양상과 귀결)

  • Kim, Young-Hyo;Park, Ki-Chan;Bae, Seong;Lee, Sang-Hun;Chun, Myung-Ho;Lee, Sang-Ki;Jun, Kwang-Su;Lee, Chan-Se
    • Tuberculosis and Respiratory Diseases
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    • v.39 no.5
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    • pp.417-424
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    • 1992
  • Background: There were many reports about the clinical aspect and outcomes of pulmonary tuberculosis in health center but few in a medium sized general hospital. The purposes of this study were to find any characteristic differencies in the patients and the general outcomes of the treatments and also to give some suggestive points for the insurance policy making. Methods: We made a retrograde analysis of the medical records of 1981 patients (male 992 female 1,059) who attended our clinics of the 4th internal department, Daedong general hospital during two years from January 1989 to December 1990. Result: 1) Of 1981 patients, 96 were diagnosed as pulmonary tuberculosis taking relatively large proportion in the prevalence. The ratio of prevalence between male and female was 7.81% to 2.27%. The 61.46% were the first diagnosis & initial treatment cases and the remaining 38.54% were the retreatment cases with no statistical significance between sex. 2) The most prevalent age group was between 21~40 years old and the prevalence rate was 45.45% of male and 76.76% of female. The lowest age group in male patient was above 61 showed 3.03%, and there was no female patients above age 60 years old. This phenomena could be thought as the negligence for the treatment of pulmonary tuberculosis in the old age groups rather than true tuberculosis prevalence and it could be proved by the higher rates towards old age groups in the national tuberculosis prevalence survey. 3) There were 57.07% of the minimal case, 48.96% of the moderate, 18.75% of the far advanced. The sputum examination showed 37.07% were culture positive, 46.88% were the negative, and 15.63% of the patients had no stutum examination. Moreover, uncoperatives among the far advanced cases were notable showing 22.22% of the stutum examination, where 16.13% in the minimal cases. The stutum positive rate among the initial treatment cases were 41.07% and 55.00% for the retreatment cases. The sputum no examination rates were 17.86% and 12.50% respectively. 4) The classfication of the mode of disease onset showed 68.75% with gradual onset, 9.38% hemoptic, 3.13% acute pneumonic and 18.75% was found through the radiologic examination in various occasions. 5) The percentages of patients who continued their treatment for more than 8 month were 35.71% (for initial treatment), 25.00% (for retrement), 16.13% (for the minimal), 27.78% (for the far advanced). 6) The group of patients who were treated more than 8 months showed the negative conversion rate of 80% on sputum and marked improvement on chest x-ray in 56.67%. However, in far advanced or retreatment cases, the rate of negative conversion on sputum and the rate of improvement on chest x-ray were low being 60% and 20% for the former and 60% and 10% for the latter, each respectively. Conclusion: It would be strongly emphasized that the improvement of National medical insurance system and social welfare system in Korea must be definite to improve overall treatment and control of tuberculosis diseases as well as physician's devotious National tuberculosis control policy.

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A Study on Influence of Foodservice Managers' Emotional Intelligence on Job Attitude and Organizational Performance (급식관리자의 개인적 감성지능이 직무태도 및 조직성과에 미치는 영향)

  • Jung, Hyun-Young;Kim, Hyun-Ah
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.39 no.12
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    • pp.1880-1892
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    • 2010
  • The purposes of this study were to: a) provide evidence concerning the effects of emotional intelligence on job outcomes, b) examine the impacts of emotional intelligence on employee-related variables such as 'job satisfaction', 'organizational commitment', 'organizational performance', and 'turnover intention' c) identify the conceptual framework underlying emotional intelligence. A survey was conducted to collect data from foodservice managers (N=231). Statistical analyses were completed using SPSS Win (16.0) for descriptive analysis, reliability analysis, factor analysis, t-test, correlation analysis, cluster analysis and AMOS (16.0) for confirmatory factor analysis and structural equation modeling. The concept of emotional intelligence (EI) has been on the radar screens of many leaders and managers over the last several decades. The emotional intelligence is generally accepted to be a combination of emotional and interpersonal competencies that influence behavior, thinking and interaction with others. The main results of this study were as follows. The four EI (Emotional Intelligence) dimensions correlated significantly with age. The means of job satisfaction score were above the midpoint (3.04 point) scale. The organizational commitment score was above the midpoint (3.41 point) scale and was higher at 'loyalty' factor than 'commitment' factor. The means of organizational performance score were above the midpoint (3.34) scale. The correlations among the four EI (emotional intelligence) factors were significant with job satisfaction; organizational commitment, organizational performance and turnover intention. The test of hypothesis using structural equation modeling found that emotional intelligence produced positive effects on job attitude and job performance. Emotional intelligence enhanced organizational commitment, and in turn, managers' attitude produced positive effects on organizational performance; emotional intelligence also had a direct impact on organizational performance. This study has identified the effect of emotional intelligence on organizational performance and attitudes toward one's job.

Evaluation on the Immunization Module of Non-chart System in Private Clinic for Development of Internet Information System of National Immunization Programme m Korea (국가 예방접종 인터넷정보시스템 개발을 위한 의원정보시스템의 예방접종 모듈 평가연구)

  • Lee, Moo-Sik;Lee, Kun-Sei;Lee, Seok-Gu;Shin, Eui-Chul;Kim, Keon-Yeop;Na, Bak-Ju;Hong, Jee-Young;Kim, Yun-Jeong;Park, Sook-Kyung;Kim, Bo-Kyung;Kwon, Yun-Hyung;Kim, Young-Taek
    • Journal of agricultural medicine and community health
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    • v.29 no.1
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    • pp.65-75
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    • 2004
  • Objectives: Immunizations have been one of the most effective measures preventing from infectious diseases. It is quite important national infectious disease prevention policy to keep the immunizations rate high and monitor the immunizations rate continuously. To do this, Korean CDC introduced the National Immunization Registry Program(NIRP) which has been implementing since 2000 at the Public Health Centers(PHC). The National Immunization Registry Program will be near completed after sharing, connecting and transfering vaccination data between public and private sector. The aims of this study was to evaluate the immunization module of non-chart system in private clinic with health information system of public health center(made by POSDATA Co., LTD) and immunization registry program(made by BIT Computer Co., LTD). Methods: The analysis and survey were done by specialists in medical, health field, and health information fields from 2001. November to 2002. January. We made the analysis and recommendation about the immunization module of non-chart system in private clinic. Results and Conclusions: To make improvement on immunization module, the system will be revised on various function like receipt and registration, preliminary medical examination, reference and inquiry, registration of vaccine, print-out various sheet, function of transfer vaccination data, issue function of vaccination certification, function of reminder and recall, function of statistical calculation, and management of vaccine stock. There are needs of an accurate assessment of current immunization module on each private non-chart system. And further studies will be necessary to make it an accurate system under changing health policy related national immunization program. We hope that the result of this study may contribute to establish the National Immunization Registry Program.

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Steroid Effect on the Brain Protection During OPen Heart Surgery Using Hypothermic Circulatory Arrest in the Rabbit Cardiopulmonary bypass Model (저체온순환정지법을 이용한 개심술시 스테로이드의 뇌보호 효과 - 토끼를 이용한 심폐바이패스 실험모델에서 -)

  • Kim, Won-Gon;Lim, Cheong;Moon, Hyun-Jong;Chun, Eui-Kyung;Chi, Je-Geun;Won, Tae-Hee;Lee, Young-Tak;Chee, Hyun-Keun;Kim, Jun-Woo
    • Journal of Chest Surgery
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    • v.30 no.5
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    • pp.471-478
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    • 1997
  • Introduction: The use of rabbits as a cardiopulmonary bypass(CPB) animal model is extremely dif%cult mainly due to technical problems. On the other hand, deep hypothermic circulatory arrest(CA) is used to facilitate surgical repair in a variety of cardiac diseases. Although steroids are generally known to be effective in the treatment of cerebral edema, the protective effects of steroids on the brain during CA are not conclusively established. Objectives of this study are twofold: the establishment of CPB technique in rabbits and the evaluation of preventive effect of steroid on the development of brain edema during CA. Material '||'&'||' Methods: Fifteen New Zealan white rabbits(average body weight 3.5kg) were divided into three experimental groups; control CA group(n=5), CA with Trendelenberg position group(n=5), and CA with Trendelenberg position + steroid(methylprednisolone 30 mglkg) administration group(n=5). After anesthetic induction and tracheostomy, a median sternotomy was performed. An aortic cannula(3.3mm) and a venous ncannula(14 Fr) were inserted, respectively in the ascending aorta and the right atrium. The CPB circuit consisted of a roller pump and a bubble oxygenator. Priming volume of the circuit was approximately 450m1 with 120" 150ml of blood. CPB was initiated at a flow rate of 80~85ml/kg/min, Ten min after the start of CPB, CA was established with duration of 40min at $20^{\circ}C$ of rectal temperature. After CA, CPB was restarted with 20min period of rewarming. Ten min after weaning, the animal was sacrif;cod. One-to-2g portions of the following tissues were rapidly d:ssected and water contents were examined and compared among gr ups: brain, cervical spinal cord, kidney, duodenum, lung, heart, liver, spleen, pancreas. stomach. Statistical significances were analyzed by Kruskal-Wallis nonparametric test. Results: CPB with CA was successfully performed in all cases. Flow rate of 60-100 mlfkgfmin was able to be maintained throughout CPB. During CPB, no significant metabolic acidosis was detected and aortic pressure ranged between 35-55 mmHg. After weaning from CPB, all hearts resumed normal beating spontaneously. There were no statistically significant differences in the water contents of tissues including brain among the three experimental groups. Conclusion: These results indicate (1) CPB can be reliably administered in rabbits if proper technique is used, (2) the effect of steroid on the protection of brain edema related to Trendelenburg position during CA is not established within the scope of this experiment.

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