• Clinical and Experimental Pediatrics
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• v.52 no.6
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• pp.674-679
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• 2009

Purpose : The authors aimed to analyze the long-term effects of treatments, especially external beam radiotherapy (EBRT), in bilateral retinoblastoma patients. Methods : This retrospective study analyzed the medical records of 22 bilateral retinoblastoma patients who were registered between October, 1987 and October, 1998 and followed-up for more than 10 years. They were treated by enucleation, EBRT, and systemic chemotherapy. Age at diagnosis, sex, delay prior to treatment, Reese-Ellsworth (RE) classification, and the local treatment modalities were analyzed in relation to recurrence-free survival (RFS) and complications. Results : Median age at diagnosis was 7.0 months (range 1.7-31.6 months). Leukocoria was the most common presenting feature. Two patients had a familial history. The RE classifications of the 44 eyes were group II in 4, III in 14, IV in 4, and V in 22. At the end of a median follow-up period of 141 months (range 55-218 months), 20 patients were alive. The 10-year ocular survival rate of the 44 eyes was $56.8{\pm}7.5%$. The 10-year RFS and ocular survival rate of the 29 eyes treated by combined EBRT and chemotherapy were 75.9% and 86.2%, respectively. Treatment delay (>3 months) was found to be related to higher risk of recurrence. Complications after EBRT were cataract, retinal detachment, phthisis bulbi, and facial asymmetry. No patient developed a second malignancy during the follow-up period. Conclusion : Early detection and prompt treatment can increase ocular survival rates. In addition, careful attention should be paid to possible long-term sequelae in these patients.

• Clinical and Experimental Pediatrics
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• v.51 no.10
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• pp.1065-1070
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• 2008

Purpose : This study aims to determine whether early closure (within 7 d) of significant patent ductus arteriosus (PDA) with indomethacin or ligation reduces neonatal morbidity when compared with delayed closure (after 7 d). Methods : Fifty-eight extremely-low-birth-weight infants admitted to the NICU of Seoul National University Hospital from April 2005 to May 2007 with PDA were studied retrospectively. Results : The mean gestational age (GA) was $26{\pm}2weeks$ (range, 23-32 wk), and the birth weight was $782{\pm}146g$ (range, 430-990 g). The delayed closure group was associated with early GA ($25.7{\pm}1.7wk$ vs $27.1{\pm}2.0wk$, P=0.013), in vitro fertilization (IVF) (55% vs 24%, P=0.017), and the absence of preeclampsia (5% vs. 34%, P=0.013). There was no difference in ductal size between the early closure and delayed closure groups. The incidence of bronchopulmonary dysplasia (95% vs 65%, P=0.012) and intraventricular hemorrhage (70% vs. 39%, P=0.027) increased in the delayed closure group. Using regression analysis adjusted for gestational age, delayed closure correlated positively with the duration of ventilator support (P=0.008), hospitalization (P=0.020), time to full enteral feeding (P<0.001), and total parenteral nutrition (P=0.010). Conclusion : Delayed closure of the hemodynamically significant patent ductus arteriosus in extremely-low-birth-weight infants is significantly related to the development of various morbidities. Thus, early closure of PDA is needed within the first week of life.

• Clinical and Experimental Pediatrics
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• v.50 no.12
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• pp.1200-1205
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• 2007

Purpose : We performed this study to investigate the outcome of surfactant replacement therapy (SRT) in above nearterm neonates who were required mechanical ventilatory care due to meconium aspiration pneumonia (MAP), respiratory distress syndrome (RDS) or other severe pneumonia (PN). Methods : 48 patients, gestational period ${\geq}36weeks$, who were admitted in NICU of Dongsan Medical Center, Keimyung University between July 1999 and June 2004 were enrolled. They were divided into three groups, MAP group (15 cases), RDS group (27 cases) and PN group (6 cases). All patients were received SRT and evaluated several clinical data (gestational age, oxygen index, duration of ventilator care) and outcome (complications and mortality rate) between pre-SRT and post-SRT. The mean dose of surfactant (modified bovine surfactant, Newfacten, Yuhan Co., Seoul, Korea) was 120 mg/kg. Results : Among each groups, mean pre-SRT OI was higher in MAP group ($21{\pm}3.2$) than other groups, mean duration (days) of ventilatory care and oxygen therapy were similar distributions. Compared with pre-SRT values, significant improvements (P<0.05) in mean values for FiO2 and oxygenation index were documented at 12 hours after SRT. Early complications (persistent pulmonary hypertension of newborm, pneumothorax) and survival rate were lower in MAP group. Within RDS group, earlier SRT (given before 12 hours of life) revealed significantly lower early complication rate than later SRT (given after 12 hours of life) (13.3% vs 58.3%, P<0.05) Conclusion : Our study suggested that SRT seems to be an effective therapy in above nearterm neonates with severe pulmonary disease, and earlier SRT tends to reduce complications in RDS group than later therapy.

• Neonatal Medicine
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• v.16 no.1
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• pp.47-54
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• 2009

Purpose: Present evidences suggest that Ureaplasma urealyticum is a cause of pneumonia, septicemia, and bronchopulmonary dysplasia (BPD) in newborn infants, particularly those born prematurely. The purpose of this work was to examine the relationship between Ureaplasma urealyticum in the tracheal aspirates and adverse outcomes, such as BPD and early onset neonatal sepsis in premature infants. Methods: A polymerase chain reaction (PCR) was performed on tracheal aspirates collected within 24 hour after birth in 176 premature infants less than 35 weeks of gestation and admitted to the neonatal intensive care unit of Bundang CHA Hospital. Results: U. urealyticum was detected in 37 of 176 preterm infants (21.0%). Gestational age ($29^{+5}{\pm}2^{+5}$ wk vs. $30^{+6}{\pm}2^+{-5}$ wk, P=0.0l3) and birth weight (1.39${\pm}$0.44 kg vs. 1.59${\pm}$0.55 kg, P=0.037) were lower in the U urealyticum-positive group compared to the control group. The incidence of early onset neonatal sepsis (16.2% vs. 6.5%, P=0.045) and BPD (45.9% vs. 29.5%, P=0.047) was higher in the U urealyticum-positive group compared to the control group, but the severity of BPD was not different between two groups. However, multiple logistic regression analysis revealed that the presence of U. urealyticum was not independently related to the development of early onset neonatal sepsis and BPD. Conclusion: The results suggest that colonization of the lower respiratory tract by U. urealyticum might not be related to the development of neonatal sepsis and BPD directly in preterm infants.

• Korean Journal of Psychosomatic Medicine
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• v.7 no.1
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• pp.116-123
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• 1999

Objectives : The authors attempted to assess how much the mechanism of dissociation affects somatization disorder patients psychopathologically, and explore the relationship between sexual or physical abuse and somatic symptoms in somatization disorder patients. Methods : The authors administered the Dissociative Experiences Scales-Korean version(DESK) and Dissociative Disorders Interview Schedule to 25 patients with somatization disorder and 51 normal subjects. Results : There were no significant demographic differences between patient and control groups. The mean score of DES-K for patient group was 18.2, and 10.0 for the control group. The percentage of the individuals with high scores(20 and over) was 36.0 in the patient group and 7.8 in the control group, respectively. The percentage of the individuals with sexual and/or physical abuse was 16.0 in the patient group and zero in the control group. Our results showed that DES-K scores were not influenced by the factor of age or religion in either group, but the scores of the patients with somatization disorder were significantly higher than those in the normal subjects. Conclusion : There was an implication that the mechanism of dissociation affects issues of psychopathogenesis and psychopathology in Korean patients with somatization disorder, even though they have different sociocultural backgrounds in comparison to Western patients. The authors suggest it is useful to focus attention on childhood abuse and dissociation in the evaluation and dynamic psychotherapy of patients with somatization disorder.

• The Journal of Korean Society for Radiation Therapy
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• v.22 no.1
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• pp.53-60
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• 2010

Purpose: We try to calculate EDW-factor easily with the formula applies essential data of EDW-factor and evaluate the validity through a measurement. Materials and Methods: We used the given value of GSTT (Golden Segmented Treatment Table) for the calculation of the EDW-factor. As to the experimental device, 0.6 cc farmer-type ion-chamber, an electrometer and water- phantom were used. A measurement was made at the maximum dose depth of the photon beam energy 6 MV and 15 MV under the condition that SSD (Source to Surface Distance) was 100 cm. The angle of the EDW (Enhanced Dynamic Wedge) which we use in an experiment was 60 degree, 30 degree, 20 degree in the Y1-OUT direction. We used Eclipse planning system (Varian, USA) as RTP system and the EDW-factor was calculated about all fields and EDW direction. In order to show the EDW-factor feature, a measurement was made at the selected field that verify the influence of the dependability about X, Y jaw and off-axis field. Results: When we change the Y1 field, it influence on the EDW-Factor and measured value. But the error between measured values and calculated values was less than 1%. The experimental result indicated the tendency that the error of the result of calculation and measured value becomes smaller as the EDW angle become smaller whether the calculation point (measurement point) and iso-center are same or not. The influence of the field size and energy did not show up. We simulated with the same condition using the RTP system. And we found that it makes no difference between the MU which is calculated manually by applying the EDW-Factor obtained from the commercial program and the value which is calculated by using RTP system. Conclusion: We excluded fitting value from well-known EDW-Factor formula and calculated EDW-factor with the formula applies essential data of EDW-factor only. As a result, there are no significant difference between the measured value and calculated value and it showed errors less than 1%. Also, we implemented the commercial program to calculate EDW-Factor conveniently without measure a factor on each field.

• The Journal of Korean Society for Radiation Therapy
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• v.22 no.1
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• pp.33-39
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• 2010

Purpose: It is very important to confirm conformance of dose distribution that is formed with treatment planning from IMRS or IMRT. It has been a problem dropped accuracy and conformance when the field size is getting smaller because of character of the 2D ion chamber. Verification of MatriXX Phantom dose distribution with a change in the SAD. Dose distribution measurement and analysis to improve the accuracy and should be useful to evaluate the award. Materials and Methods: A use of Novalis linear accelerator 6 MV photon beams. In general, IMRS were 25 patients with small field size. The selected patients were divided into three groups on the basis of the field size. SAD was changed from 80 to 130 cm and field size to determine the dose distribution to the change, each dose was measured using MatriXX Phantom. Analysis of measured values obtained from the program for each patient through the treatment planning system comparison and analysis of the dose distribution and gamma values were expressed. Result: SAD 80, 100, and 120 cm in size in the gamma value to the investigation of patients less than $3\;cm^2$ average 0.939, 0.969, and 0.979, respectively. Patients with more than $5\;cm^2$ 0.962, 0.983, and 0.988, respectively. $5\;cm^2$ or more patients 0.982, 0.990, and 0.992, respectively. Conclusion: The error rate of less than $3\;cm^2$ field size is increased rapidly. If the field size is increased, resolution is increased by 2D ion chambers. It has been approved that it can be credible if it is around $3\;cm^2$ when measuring dose distribution using MatriXX. Adjusting geometric field size by changing SAD is likely to be very useful when you measure dose distribution using MatriXX.

• Korean Journal of Head & Neck Oncology
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• v.17 no.2
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• pp.139-147
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• 2001

Objectives: The most important differential point of follicular carcinoma from adenoma is capsular invasion or angioinvasion of follicular cells. Serial sections for examination of levels of tumor margins are necessary to watch the invasion. However, the interpretation of capsular invasion or angioinvasion is sometimes not feasible on the routine staining of tumor tissue. The aim of this study is to evaluate the clinical significance of expressions of $p27^{KIP1}$, MIB-1, bcl-2 and p53 in differential diagnosis of follicular adenoma and carcinoma. Materials and Methods: 16 cases of follicular carcinoma and 26 cases of follicular adenoma were entered on study of immunohistochemical stains for $p27^{KIP1}$, MIB-1, bcl-2 and p53. In carcinoma cases, correlation between the above markers, patient's age, tumor size, infiltration pattern and metastasis was studied. Results: $p27^{KIP1}$ labelling index (LI) of follicular carcinoma and adenoma was $4.89{\pm}6.92$ and $14.52{\pm}9.17$, respectively, but there was no significant difference between adenoma and carcinoma (p=0.2560). MIB-1 LI of carcinoma and adenoma was $4.11{\pm}3.89$ and $0.80{\pm}0.75$, respectively, and MIB-1 LI was significantly higher in carcinoma (p=0.0000). bcl-2 expression was seen in 2(12.5%) of 16 carcinoma cases and 130(50.0%) of 26 adenoma cases, and bcl-2 expression rate was higher in adenoma than in carcinoma(p=0.014). In one adenoma and one carcinoma case, p53 expression was noted. In follicular adenoma with atypia compared to adenoma without atypia, lower $p27^{KIP1}$ LI, higher MIB-1 LI and lower bcl-2 expression rate were seen. In follicular carcinoma, MIB-1 LI was significantly higher in invasive carcinoma(p=0.045) and was relatively increased in tumors larger than 3.0cm, showing angioinvasion and distant metastasis. But $p27^{KIP1}$ LI was higher in cases over 40 years old(p=0.008) and with conspicuous capsular invasion. There were no positive correlations between expressions of MIB-1, bcl-2 and p53. Conclusion: MIB-1 labelling index and bcl-2 expression could be helpful for differential diagnosis of follicular adenoma and carcinoma, but p53 showed very low expression rate and no significance in differential diagnosis. $p27^{KIP1}$ labelling index reveals decreasing tendency in carcinoma compared with adenoma, MIB-1 LI was considered as a poor prognostic marker in follicular carcinoma, but $p27^{KIP1}$ LI was higher in carcinoma cases over 40 years old with showing conspicuous capsular invasion. Further study for the significance of $p27^{KIP1}$ labelling index in follicular neoplasms is necessary to evaluate diagnostic value of follicular carcinoma.

• Horticultural Science & Technology
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• v.19 no.3
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• pp.378-383
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• 2001

Embryo culture, ovule culture and ovary slice culture were tested to find optimum method for overcoming post fertilization barrier in interspecific crosses between L. longiflorum 'Gelria' and L. cernuum. Although reciprocal crosses between the species were carried out by cut-style pollination method, fruits developed only in crosses of L. longiflorum${\times}$L. cernuum. On the 40 days after pollination, ovaries were sliced into 2-4mm thickness and cultured on a hormone-free Murashige-Skoog (MS) medium, supplemented with 2%, 4%, 6%, 8% and 10% sucrose. For the L. longiflorum Gelria'${\times}$L. cernuum cross, ovule development was found to be best at 6% sucrose and a lot of hybrid plant lets established directly from the ovary slice culture and subsequent ovule culture. High concentration of sucrose above 8% made ovules abort or vitrificate from 40 days after culture. In contrast, ovules from the L. cernuum${\times}$L. longiflorum 'Gelria' cross swelled well in ovary slice culture, however, they did not germinated in subsequent ovule culture. On the 60 days after pollination, ovules thicker than 0.6mm was interpreted as one containing embryo. The embryo size ranged from 1.2 mm to 1.7 mm, and in vitro development of the excised embryos was found to be best with the MS medium (pH 5.8), supplemented with $0.1-1 mg{\cdot}L^{-1}$ NAA and 6% sucrose. Thick ovules excised 60 days after pollination germinated about 60% as normal seeds in MS medium supplemented with 6% sucrose and free hormone. The ovule culture 60 days after pollination was concluded to be most recommendable to produce interspecific hybrids in large scale crosses between L. longiflorum 'Gelria' and L. cernuum by the reason of easy procedure.

• Clinical and Experimental Pediatrics
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• v.48 no.8
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• pp.813-819
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• 2005

Purpose : Medicolegal problems start when the patient asserts the mistake of doctor and doctor does not accept it. The purpose of this study is to assess the actual condition of medicolegal problems and to provide solutions of medicolegal problems in the pediatric field. Methods : There is not official statistical data about medicolegal problems in our country. We gathered data of legal insurance program of Korean Medical Association(KMA) and court cases and other fragmentary data. Results : Between 1981 and 1995, of total 2,338 cases reported to legal problem insurance program of KMA, most common ones were 748 cases of obstetrics and gynecology. Pediatric case was ranked at the 5th, 74 cases(3.1%). According to analysis of 41 medicolegal cases' after 1990, maltreatment of patient had the highest incidence of 14 cases, injection and medication were related to 12 cases, misdiagnosis was 9 cases, patient management were related to 4 cases, and others were 2 cases. The trial result of the medicolegal cases was that 31 cases were compensated, and 8 cases were defeated, and 2 cases were still in the process. Conclusion : The aspect of medical legal problem has the tendency of radicalism and systematization. This brings an economic destitution in the patient and gives damage to a doctor. In order to reduce medicolegal problem, doctor should offer a duty of explanation and efforts to his best to satisfy patient and endeavor to make an intimate doctor-patient relationship.