• Sleep Medicine and Psychophysiology
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• v.11 no.1
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• pp.22-28
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• 2004

Objective: The purpose of this study is to investigate the prevalence rate of OSA in subjects whose main sleep complaint is insomnia and to find differential factors of OSA in these insomniac subjects. Method: We reviewed the medical records and polysomnographic findings of patients referred to the Sleep Laboratory at Seoul National University Hospital from January 1996 to December 2002. Four-hundred and seventy subjects complained of insomnia as their main sleep problem (235 males and 235 females, mean age $53.6{\pm}12.4\;years$). First, we investigated the prevalence rate of OSA in these insomniac patients. Second, we compared the clinical and demographic characteristics of the OSA-associated group with those of the non-associated group. Third, we examined whether the degree or presence of differential factors within the OSA group correlate with severity of OSA, as determined by the respiratory disturbance index (RDI). Results: Among 470 insomniac subjects, 125 subjects (26.6%) were diagnosed as OSA by nocturnal polysomnography. OSA-associated subjects were significantly older ($58.4{\pm}12.3\;years$ vs. $51.8{\pm}11.2\;years$, p<0.01), and had significantly higher body mass index (BMI) ($23.4{\pm}3.3\;kg/m^2$ vs. $22.5{\pm}3.1\;kg/m^2$, p=0.44) than non-associated subjects. The OSA-associated group had more subjects with male gender (64.0% vs. 44.9%, p<0.01), hypertension (20.0% vs. 9.3%, p<0.01) or snoring (96.0% vs. 63.5%, p<0.01). Within the OSA-associated group, age had a significant positive correlation with RDI (p=0.01). Conclusion: We found that a considerable portion of patients complaining of insomnia as their main sleep problem were diagnosed as OSA. Snoring, old age, male gender, obesity, and comorbid hypertension were found to be differential factors of OSA in insomniac patients. We suggest that diagnostic efforts including nocturnal polysomnography are needed for insomniac patients with any of the above risk factors of OSA.

• Tuberculosis and Respiratory Diseases
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• v.44 no.2
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• pp.401-408
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• 1997

Background : Pulmonary sequestration is a rare congenital malformation, which is manifested by formation of nonfunctioning lung tissue lacking normal communication with the tracheobronchial tree. The preoperative diagnostic rate has been relatively low, and without consideration of pulmonary sequestration, unexpected bleeding from aberrant vessels may be a serious problem during the operation. The purpose of our study is to describe the clinical features of pulmonary sequestration based on a review of 15 cases treated by operation. Method : Fifteen patients with pulmonary sequestration who had undergone surgical treatment from 1991 through May 1996 at Yongdong Severance Hospital and Severance Hospital were reviewed retrospectively. Results : The mean age of the patients was 22.5 years (range 5~57), and male to female ratio was 9 : 6. Clinical presentations varied from recurrent respiratory infections such as fever, cough, and sputum or chest pain to no symptom. The chest simple X-rays showed multicystic shadow(10/15) and solid mass-like shadow(5/15). The chest CT scans, done in twelve cases, showed multicystic lesion with or without lung infiltration(8/12), solid mass-like lesion(4/12), The chest MRIs, done in three cases, revealed the aberrant arteries originating from descending aorta(2/3). Aortograms, done in four cases, showed the aberrant arteries originating from descending thoracic aorta(2/4), abdominal aorta(I/4), and intercostal artery(1/4). and the venous returns were via the pulmonary veins. Pulmonary sequestration was considered preoperatively in six patients of fifteen. Other preliminary diagnosis were lung tumor(3/15), lung abscess(21/15), bronchiectasis(2/15), and mediastinal tumor(2/15). In the operative findings, twelve cases were of intralobar type and three cases of extralobar type. The left lower lobe was most often affected(9/15) and one extralobar sequestration was in the pericardium. The aberrant arteries originated from descending thoracic aorta(6/15), abdominal aorta(1/15), internal thoracic arteries (2/15), intercostal artery(1/15), pericardiophrenic artery(1/15), but in four cases, the origins could not be defined. There was no mortality or complication postoperatively. Conclusion : In our study, preoperative diagnostic rate was relatively low, and clinical features were similar to previous reports. Preoperative vigorous diagnostic approach including aortography is strongly advocated not only for its diagnostic value, but also for accurate localization of the aberrant vessels, which is major concern to surgical procedure.

• Tuberculosis and Respiratory Diseases
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• v.45 no.1
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• pp.116-127
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• 1998

Background: The natural course of sarcoidosis is variable from spontaneous remission to significant morbidity or death. So the assessment of disease activity is important but no single parameter was generally accepted as a good marker. Recently several studies suggested that adhesion molecules, especially ICAM-1 can be a marker, but there are some controversies. And only few data are available about the relationship of ICAM-1 with clinical follow-up course. Methods: We measured the expression of adhesion molecules on BAL cells by flow cytometry and the level of soluble ICAM-1(sICAM-1) in serum and BALF at the time of diagnosis in 12 patients with active disease and 7 inactive sarcoidosis(5 male, 14 female, mean age: $39.4{\pm}10.7$ years, mean follow-up : $20{\pm}15$ months). Follow-up clinical course were compared with the changes in serum sICAMA-1 level and the adhesion molecule on BAL cells. Results: In the patients with active disease, the ICAM-1 on AM(RMFI: $3.68{\pm}1.71$) and sICAM-1 level in serum($582{\pm}193$ng/ml) and BAL fluid($47.8{\pm}16.5$ng/ml) were all higher than those of 7 inactive disease(RMFI: $1.89{\pm}0.75$, p=0.0298, serum: $294{\pm}117$ ng/ml, p=0.0049, BALF: $20.9{\pm}8.3$ ng/ml). In the active sarcoidosis, ICAM-1 on AM(RMFI : $1.51{\pm}0.84$) and serum sICAM-1 were decreased after the therapy($250{\pm}147$ ng/ml) but no significant change was noted in inactive disease. Also we found the initial ICAM-1 on AM and serum sICAM-1 had a significant correlation with the degree of improvement in PFT after the therapy. During the follow-up, the disease relapsed in 4 patients after the discontinuation of steroid and the serum sICAM-1 level went-up again at the time of relapse. Conclusion: Our data suggest that the serum sICAM-1 level and the ICAM-1 expression on AM can be a good marker of disease activity and also a predictor of outcome in sarcoidosis.

• Tuberculosis and Respiratory Diseases
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• v.47 no.4
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• pp.507-516
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• 1999

Background : Patients with lung cancer and their relatives often ask the advice of relative or friends who are doctors on the treatment and prognosis of the disease. Therefore a doctor's opinion may play a role in determining the treatment modality and affect therapeutic compliance of patients. The purpose of this study was to find the opinion of general practitioners on lung cancer treatment. Method : A mail survey for general practitioners in Taegu City and Northern Kyungsang Province was performed. Each individual was sent a written questionnaire in which he or she was asked for ten questions about management and prognosis of lung cancer. Results : Two hundred and twenty eight doctors filled in the questionnaire. Of the respondents, 68% had the experience of being asked about lung cancer by their friends or relatives. About 52% replied that it was better to tell the patient of his or her disease. And about 22% considered it better to follow the relatives' opinion. On the question about choosing the treatment modality, following the doctors' plan was most appropriate in 86.9%, showing that most respondents favored actively recommending doctors. Nonsurgical treatment was preferable in patients over 80 years old with resectable lung cancer and with an increase in age, significant increase was observed in respondents recommending nonsurgical treatment. Most respondents said that they would actively recommend or advise following the doctors' plan about radiotherapy and chemotherapy. But a large percent of the respondents had a negative view on the effect of radiotherapy and chemotherapy. Conclusion : The opinions of general practitioners on the treatment and prognosis of lung cancer was variable. And they did not prefer active treatment for patients with old age or advanced lung cancer.

• Tuberculosis and Respiratory Diseases
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• v.56 no.4
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• pp.364-373
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• 2004

Background : Obstructive sleep apnea is a contributory factor of hypertension, arrhythmia, ischemic heart disease and other cardiovascular diseases. However, the pathophysiology underlying this relationship is unclear. Recent reports have shown that the soluble intercellular adhesion molecule-1(sICAM-1) and vascular endothelial growth factor(VEGF) are involved in the initiation and progression of atherosclerosis, and some reports state that increased levels of these cytokines are found in patients with obstructive sleep apnea. In this study, the levels of sICAM-1 and VEGF were measured in patients with obstructive sleep apnea in order to determine if obstructive sleep apnea is involved in the pathophysiology of cardiovascular diseases. Methods : Thirty-seven patients were chosen amongst a population who visited the Sleep Disorders Clinic of St. Paul's Hospital in Seoul, Korea for a diagnosis of obstructive sleep apnea and who had subsequently undergone an overnight polysomnography at the clinic. The sera from these patients were retrieved after an overnight polysomnography session and the samples were kept at $-70^{\circ}C$. The cytokine levels were determined with ELISA and the relationships between the serum levels of sICAM-1 and VEGF along with polysomnography parameters were analyzed. Results : No statistically significant correlation was observed between the sICAM-1 levels and the apnea-hypopnea index(r=0.27, P>0.05). Positive correlations were found between the apnea-hypopnea index and serum VEGF levels (r=0.50, P<0.01), the apnea index and the serum sICAM-1 levels (r=0.31, P<0.01), and the apnea index and the serum VEGF levels (r=0.45, P<0.01). Conclusions : Obstructive apnea or hypopnea leads to an increase in the sICAM-1 and VEGF levels. Such an increase in the cytokine levels most likely leads to the higher incidence of cardiovascular diseases observed in patients with obstructive sleep apnea.

• Clinical and Experimental Reproductive Medicine
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• v.37 no.1
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• pp.57-64
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• 2010

Objectives: Likewise fresh cycle, it is also important to select right blastocysts for transfer in purpose of improving the pregnancy and implantation rates in frozen-thawed embryo transfer (ET) cycles. To investigate the relationship between the developmental velocity at the time of cryopreservation and pregnancy rates, we compared pregnancy rates between the day 5 cryopreservation group and the day 6 cryopreservation group. Methods: Transfers of frozen-thawed blastocysts which had been cryopreserved by vitrification on day 5 or day 6 were performed between January 2006 and June 2007. Ethylene glycol, DMSO, and pull and cut straws were used for vitrification and artificial shrinkage was done in expanded blastocysts. Thawing was performed on the day before transfer and thawed blastocysts were cultured in for 15~18 hrs in Quinn's blastocyct media. Blastocyst survival was assessed before transfer and post-thaw survival was defined as >50% of cells remaining intact and blastocoele re-expansion by the time of transfer. Results: Transfers of thawed blastocyst had been cryopreserved on day 5 were 52 cycles and 41 transfer cycles were cryopreserved on day 6. Patient characteristics, the number of transferred embryos and the survival rate of thawed blastocysts were not different in each cryopreservation day. But the biochemical pregnancy, clinical pregnancy, ongoing pregnancy, and implantation rate were significantly high in transfer of frozen-thawed blastocyst which were cryopreserved on day 5. Conclusions: The clinical pregnancy and implantation rate of day-5 blastocyst showed significantly higher than those of day-6 blastocyst in frozen-ET cycles. This result indicated that developmental rate of blastocyst at cryopreservation time in frozen-thawed cycle is discriminative marker of pregnancy outcome as like in fresh cycle.

• Tuberculosis and Respiratory Diseases
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• v.45 no.5
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• pp.1000-1011
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• 1998

Background: For the diagnosis or evaluation of airway obstruction in bronchial asthma and chronic obstructive lung disorders, various parameters derived from the forced expiratory volume curve and maximal expiratory flow volume curve have been used. Recently the peak expiratory flow(PEF) measured by the peak flow meter is widely used because of its simplicity and convenience. But there were still no data of the predicted normal values measured by the peak flow meter in Korea. This study was to obtain the predicted normal value of PEF and to know the accuracy of this value to predict $FEV_1$. Method: The measurements of PEF by the MiniWright peak flow meter and several parameters derived from the forced expiratory volume and maximal expiratory flow volume curves by the Microspiro HI 501(Chest Co.) were done in 129 men and 125 women without previous history of the respiratory diseases. The predicted normal values of parameters according to the age and the height were obtained, and the regression equation of $FEV_1$ by PEF was calculated. Results: The predicted normal values of PEF(L/min) were -2.45$\times$Age(year) +1.36 $\times$ Height(cm)+427 in men, and -0.96 $\times$ Age (year) + 2.01 $\times$ Height (cm) + 129 in women. FEFmax derived from the maximal expiratory flow volume curve was less than by 125 L/min in men and 118 L/min in women respectively compared to PEF. $FEV_1$(ml) predicted by PEF was 5.98 $\times$ PEF(L/min) + 303 in men, and 4.61 $\times$ PEF(L/min) + 291 in women respectively. Conclusion : The predicted normal value of PEF measured by the peak flow meter was calculated and it could be used as a standard value of PEF while taking care of patients with airway obstruction. $FEV_1$, the gold standard of ventilatory function, could be predicted by PEF to a certain extent.

• The Journal of Korean Society for Radiation Therapy
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• v.29 no.1
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• pp.77-84
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• 2017

Purpose: To evaluate the image quality improvement and dosimetric effects on virtual monochromatic images of a Dual Source-Dual Energy CT(DS-DECT) for radiotherapy planning. Materials and Methods: Dual energy(80/Sn 140 kVp) and single energy(120 kVp) scans were obtained with dual source CT scanner. Virtual monochromatic images were reconstructed at 40-140 keV for the catphan phantom study. The solid water-equivalent phantom for dosimetry performs an analytical calculation, which is implemented in TPS, of a 10 MV, $10{\times}10cm^2$ photon beam incident into the solid phantom with the existence of stainless steel. The dose profiles along the central axis at depths were discussed. The dosimetric consequences in computed treatment plans were evaluated based on polychromatic images at 120 kVp. Results: The magnitude of differences was large at lower monochromatic energy levels. The measurements at over 70 keV shows stable HU for polystyrene, acrylic. For CT to ED conversion curve, the shape of the curve at 120 kVp was close to that at 80 keV. 105 keV virtual monochromatic images were more successful than other energies at reducing streak artifacts, which some residual artifacts remained in the corrected image. The dose-calculation variations in radiotherapy treatment planning do not exceed ${\pm}0.7%$. Conclusion: Radiation doses with dual energy CT imaging can be lower than those with single energy CT imaging. The virtual monochromatic images were useful for the revision of CT number, which can be improved for target coverage and electron densities distribution.

• Journal of radiological science and technology
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• v.29 no.2
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• pp.57-62
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• 2006

Purpose : This study was to understand about the measurement of shoulder motion fraction and motion ratio. We proposed the radiological criterior of glenohumeral and scapulothoracic movement ratio. Materials and Methods : We measured the motion fraction of the glenohumeral and scapulothoracic movement using CR(computed radiological system) of arm elevation at neutral, 90 degree, full elevation. Central ray was $15^{\circ},\;19^{\circ},\;22^{\circ}$ to the cephald for the parallel scapular spine, and the tilting of torso was external oblique $40^{\circ},\;36^{\circ},\;22^{\circ}$ for perpendicular to glenohumeral surface. Healthful donor of 100 was divided 5 groups by age(20, 30, 40, 50, 60). The angle of glenohumeral motion and scapulothoracic motion could be taken from gross arm angle and radiological arm angle. We acquired 3 images at neutral, $90^{\circ}$ and full elevation position and measured radiographic angle of glenoheumeral, scapulothoracic movement respectively. Results : While the arm elevation was $90^{\circ}$, the shoulder motion fraction was 1.22(M), 1.70(W) in right arm and 1.31, 1.54 in left. In full elevation, Right arm fraction was 1.63, 1.84, and left was 1.57, 1.32. In right dominant arm(78%), $90^{\circ} and Full motion fraction was 1.58, 1.43, in left(22%) 1.82, 1.94. In generation 20, $90^{\circ} and Full motion fraction was 1.56, 1.52, 30' was 1.82, 1.43, 40' was 1.23, 1.16, 50' was 1.80, 1.28, 60' was 1.24, 1.75. There was not significantly by gender, dominant arm and age. Conclusion : The criterior of motion fraction was useful reference for clinical dignosis the shoulder instability.

• Neonatal Medicine
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• v.15 no.1
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• pp.32-37
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• 2008

Purpose : Perinatal asphyxia is an important cause of neonatal mortality and subsequent lifelong neurodevelopmental handicaps. Although many treatment strategies have been tested, there is currently no clinically effective treatment to prevent or reduce the harmful effects of hypoxia and ischemia in humans. In the clinical setting, maternal hyperthermia induces adverse effects on the neonatal brain, but recent studies have shown that hyperthermic pretreatment (PT) plays some role in hypoxic-ischemic (HI) injuries of the developing brain. The present study investigated the effect of hyperthermic PT on HI brain injuries in newborn rats. Methods : HI was produced in 7-day-old neonatal rats by unilateral common carotid artery ligation, followed by hypoxia with 8% oxygen at $38^{\circ}C$ for 2 hours. Twenty-four hours before HI, one-half of the pups were exposed to a $40^{\circ}C$ environment for 2 hours. The severity of the brain injury was assessed 7 days after the HI. Results : Hyperthermic PT reduced the gross and histopathologic findings of brain injury from 64.7 to 31.2% (P<0.05). There were no differences in location and severity of injury between the pretreated and control brains. Conclusion : These findings indicate that hyperthermic PT provides neuroprotective benefits on HI in the developing brain. Also, these findings suggest maternal hyperthermia may have protective effect on perinatal HI brain injuries.