• Journal of Chest Surgery
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• v.37 no.10
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• pp.827-832
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• 2004

Background: The significance of MIDCAB is emerging topics recently as OPCAB is going to be universalized, and long-term outcome of bypass graft surgery was proved to be more excellent than balloon dilation or stent insertion. We report our MIDCAB results in 73 patients in the last three years. Material and Method: Retrospective analysis of medical records was done from November 1, 2000 through November 31, 2003. There were 47 males and 26 females ranging in age from 31 years to 79 years (average $61.3\pm9.8$ years). Observation periods after operative procedures were 10 to 1238 days (average $763\pm319.8$ days). Left longitudinal parasternal incision as a standard procedure was done to approach the heart after dissection of the left internal thoracic artery by partial or total resection of 3rd to 5th ribs. Result: Of those patients, 46 patients were transferred to ICU after extubation at operation room and 58 patients were extubated within 3 hours after operation. Average ICU staying periods was $26.8\pm11.5$ hours. Follow-up angiography during admission was done in 36 patients and showed 100% patency. Only one patient died on the 10$^{th}$ post operative day because of sudden CVA. Complications included wound problems in 4 patients, and constructing pericardial window using thoracoscopy due to continuous pericardial effusion in 1. Permanent pacemaker was inserted in one patient owing to sick sinus syndrome. In one patient with recurrence of angina 8 months after operation, stenosis at anastomic site was found and improved with balloon dilatation. Conclusion: We were satisfied with our results of MIDCAB in single and multi-vessel coronary artery disease. These results have made the cardiologists tried to operate positively and we expect widening operative indications including hybrid revascularization.

• Tuberculosis and Respiratory Diseases
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• v.53 no.6
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• pp.635-643
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• 2002

Background : The Aim of this study was to compare the recovery of mycobacteria from sputum samples of pulmonary tuberculosis patients using the MB/BacT rapid culture system(Organon Teknika, USA) with that obtained using Lowenstein-Jensen solid medium. Methods : The two culture systems were compared using sputum samples of 99 pulmonary tuberculosis patients. Culture media were incubated at $35-37^{\circ}C$ for six weeks in the MB/BacT system and for 12 weeks in Lowenstein-Jensen solid medium. Solid media were examined macroscopically once a week, and the MB/BacT system positive vials were unloaded from the machine as soon as possible after positive signal from the connected computer was detected Confirmation of growth for mycobacteria was done by Ziehl-Neelson stained smears. Isolates were identified to differentiate Mycobacterium tuberculosis from mycobacterium other than tuberculosis(MOTT) by phenotypic and molecular methods. Results : Of the sputum samples of the 99 patients, 58 samples were smear positive and 41 in negative smear. Mycobacteria were recovered from 67(67.7%) samples by using both culture systems. The yield with MB/BacT was higher than that with Lowenstein-Jensen [67(67.7%) vs. 52(52.5%), p<0.001]. Moreover, 15(15.2%) samples were positive only in the MB/BacT, whereas none of samples was positive only in Lowenstein-Jensen. In smear-positive and smear-negative samples, the recovery rate with MB/BacT was also higher than that with Lowenstein-Jensen [sputum-positive; 56/58(96.6%) vs. 46/58(79.3%), p=0.005, sputum-negative; 6/41(14.6%) vs. 5/41(12.2%), p<0.001]. The mean times to detection of Mycobacteria were 13.3 and 27.2 days with MB/BacT and Lowenstein-Jensen respectively(p<0.001). Conclusion : This results indicate that the the MB/BacT is more efficient and faster than Lowenstein-Jensen for the recovery of mycobacteria.

• Journal of Yeungnam Medical Science
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• v.11 no.1
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• pp.42-48
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• 1994

Among the erythrocyte membrane defects, hereditary spherocytosis is the most common. The erythrocyte membrane defect results from a deficiency of spectrin, the most important structural protein in red cell. Hereditary spherocytosis often presents with hemolytic anemia, jaundice, moderate splenomegaly. Diagnosis is established by the presence of spherocytes in the peripheral blood, reticulocytosis, an increased osmotic fragility, and a negative Coombs test. In children, splenectomy is usually performed after age 6 years but can be done at a younger age if warranted by the severity of the anemia and the need for frequent transfusions. In the period December 1987 to Agust 1993, 9 patients with hereditary spherocytosis underwent splenectomy and the following results were obtained. 1. Nine patients were comprised of five males and four females. 2. Five patients(55.6%) had been admitted to our hospital during age 6-10 years. 3. Four of the nine patients had autosomal dominant inheritance with variable expression. The other five patients had no known inheritance. 4. The diagnosis of the spherocytosis was based on the increased osmotic fragility and increased autohemolysis of the erythrocytes, as well as on the appearance of spherocytes in the peripheral blood smear. 5. In all cases splenectomy was performed. Two patients had concomitant gall stones and choledocholithiasis, respectively. One patient with concomitant gall stones underwent simultaneous cholecystectomy and splenectomy. The other patient associated with choledocholithiasis underwent splenectomy, cholecystectomy, choledocholithotomy, and T-tube drainage. 6. Complete hematologic recovery was obtained by the splenectomy in all cases. 7. Postoperative complication was not occurred.

• Clinical and Experimental Pediatrics
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• v.48 no.12
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• pp.1362-1369
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• 2005

Purpose : This study aimed to investigate the correlation between the plasma level of N-terminal pro-B-type natriuretic peptide(pro-BNP) and several known risk factors influencing outcomes after Fontan operations, and to assess whether pro-BNP levels can be used as predictive risk factors in Fontan operations. Methods : Plasma pro-BNP concentrations were measured in 35 patients with complex cardiac anomalies before catheterization. Cardiac catheterization was performed in all subjects. Mean right atrium pressure, mean pulmonary artery pressure(PAP), and ventricular end-diastolic pressure(EDP) were obtained. Cardiac output and pulmonary vascular resistance were calculated by Fick method. Results : Plasma pro-BNP levels exhibited statistically significant positive correlations with mean PAP(r=0.70, P<0.001), pulmonary vascular resistance(r=0.57, P<0.001), RVEDP(r=0.63, P<0.001), LVEDP(r=0.74, P<0.001), and cardiothoracic ratio(r=0.71, P<0.001). The area under the ROC curve using pro-BNP level to differentiate risk groups in Fontan operations was high : 0.868(95 percent CI, 0.712-1.023, P<0.01). The cutoff value of pro-BNP concentrations for the detection of risk groups in Fontan operations was determined to be 332.4 pg/mL(sensitivity 83.3 percent, specificity 82.7 percent). Conclusion : These data suggest that plasma pro-BNP levels may be used as a predictive risk factor in Fontan operations, and as a guide to determine the mode of therapy during follow-up after Fontan operations.

• Childhood Kidney Diseases
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• v.11 no.2
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• pp.220-228
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• 2007

Purpose : We studied the value of clinical signs, laboratory findings and $^{99m}technetium$ dime-rcaptosuccinic acid(DMSA) scan in predicting the presence of vesicoureteral reflux(VUR) in children with first febrile urinary tract infection(UTI). Methods : A retrospective analysis of 84 hospitalized children with first febrile UTI was performed. They underwent DMSA scan and voiding cystourethrography(VCUG) during the acute phase, and were divided into three groups according to the results of the VCUG: absence of VUR, mild(grade I-II) and severe VUR(grade III-V). We studied the relation of VUR to age, gender, fever duration, causative organism, white blood cell count, serum C-reactive protein and result of DMSA scan. Results : Among 84 patients, 6 had mild and 17 had severe VUR. Thirty-eight had abnormal DMSA scan. results Patients with VUR were older than those without VUR(P<0.01). There was a lower probability of infection with Escherichia coli in patients with severe VUR than in those with mild and absent VUR(P<0.01). An abnormal DMSA scan correlated with the presence and severity of VUR(P<0.05). Severe VUR was present in 10.9% of patients with normal DMSA scan. The sensitivity, specificity, positive and negative predictive values of the DMSA scan in predicting the presence of VUR were 69.6%, 63.9%, 42.1%, and 84.8%, respectively. Conclusion : An abnormal DMSA scan correlated to the presence and severity of VUR, but the sensitivity, specificity and positive predictive value of the DMSA scan were low. There-fore, patient with an abnormal DMSA scan requires a VCUG. In order to prevent missing the 10.9% of patients with severe VUR but normal DMSA scans, a VCUG should be performed in patient with normal DMSA scan.

• Pediatric Infection and Vaccine
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• v.16 no.2
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• pp.123-130
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• 2009

Purpose : This study was performed to determine the clinical and epidemiologic characteristics of nosocomial rotavirus gastroenteritis. Methods : We retrospectively analyzed 628 medical records of patients with rotavirus gastroenteritis between 2001 and 2005. The patients were divided into two groups (the community-acquired group [528 cases] and the nosocomial group [100 cases]. The epidemiologic and clinical indices between the groups were analysed. For clinical comparison, 100 agematched cases were selected from the community-acquired group. Results : The male-to-female ratio was similar (1.4:1 vs. 1.5:1), but the mean age was lower in the nosocomial group compared to the community-acquired group (21.9${\pm}$15.5 months vs. 16.6${\pm}$10.3 months, P <0.001). The patterns of age distribution, annual frequency, and seasonal distribution were similar in both groups. The proportions of nosocomial cases in each year ranged from 9.8% to 22.4% of annual rotaviral infections, and these were not proportional to annual cases. The duration of fever appeared more prominent in the nosocomial group, and the severity of diarrhea was not different between the groups. The cases with a BUN >20 mg/dL were more in the community-acquired group (16% vs. 4%, P=0.01). Conclusion : The clinical and epidemiologic charateristics of nosocomial rotavirus gastroenteritis were similar and correlated to those of the community-acquired gastroenteritis.

• Journal of Haehwa Medicine
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• v.5 no.2
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• pp.501-501
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• 1997

당뇨병성(糖尿病性) 주위신경병변(周圍神經病變)은 당뇨병(糖尿病)에서 가장 많이 볼 수 있는 삼대합병증(三大合倂症) 중(中)의 하나이다. 환자(患者)의 임상표현(臨床表現)은 사고(四股) 및 구간부(軀幹部)가 마목(麻木)하고,동통(疼痛)이 칼로 베는 듯하거나 침(鍼)으로 찌르는 듯하여 참기 힘들며, 환자(患者)로 하여금 작업능력(作業能力)을 상실(喪失)하게 하고 휴식(休息)과 수안(睡眼)에 엄중(嚴重)한 영향(影響)을 준다. 지금까지 국내외(國內外)에서는 아직 효과적(效果的)인 치료방법(治療方法)이 없다. 우리는 임상(臨床)에서 관찰(觀察)해 본 결과(結果), 이 병(病)의 임상표현(臨床表現)인 "사고마목(四股麻木), 자통(刺痛), 야간가중(夜間加重), 통처고정(痛處固定)"의 특징(特徵)이 중의임상(中醫臨床)에서 표현(表現)되는 "혈어형(血瘀型)" 동통(疼痛)과 완전(完全)히 상동(上同)하였다. 우리는 "활혈화어(活血化瘀), 통락지통(通絡止痛), 거어생신(祛瘀生新)"을 치료원칙(治療原則)으로 중약복방(中藥復方) 제제(制劑) "당말녕(糖末寧)"을 제조(製造)하여 이 병(病)을 치료(治療)하는데 만족(滿足)스러운 임상치료효과(臨床治療效果)를 거두었다. 전체(全體)의 병례(病例)는 모두 우리 과(科)의 입원환자(入院患者)로써 모두 45례(例)인데, 병기(病機)에 따라 양조(兩組)로 나누었다. 관찰조(觀察組) 30례(例) 중(中)에는 남성(男性)이 19례(例)이고 여성(女性)이 12례(例)이며, 年齡(연령)은 25세(歲)에서 68세(歲)까지로 평균연령(平均年齡)이 49.8세(歲)이다. I형(型) 당뇨병(糖尿病)이 10례(例)이고 II형(型) 당뇨병(糖尿病)이 20례(例)이며, 당뇨병(糖尿病)의 병정(病程)은 6개월(個月)에서 17년(年)사이로 평균(平均) 7.1 년(年)이다. 주위신경병변(周圍神經病變)의 병정(病程)은 2주(周)에서 3년(年)까지로 평균(平均) 1년(年)이다. 대조조(對照組)는 15례(例)로 남성(男性)이 8례(例)이고 여성(女性)이 7례(例)이며, 연령(年齡)은 20세(歲)에서 65세(歲)까지로 평균(平均) 49세(歲)이다. I형(型) 당뇨병(糖尿病)이 7례(例)이고 II형(型) 당뇨병(糖尿病)이 8례(例)이며, 橋民病의 병정(病程)은 3개월(個月)에서 12년(年)까지로 평균(平均) 7.5년(年)이다. 주위신경병변(周圍神經病變)의 병정(病程)은 1개월(個月)에서 3년(年)까지로 평균병정(平均病程)은 11.6개월(個月)이다. 양조(兩組)사이의 병정(病程)은 현저(顯著)한 차이는 없으나 서로 비교(比較)해 볼만하다. 당말녕(糖末寧)은 주(主)로 삼궁(三芎),원호(元胡), 당귀(當歸), 계혈승 등(等)의 약물(藥物)로 조성(組成)되었고, 약제실(藥劑室)에서 濃縮液(농축액)(매(每) ml당(當) 생약량(生藥量) 2.5g 함유(含有))으로 제조(製造)하였다. 관찰조(觀察組)는 매차례(每次例) 당말녕(糖末寧) 50ml를 하루 세번씩 복용(服用)하였고; 대조조(對照組)는 비타민 $B_1$, 비타민 $B_6$을 각각(各各) 20mg씩 하루 세차례 복용(服用)하였다. 양조(兩組) 모두 사주(四周)를 한번의 치료료정(治療療程)으로 하였다. 우리는 모두 45례(例)의 환자(患者)를 관찰(觀察)하였는데, 그 중(中) 관찰조(觀察組)가 30례(例)이고 대조조(對照組)가 15례(例)이다. 임상표현(臨床表現) 분급(分級)과 신경근전도(神經筋電圖)(운동신경(運動神經)과 감각신경(感覺神經)의 전도(電圖) 속도(速度))를 치료(治療) 전(前)과 후(後)의 대조지표(對照指標)로 하였고. 매(每) 4주(周)를 한개의 료정(療程)으로 총(總) 1-2개(個)의 료정(療程)을 진행(進行)하여 比較硏究(비교연구)하였다. 총유효율(總有效率)은 96.7%이고 총현효율(總顯效率)은 50%로써 대조조(對照組)보다 뚜렷하게 높았다. 치료전(治療前) MNCV와 SNCV를 측정(測定)한 것은 당말녕(糖末寧)이 당뇨병(糖尿病) 주위신경병변(周圍神經病變) 환자(患者)의 신경전도속도(神經電圖速度)를 명확(明確)하게 개선(改善)하였음을 표현(表現)하고 있다. 신경근전도(神經筋電圖)에서 자발전위(自發電位)는 눈에 띄게 감소(減少)되고 소력수축(小力收縮)의 평균시한(平均時限)은 명확(明確)히 연장(延長)되었으며 다상전위(多相電位)는 명확(明確)하게 증가(增加)되었는데, 이는 신경지측(神經支測)이 재생(再生)되고 회복(恢復)하였음을 설명(說明)하고 있다. 중약복방제제(中藥復方制劑) "당말녕(糖末寧)"이 본병(本病)을 치료(治療)하는 기전(機轉)은 여러 방면(方面)일 것이다. 그 중(中) 微循環(미순환)을 개선(改善)하고 적혈구(赤血球)의 변형성(變形性)을 향상(向上)하여 신경세포(神經細胞)에 혈액(血液)과 산소공급(酸素供給) 및 영양공급(營養供給)을 향상(向上)함으로써 神經損傷(신경손상)의 수정(修整)과 회복(恢復)을 촉진(促進)하는 것이 주요(主要)한 일환(一環)이 될 것이다.

• Tuberculosis and Respiratory Diseases
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• v.42 no.6
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• pp.838-845
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• 1995

The determination of ADA(adenosine deaminase) activity in pleural fluid is useful in differental diagnosis of pleural effusion. The conventional method of determining ADA activity used by Giusti was influenced by contamination of ammonia. Additionally, because Giusti's method was mannual method a determining the ADA activities in sample, was not easily automated. In 1993, Oosthuizen HM with collegues developed simple kinetic method for determining ADA activity. It was reliable and suiable method for automation. In this study, we have measured ADA activity in 162 patients with various pleural effusion by Hitachi 747 autoanalyser using the Oosthuizen kinetic method for the purpuse of determination of new diagnostic cut-off value for the tuberculous effusion and evaluation of the correlation between the conventional method and new automated method. This new method of an enzymatic reaction involves 2, 6-dichlorophenolindophenol dye(DICP), adenosine, xanthine oxidase(XO), and nucleoside phosphorylase(NP). The results were as follows: 1) The mean pleural ADA activity of the tuberculous effusion was $52.53{\pm}16.43\;U/L$ and significantly higher than that of other groups(p<0.001). If the diagnostic cut-off value of pleural ADA activity for tuberculous effusion is above 30 U/L, the sensitivity is 96% and the specificity is 90%. 2) The mean pleural to serum ADA activity ratio of the tuberculous effusion was $2.29{\pm}0.96$ and it was also significantly higher than that of other pleural groups(p<0.001). If the diagnostic cut-off value of pleural to serum ADA activity ratio is 1.5, the sensitivity is 80% and the specificity is 88% in the diagnosis of tuberculous pleural effusion. 3) The new kinetic method is correlates well to Giuisti's conventional method(r=0.971). In conclusion, the new kinetic method described is easily automated and seems to be suitable for the routine determination of ADA activity.

• Childhood Kidney Diseases
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• v.9 no.1
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• pp.31-37
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• 2005

Puruose : Thin glomerular basement membrane disease(TGBMD) is found in patients with family history of hematuria. TGBMD is autosomal dominant and is known to be one of the commonest causes of asymptomatic hematuria. This study was conducted to evaluate the histological and clinical features of patients with TGBMD. Methods : 150 cases diagnosed with TGBMD by renal biopsy while admitted in the department of pediatrics, Kyungpook National University Hospital between January 1999 and December 2003 comprised the study group. The following parameters were retrospectively anaIyzed age of onset, hematuria pattern, existence of proteinuria, process of diagnosis, laboratory findings, thickness and character of basement membrane and family history. Results : The mean age at the time of diagnosis was 7.9 years. The male to female ratio was 65:77. 94 patients or 66% visited the hospital with a chief complaint of persistent microscopic hematuria. Gross hematuria accounted for 13 cases or 9%. 78 cases(55%) were found to have hematuria for the first time from a routine school urinalysis screening. The renal biopsy showed the thickness of basement membrane to be 186$\pm$36 nm. Focal lamellation of the basement membrane was found in eight cases. In the family history, hematuria was shown in 10 cases on the Paternal side, 13 on The maternal side and none on both sides. In seven cases, hematuria was shown among siblings. No significant differences were found among the laboratory test results which were conducted at an average interval of fifteen months. Conclusion : TGBMD is one of the major causes of asymptomatic hematuria in children, which was diagnosed in increasing numbers since school urinary mass screening test started in 1998. In cases with familial progressive renal disease or focal duplication in the basement membrane Alport syndrome should be considered.

• Laboratory Medicine Online
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• v.1 no.1
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• pp.26-34
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• 2011

Background: Laboratory diagnosis of new influenza A (H1N1) is crucial for managing patients and establishing control and prevention measures. We compared the diagnostic accuracies of the real time RT-PCR (rRT-PCR) test recommended for the confirmation of the new flu and the viral culture method used conventionally for viral disease with that of the rapid antigen test (RAT). Methods: We performed RAT, R-mix culture, and real-time PCR by using 861 respiratory samples collected from December 2009 to January 2010 and evaluated the abilities of these methods to detect new influenza A. The relationship among the positive rates of RAT, grades of culture, and the cycle threshold (Ct) values of rRT-PCR was also evaluated. Results: Of the 861 patients, 308 (35.8%) were diagnosed with new influenza A. The sensitivities, specificities, positive predictive values, and negative predictive values of the tests were respectively as follows: 59.7%, 99.5%, 98.4%, and 81.6% for RAT; 93.2%, 100%, 100%, and 96.3% for R-mix culture; and 95.8%, 100%, 100%, and 97.7% for rRT-PCR. Samples with weak positive grade in culture and those with Ct values of 30-37 in rRT-PCR showed positivities as low as 25.3% and 2.3% in RAT, respectively. The hospitalization rate and death rate of the confirmed patients were 3.2% and 0.3%, respectively, and gastrointestinal symptoms were observed in 7.2% of the patients. Conclusions: R-mix culture and rRT-PCR tests showed excellent reliability in the diagnosis of new influenza A and could be very useful, especially for samples with low viral load.