• Tuberculosis and Respiratory Diseases
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• v.51 no.4
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• pp.334-345
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• 2001

Background : Pulmonary tuberculosis(TB) is still prevalent and remains a significant clinical problem for the elderly. However, the disease presents in many ways, and there are frequent adverse drug reactions that may prevent the early diagnosis and treatment of elderly TB patients compared to the young. The purpose of this study was to determine whether or not there are any differences in the clinical feature of pulmonary tuberculosis(TB) in both the diagnosis and treatment between the young (less than 64 years) and the elderly (65 years and more). Methods : The medical records of 125 young and 70 elderly pulmonary TB patients, who were diagnosed with and treated for pulmonary TB at the Seoul Municipal Boramae Hospital from November 1991 to January 1997, were analyzed retrospectively. Results : Anorexia(12% vs. 31.4%), general weakness (20.0% vs. 54.3%), dyspnea(21.6% vs. 37.1%) and an abnormal mentality (0.8% vs. 15.7%) were more frequent presenting symptoms in elderly TB patients, whereas hemoptysis (32.8% vs. 10.0%) and fever (BT > $37^{\circ}C$, 58.4% vs. 35.7%) were more frequent in the young. The elderly had a higher number of cardiovascular and chronic obstructive pulmonary diseases as underlying illnesses. In chest PA, there were no differences in the location of the TB lesion, but the appearances were initially diagnosed more frequently as pneumonia or lung cancer (8.8% vs. 30.0%, p<0.05) in the elderly. There was no difference in the detection rate of acid fast bacilli(AFB) in the sputum between the two groups. There were no differences in the treatment response and follow-up loss. However, adverse drug reactions (13.6% vs. 45.7%, p<0.05), and changes in medication (4.9% vs. 25.7%, p<0.05) during treatment occurred more frequently in the elderly. One among the 125 young patients died from tuberculosis whereas 6 among the 70 elderly patients died from the disease. Conclusion : Because the clinical and radiological presentations were more atypical, a sputum AFB smear and culture should be done immediately in the elderly who are TB. The elderly experienced more frequent adverse drug reactions and mortality during treatment, but the response to treatment was good and rapid.

• Investigative Magnetic Resonance Imaging
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• v.9 no.2
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• pp.101-108
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• 2005

Purpose : Early detection of small brain metastases is important. The purpose of this study was to compare the detectability of brain metastases according to the size between 1.5 T and 3.0 T MRI. Materials and Methods : We reviewed 162 patients with primary lung cancer who were examined for TNM staging. After administration of double dose of Gd-DTPA, MR imaging was performed with SPGR by 3.0 T MRI and then with T1 SE sequence by 1.5 T MRI. In each patient, three readers performed qualitative assessment. Sensitivity, positive predictive value, and diagnostic accuracy were calculated in 3.0 T and 1.5 T MRI according to size. Using the signal intensity (SI) measurements between the metastatic nodules and adjacent tissue, nodule-to-adjacent tissue SI ratio was calculated. Results : Thirty-one of 162 patients had apparent metastatic nodules in the brain at either 1.5 T or 3.0 T MR imaging. 143 nodules were detected in 3.0 T MRI, whereas 137 nodules were detected at 1.5 T MRI. Six nodules, only detected in 3.0 T MRI, were smaller than 3.0 mm in dimension. Sensitivity, positive predictive value, and diagnostic accuracy in 3.0 T MRI were 100 %, 100 %, and 100 % respectively, and in 1.5 T MRI were 95.8%, 88.3%, and 85.1% respectively. SI ratio was significantly higher in the 3.0 T MRI than 1.5 T MRI (p=0.025). Conclusion : True positive rate of 3.0 T MRI with Gd-DTPA was superior to 1.5 T MRI with Gd-DTPA in detection of metastatic nodules smaller than 3.0 mm.

• The Korean Journal of Nuclear Medicine Technology
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• v.13 no.1
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• pp.112-115
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• 2009

Purpose: The test had been applied for outpatient by end of 2006, however, it has been included in the medical examination since January 2007, as demand and interests have been gradually increasing in the thyroid gland disease and cancer. thus, we would necessarily evaluate usefulness of the test by comparing the number of patients who are diagnosed as "benignancy" by the medical test with the number of outpatient who attend and are diagnosed as autoimmune thyroid disease among the benign patient, in samsung medical center for a certain period. Materials and Methods: Based on the result for Anti-TPO Antibody test by RIA for the 12,937 patients in samsung medical center from October 2007 to March 2008, for six months, benignancy rate classified by sex and age is measured statistically and number of the patients who are diagnosed as autoimmune thyroid disease are kept tracked on. Results: According to the analysis of the Anti-TPO antibody test 1,135 of 12,937, which is 8.77% are benign and 218 treated patient of them, which is 19.2%, were diagnosed as autoimmune thyroid disease. Conclusions: Based on the statistics, usefulness of the test seem to have co relationship with derivation of autoimmune thyroid disease. this is 19.2% of probability relatively high. this figure, however, does not have strong relationship with specialty of the disease. Thus screening test seems to have somewhat effectiveness, considering other experiments and their margin.

• Investigative Magnetic Resonance Imaging
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• v.18 no.1
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• pp.1-6
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• 2014

Purpose : $T_2{^*}$ relaxation time which includes susceptibility information represents unique feature of tissue. The objective of this study was to investigate $T_2{^*}$ relaxation times of the normal glandular tissue and fat of breast using a 3T MRI system. Materials and Methods: Seven-echo MR Images were acquired from 52 female subjects (age $49{\pm}12 $years; range, 25 to 75) using a three-dimensional (3D) gradient-echo sequence. Echo times were between 2.28 ms to 25.72 ms in 3.91 ms steps. Voxel-based $T_2{^*}$ relaxation times and $R_2{^*}$ relaxation rate maps were calculated by using the linear curve fitting for each subject. The 3D regions-of-interest (ROI) of the normal glandular tissue and fat were drawn on the longest echo-time image to obtain $T_2{^*}$ and $R_2{^*}$ values. Mean values of those parameters were calculated over all subjects. Results: The 3D ROI sizes were $4818{\pm}4679$ voxels and $1455{\pm}785$ voxels for the normal glandular tissue and fat, respectively. The mean $T_2{^*}$ values were $22.40{\pm}5.61ms$ and $36.36{\pm}8.77ms$ for normal glandular tissue and fat, respectively. The mean $R_2{^*}$ values were $0.0524{\pm}0.0134/ms$ and $0.0297{\pm}0.0069/ms$ for the normal glandular tissue and fat, respectively. Conclusion: $T_2{^*}$ and $R_2{^*}$ values were measured from human breast tissues. $T_2{^*}$ of the normal glandular tissue was shorter than that of fat. Measurement of $T_2{^*}$ relaxation time could be important to understand susceptibility effects in the breast cancer and the normal tissue.

• Radiation Oncology Journal
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• v.18 no.1
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• pp.40-45
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• 2000

Purpose : To evaluate the histopathological prognostic factors, relapse pattern and survival in patients with endometrial carcinoma who were treated with surgery and postoperative adjuvant radiotherapy (RT). Methods and Materials : From September 1991 to December 1997, 27 patients with endometrial carcinoma treated with surgery and postoperative adjuvant RT at Asan Medical Center were entered in this study. Surgery was peformed with total abdominal hysterectomy in six, total abdominal hysterectomy with pelvic lymph node dissection in eight and radical hysterectomy in 13 patients. External RT of 50.4 Gy was done to all patients and among these, additional high dose rate vaginal vault irradiation of 20$\~$25 Gy with fractional dose of 4$\~$5 Gy was boosted In 16 patients. The patients were followed for 6$\~$95 months(median 30). Results : The number of patients according to FIGO stage were I 18 (67$\%$), II 1 ($4\%$) and III 7 ($26\%$). Patients with poor histologic grade, deep myometrial invasion, adnexal involvement, lymphovascular invasion showed more pelvic lymph node involvement, but no statistical significance was indicated. The 5 year overall and disease free survival were 100$\%$ and 76.8$\%$, respectively. Relapse sites were pelvic, para-aortic lymph node, and multiple metastases including lung, and no vaginal relapse was developed. Factors that were associated with disease free survival were FIGO stage (p=0.01), lymphovascular invasion (p=0.03), pelvic lymph node involvement (p=0.0001). There was only one Grade 1 rectal bleeding without moderate to severe complications. Conclusion : Postoperative adjuvant RT is considered to reduce the loco-regional failure, resulting the improvement of survival. The group of patients with the risk of vaginal failure without vaginal vault irradiation should be investigated according to stage and grade.

• Journal of Life Science
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• v.19 no.6
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• pp.770-780
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• 2009

A new photosensitizer, 9-Hydroxypheophorbide-a (9-HpbD-a), was derived from Spirulina platensis. We conducted a series of experiments, in vitro and in vivo, to evaluate the anticancer effect and mechanism of photodynamic therapy using 9-HpbD-a and 660 nm diode lasers on a squamous carcinoma cell line. We studied the cytotoxic effects of pheophytin-a, 9-HpbD-a, 9-HpbD-a red and 660 nm diode lasers in a human head and neck cancer cell line (SNU-1041). Cell growth inhibition was determined by using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) reduction assay. The effects of 9-HpbD was higher than those of 9-HpbD-a red or pheophytin-a in PDT. We then tested the cytotoxic effects of 9-hydroxypheophorbide-a (9-HpbD-a) in vitro. The cultured SNU-I041 cells were treated with serial concentrations of 9-HpbD-a followed by various energy doses (0, 0.1, 0.5, 3.2 J/$cm^{2}$) and by various interval times (0, 3, 6, 9, 12 hr) until laser irradiation, then MTT assay was applied to measure the relative inhibitory effects of photodynamic therapy (PDT). Optimal laser irradiation time was 30 minutes and the cytotoxic effects according to incubation time after 9-HpbD-a treatment increased until 6 hours, after which it then showed no increase. To observe the cell death mechanism after PDT, SUN-I041 cells were stained by Hoechst 33342 and propidium iodide after PDT, and observed under transmission electron microscopy (TEM). The principal mechanism of PDT at a low dose of 9-HpbD-a was apoptosis, and at a high dose of 9-HpbD-a it was necrosis. PDT effects were also observed in a xenografted nude mouse model. Group I (no 9-HpbD-a, no laser irradiation) and Group II (9-HpbD-a injection only) showed no response (4/4, 100%), and Group III (laser irradiation only) showed recurrence (1/4,25%) or no response (3/4, 75 %). Group IV (9-HpbD-a + laser irradiation) showed complete response (10/16, 62.5%), recurrence (4/16, 25%) or no response (2/16, 12.5%). Group IV showed a significant remission rate compared to other groups (p<0.05). These results suggest that 9-HpbD-a is a promising photosensitizer for the future and that further studies on biodistribution, toxicity and mechanism of action would be needed to use 9-HpbD-a as a photosensitizer in the clinical setting.

• Radiation Oncology Journal
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• v.5 no.2
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• pp.97-104
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• 1987

From January 1970 through December 1984, 15 patients with sinonasal Non-Hodgkin's lymphoma combined to the head and neck were treated by external irradiation.13 patients were stage It and 2 were stage IIE by Ann Arbor Classification. However, when using TNM system, 7 were locally advanced T3, T4 lesions. All patients had follow up from 3.7 to 16 years with the median follow-up of 8.5 years. The overall actuarial 5-year survival rates were $25\%,\;28\%$ for IE and $0\%$ for IIE. Total tumor dose varied from 40 to 68 Gy. $100\%$ complete response with a total tumor dose of more than 55 Gy and $73\%$ complete response with less than 55Gy. When the disease was staged using the TNM (AJC) system, the five-year disease free survival for T1 and T2 patients was $50\%$ as compared with $14\%$ for T3 and T4. Failure rate by stage was $33\%(2/6)$ for T1 and T2, $86\%(6/7)$ for T3 and T4, and $100\%$(2/2) for IIE. The results suggest that 1. Higher CR could be obtained with a total tuner dose of more than 55 Gy. 2. Use of TNM staging system is as important as Ann arbor in management of sinonasal NHL. 3. The addition of combination chemotherapy should be considered for T3, T4 and IIE the sinonasal Non-Hodgkin's lymphoma although the disease is limited to head and neck.

• The Korean Journal of Nuclear Medicine
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• v.17 no.1
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• pp.41-53
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• 1983

It is already well known that many factors are involved in maintaining normal blood glucose level. The amount and components of meal are also thought to be some of the factors which affect the blood glucose and insulin levels. It is reported that as for Koreans sugar takes up over 75% out of 2,098 kcal, the average daily calorie intake per adult. It implies that Koreans take a high-sugar diet compared with Westerners who take $40\sim50%$ of sugar out of their total average daily calorie. For the purpose of studying diurnal variations in serum glucose, insulin and C-peptide of normal Korean adults based on ordinary Korean diet, we selceted 13 normal Korean male adults and divided them into two groups, Group I (7 persons) and Group II (6 persons). We put Group I on 3,100kcal and 75% sugar diet, and Group II on 2,100 kcal and 69% sugar diet per day for over 4 days. Serum glucose, insulin and C-peptide were checked every 30 minutes or every hour throughout 24 hours. Results are as follows: 1. As for serum glucose level, in the prep ran dial fasting state in the morning, $mean{\pm}S.D.$ of Group I was $91.1{\pm}8.2mg%$, while that of Group II is $82.5{\pm}4.4mg%$. Both groups showed peaks of increased glucose level at postprandial 1 hour after each meal. The peak returned to the level shown during the fasting state at postprandial 1 hour after breakfast while the relatively high glucose levels were maintained respectively even for 2 or 3 hours.after lunch and dinner. 2. As for serum insulin level, Group showed $mean{\pm}S.D.$ of $14.7{\pm}3.0{\mu}U/ml$ while Group II shows that of $7.0{\pm}2.6{\mu}U/ml$ in the fasting state. Group I particularly showed the largest peak from preprandial a half or one and half an hour to postprandial one hour of lunch, and made relatively small peaks $(47.7{\pm}10.8{\mu}U/ml)$ at postorandial 1 hour after breakfast and dinner. No such large peak was marked in Group II, though it showed relatively similar patterns of peak after each meal. 3. As for C-peptide, in the fasting state, Group I and Group II showed $3.50{\pm}1.85$ and $1.66{\pm}0.53ng/ml$ of $mean{\pm}S.D.$, respectively. Group II showed peaks parallel to those for insulin level. None out of seven in Group I showed expected increase in C-peptide based insulin secretion at a half or one and half an hour before lunch. On the contrary, C-peptide increased in 5 subjects out of seven in Group I at 11:00 p.m. when insulin did not increase. 4. According to the integrated concentration method for a measurement of 24-hour total. insulin secretion rate, the $mean{\pm}S.D.$ of Group I was $76.4{\pm}15.2$ U and that of Group II was $58.6{\pm}21.1$ U. The above results confirm that Koreans, when given ordinary diet of 2,100 kcal and 69%, sugar, show insulin secretion pattern essentially similar to that of Westerners. On the contrary, when they are put on a high-calorie diet of 3,100 kcal a day, 75% of which is sugar, insulin secretion can be increased before lunch without increase in blood glucose. These results implies that insulin secretion can be affected by some other factors. The observation that an increase in C-peptide after 11 : 00 p.m. independent of insulin level supports an assertion that insulin secretion and C-peptide secretion can be thought as being physiologically dissociable, and these changes of diurnal patterns in the levels of serum insulin and C-peptide are thought to be resulted from the large meal and high-carbohydrate diet.

• Nuclear Medicine and Molecular Imaging
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• v.43 no.5
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• pp.402-410
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• 2009

Purpose: The aim of this study was to determine the incidence and malignant rate of incidental asymmetric palatine tonsillar uptake (ATU) on $^{18}F$-FDG PET/CT in various clinical indications and to evaluate the clinical and PET/CT findings suggesting malignancy. Materials and Methods: We retrospectively reviewed a total of 2,901 patients ($58.4{\pm}12.3$ yrs, range 20~88 yrs, M:F = 1,841:1,060) who underwent $^{18}F$-FDG PET/CT during an 1-year period with various indications except primary tonsillar cancer and lymphoma evaluation. On $^{18}F$-FDG PET/CT, metabolic abnormality of the palatine tonsil and cervical lymph node were visually assessed. ATU was defined as increased palatine tonsillar uptake with diffuse, focal, or irregular pattern compared to contralateral side. The incidence and malignant ratio of ATU were evaluated according to clinical and PET/CT findings. Results: Of 2,901 cases, 290(10,0%) showed ATU. The incidence of ATU showed seasonal variation and was high in the winter (12.1%). Of 209 cases with ATU confirmed pathologically and/or clinically, five (2.4%) were malignant lesions. ATU with irregular uptake pattern (2/2) and in cases referred for cervical lymph node metastasis of unknown origin (3/5) were frequently associated with malignant lesion (p<0.05). Conclusion: ATU was not infrequently observed on $^{18}F$-FDG PET/CT, and the malignant risk of ATU was low. However, ATU with cervical lymph node metastasis or with irregular pattern on PET/CT would be further evaluated by the histopathologic examination.

• The Korean Journal of Pain
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• v.2 no.2
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• pp.135-144
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• 1989

Celiac plexus block is recommended in patients with intractable upper abdominal cancer pain. The success rate of a celiac plexus block is variable among the authors. One of the causes of this is the anatomical variations of the celiac plexus. There has not been a study concerning anatomical observations of the celiac plexus in Korean cadavers. So, anatomical dissections were performed and observations were made of the celiac plexus and related structures in Korean cadavers. The results were as follows: 1) The subjects were 21 male bodies and 5 female bodies. The mean age at death was $69.9{\pm}15.5$ years (range 37~93). The mean height was $155.5{\pm}8.3\;cm$ (range 143~172). 2) The number of celiac ganglia ranged from 1~4. The mean numbers were $2.3{\pm}1.9$ in the right plexus and $1.9{\pm}0.8$ in the left, and the mean sizes were $18.9{\pm}7.7{\times}8.0{\pm}3.8\;mm^2$ and $18.5{\pm}8.3{\times}9.5{\pm}3.9\;mm^2$ respectively. 3) Celiac ganglia were most frequently located at the level of the upper third and middle third of L1 in both sides (65.5% in right, 64.0% in left). The vertical range of celiac ganglia ranged from 1 space, which is one third the height of one vertebral body, to 4 spaces. Mean vertical ranges were $1.5{\pm}0.6$ spaces in the right plexus and $1.6{\pm}0.7$ spaces in the left. The celiac ganglia located at the level of the upper third of L1 in the right and the lower third of L1 in the left side, had the largest vertical ranges respectively ($1.8{\pm}0.5$ spaces in right, $2.3{\pm}0.6$ spaces in left) 4) Right side celiac ganglia were located near the midline of the vertebrae compared to the left ones (mean 5.0 mm) The horizontal dimension was greater in the right ganglia ($24.2{\pm}9.2\;mm$) than in the left ganglia ($l8.8{\pm}7.0\;mm$). 5) There was no vertebral level difference between both celiac ganglia in most cases (60%). However, of the 40% of cases at different levels, in half of these (20%) the right ganglia were located higher than the left ganglia; and in the other 20%, this was reversed. 6) The origin sites of the celiac artery were most frequently in the upper third and middle third of L1 (61.6%). The celiac ganglia were usually located at the same level as the site of origin of the celiac artery (61.6% in right, 52.0% in left). 7) The vertebral level of the splanchnic nerves piercing the abdominal surface of the diaphragm was most frequently in the upper third and middle third of L1 (66.6% in right, 66.7% in left). 8) The level of the origin of diaphragmatic crura from the anterior surface of the vertebral bodies varied from the L1-L2 interspace to the L3-L4 interspace. Right crura most frequently originated at the level of the lower third of L2 to the upper third of L3 (57.6%), while left crura originated from the level of the L2-L3 interspace to the middle third of L3 (69.3%). From the above results, we realized that there were some anatomical variations of the celiac plexus and its relations to adjacent structures in Korean bodies. However, when the needle point is behind the anterior margin of the upper third of L1, it is possible to perform a successful retrocrural splanchnic nerve block.