• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.6 no.1
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• pp.39-46
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• 2003

Purpose: In a retrospective study for the pediatric patients who underwent liver transplantation in the past 6 years at Samsung Medical Center, the clinical features of 5 patients with posttransplant lymphoproliferative disorder (PTLD) were analyzed. Methods: Between June 1996 and June 2002, 41 pediatric patients underwent liver transplantation. Seven of them died in the postoperative period. Thirty-five including one patient who died of PTLD were finally reviewed. Patients were divided into two groups: high risk group, EBV naive recipients of EBV-positive grafts; low risk group, the patients other than those in high risk group. The authors reviewed age at operation, immunosuppressive agent, postoperative duration until diagnosis, postoperative duration until EBV seroconversion, presence of treatment against rejection, and presenting symptoms of PTLD. Results: Five of 41 patients (12.2%) developed PTLD. All of them belonged to high risk group, and the incidence of PTLD in high risk group was 31.3% (5/16). The mean age at operation was 10.8 months old and the mean duration between operation and diagnosis for PTLD was 9.8 months. Primary EBV infection developed after a median of 6 months after transplantation. One patient was diagnosed as laryngeal and gastrointestinal PTLD and the other four, gastrointestinal PTLD. The following symptoms and signs were seen in the patients: anemia (100%), hypoalbuminemia (100%), fever (80%), diarrhea (80%), gastrointestinal bleeding (80%), and anorexia (60%). Conclusion: PTLD is one of the major complications after pediatric liver transplantation, especially in the group of high-risk recipients. Anemia, hypoalbuminemia, fever, diarrhea and gastrointestinal bleeding were features that are characteristic of PTLD. The common features of PTLD development were: (i) EBV-positive donors placed into EBV naive recipients, (ii) primary EBV infection about 6 months after transplantation, (iii) young age, about 1 year old at operation, and (iv) the requirement for intensive posttransplant immunosuppression.

• Journal of Korean society of Dental Hygiene
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• v.2 no.1
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• pp.63-83
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• 2002

The purpose of this study was to serve as a basis for more efficient dental hygienist human resources utilization and for determining some of the right directions for supplementary education for dental hygienists, by examining how they actually worked and what they thought of job-related things. The subjects in this study were 537 dental hygienists who participated in a seminar by the Korea Dental Hygienist Association. After a survey was conducted, the following findings were given: 1. 50.2% of the dental hygienists investigated completed legally required eight-class education. Those who worked in clinics took less supplementary education classes than the others in the other types of dental institutions. The main reason they didn't receive supplementary education was financial burden and uncooperative employers. 73.2% took supplementary education at the association or its branches. The association was most favored by those in clinical sector as a place that provides supplementary education, followed by its branch and university in the order named. And the dental hygienists in public health sector preferred university most, and the next best favored one was the association and its branch in the order named. Those in clinical sector hoped to acquire clinical information on patient management, implant or aesthetics, and the dental hygienists in public health sector wanted to learn about health administration, public oral health operations and oral health education, which were different from what those in clinical sector wanted. 2. Regarding the period of service, 492% had worked for three years or more. This fact suggested that their service term and average age continued to grow. And they thought they would decide the retirement time on their own. 3. The most common yearly income ranged from 12 million won to 16 million won(40.7%). For-those in clinics, yearly income was 14.36 million won, and that of the dental hygienists who had worked for less than 3 years was 12.90 million won. 4. The Korea Dental Hygienist Association was most required to protect the rights and interests of the members and offer new knowledge and technology. 5. The largest group of them were engaged in patient management, and this type of job also was the most favored one for them to do. The greatest number of the dental hygienists in public health sector were in charge of dental treatment. 6. Concerning their turnover rate, 492% had never changed their occupation. Specifically, 70.0% of the respondents who had worked for less than 3 years had have no experience to do that. The time constraints for self-development and conflicts with other workers were the cause of their turnover. Those in dental hospital and general hospital changed their occupation chiefly due to the lack of time for self-development, and for the dental hygienists in clinics, the conflicts with other workers were the main reason. The above-mentioned findings suggested that the way the dental hygienists looked at things was undergoing change. The service area made a difference to their preference for the type of supplementary education and institution in charge of it, as those in public health and clinical sectors had a different opinion. And the dental hygienists in clinical sector had a different opinion as well, according to service area, about salaries, reason of not taking supplementary education, preferred type of supplementary education, cause of turnover, and type of occupation to which they hoped to change employment. To utilize and supply human resources in a more stabilized manner, job description should be more segmented, standardized and classified clearly, and dental hygienists should be motivated to perform their substantial jobs, including oral disease prevention, oral prophylaxis and oral health education. To make it happen, it seems that dentists are required to have a clear understanding of dental hygienist job and to change the way they look at it.

• Radiation Oncology Journal
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• v.19 no.2
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• pp.142-145
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• 2001

Purpose : Acute leukemia with hyperleukocytosis (more than $10^5/mm^3$) is at high risk of early sudden death, usually from intracerebral hemorrhage. Emergency cranial irradiation is a relatively simple approach to solve this the problem. We summarized our experience of cranial irradiation in 24 leukemic children who presented with hyperleukocytosis. Methods and Materials : Between 1990 and 1998, 40 children with acute leukemia presenting with hyperleukocytosis were referred for emergency cranial irradiation. Among these patients, 24 children were evaluable. There were 16 boys and eight girls, their ages ranged from 2 to 13 years (median 9.5 years). The initial leukocyte counts ranged $109,910/mm^3\;to\;501,000/mm^3$. Peripheral blood smear was peformed in all patients and noted the morphology of the blast. Introduction of emergency cranial irradiation was determined by the leukocyte counts (more than 100,000/mm) and the existence of the blast in peripheral blood smear. All patients were treated with intravenous hydration with alkaline fluid and oral allopurinol. Cranial irradiation started on the day of diagnosis. With 2 Gy in one fraction in 4 patients, 4 Gy in two fractions in 20 patients. Results : The WBC count had fallen in 19 patients (83%) and no intracerebral hemorrhage occurred after irradiation. There were five cases of early deaths. Four patients died of metabolic complications, and one patient with intracerebral hemorrhage. He died 5 hours after cranial irradiation. No patient had any immediate side effect from cranial irradiation. Conclusion : Our data suggest, that emergency cranial irradiation can be safely chosen and effective in childhood leukemic patients presenting with high leukocyte counts.

• The Korean Journal of Nuclear Medicine Technology
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• v.14 no.2
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• pp.65-76
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• 2010

Purpose: he use of PET scanners and the number of patient in Korea have been increased for recent several years dramatically. For this reason, technologists have more possibilities to be exposed to the radiation. The hospitals using PET scanners should make an effort to reduce the radiation exposure dose. The purpose of this study was to evaluate the radiation exposure does when using radiation shielding devices. The evaluation was performed through questionnaire survey and experiment. Materials and Methods: First, the technologists who had experience working in PET center in 2008-2009 were surveyed with questionnaire and TLD Figures, personal opinion of utilization of radiation shielding devices are analyzed. Second, we measured the shielding rate of shielding devices which have been using in PET study procedures. We divided the procedures into four steps; distribution, moving, injection of $^{18}F$-FDG and patient setup. Results: First, the results of this survey, using of L-block+Syringe shield, L-block, Syringe shield, No shield during the injection, were each 58.5%, 20%, 9%, 12.3%. The TLD values according to utilization of radiation shield, using both L-block+Syringe Shield and L-block showed the lower TLD values, and Syringe shield only or No shield showed the higher TLD values. Second, the results of experiments according to PET study procedures measured the shielding rates as follows. The shielding rates during the distribution using L-block, L-block+Apron shield were measured 97.4%, 97.7%. The shielding rates during the $^{18}F$-FDG delivery to the injection room using mobile Syringe shield, Syringe holder, Syringe shield carrier were each 81.7%, 98.9%, 99.7%. The shielding rates during the injection using Syringe shield, L-block, L-block+Syringe shield were measured each 51.9%, 98.3%, 98.7%. The shielding rates of Apron were measured in each 30, 60, 90, 120, 150 cm distance. The measurement were each 16.9%, 14.2%, 16.6%, 17.1%, 18.1%, 18.6%. Conclusion: The most effective method for radiation shielding is to using L-block during the $^{18}F$-FDG distribution and Syringe shield carrier during in moving $^{18}F$-FDG. For the $^{18}F$-FDG injection, L-block+Syringe shield have to be used. The shielding effect of Apron has shown average 16.4%. According to the survey of questionnaire, the operators recognized well risk of the radiation exposure but, tended ignore in working. The radiation dose according to recognition of radiation exposure risk was not relevant. but radiation dose according to utilization of radiation shield lower the more use it. The main reason of no use of shielding devices is cumbersome, 55% of the respondents answered. I'm sure, by use of radiation shield in all PET procedure, radiation exposure will be reduced considerably.

• Research in Community and Public Health Nursing
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• v.5 no.2
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• pp.181-202
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• 1994

This study was conducted in order to grasp the condition of the student's knowledge and attitude about tuberculosis. And to offer the basic materials for the prevent tuberculosis in elementary school. The objects were comprised 395 of volunteered 6th grade students who study in two elementary schools. The material of this study was the questionaire(chronbach $\alpha=.9016$) suited to the purposed of this research which has been made through studying references. All the questionaire were collected immediately without explanation. The data was collected from 13rd to 25th of May on 1994. Analysis of the data was done utilizing SPSS for percentage, mean, ANOVA and pearson-Correlation Coefficient. The Result are as follows; 1. General features of the objects of study. Sex distribution was similar. Salary of 1000-1500 thousand won were highest (40.2%), nuclear family was highest (87.1%), fathers of graduated high school were the highest(44.0%), mothers of graduated high school were the highest(56.8%). And there was nobody about tuberculosis patient in one's close relatives were highest(95.4%). 2. The conditions of attitude about tuberculosis. Having experience of tuberculin test were highest(59.0%). Less than 9mm indulation among the tuberculin tested group were 85.1%, more than indulation were 14.9%. Have a B. C. G. injection among the less than 9mm indulation were 83.2%. Leave alone among the more than 10mm indulation were 56.0%. Think it too much trouble to do not tuberculine test were 63.0%. Do not take a chest X-ray in the past were 60.3%. And take a chest X-ray in the past were 39.7%. Health educated group was 74.3%. If tuberculosis sign was developed, notified to parent was 73.8%. 3. The condition of knowledge about tuberculosis. When 5 points was given to 'very affiming' and 1 point was given to 'very deny', the total average was 3.54. And symptom of tuberculosis secion was 3.67, vaccination of tuberculosis section was 3.66, tuberculine test section was 3.56, epidemiology of tuberculosis section was 3.54, infection of tuberculosis section was 3.38. And every section showed affirmative correlation(P<.001). 4. Correlation between the general features and attitude variables. High incomed group may have more attitude on tuberculin test than low incomed group($x^2=16.$ 190, P<.01). High educated group may have more attitude on tuberculin test than low educated group(Father : $x^2=28.530$, P<.001, Mother: $x^2=26.060$, P<.001). High educated group may have more attitude on health education than low educated group(Father: $x^2=20.$ 767, P<.000, Mother: $x^2=10.639$, P<.05). Nuclear family may have more attitude on notify to parent than others($x^2=51.45$, P<.000). Tuberculosis patient in one's close associates have more attitude on notify to parent than others($x^2=51.$ 45, P<.000). 5. Difference between the general features and knowledge of tuberculosis. High incomed group were highest score in knowledge (F=3.99, P<.01). High educated group were highest score in knowledge(Father : F=8.81, P<.000, Mother: F=9.09, P<.000). 6. Difference between the attitude and knowledge of tuberculosis. Tuberculin tested group were highest score in knowledge(t=9.88, P<.000). Taken chest X-ray group were highest score in knowledge (t=2.07, P<.05). Received health education group were highest score in knowledge(t=6.83, P<.000). Notified symptoms to teachers and parent group were highest score in knowledge(F=3.89, P<.01).

• Journal of Chest Surgery
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• v.42 no.1
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• pp.28-33
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• 2009

Background: Functional tricuspid regurgitation (TR) greater than or equal to a mild grade requires tricuspid valvuloplasty, and tricuspid valvuloplasty with ring annuloplasty has shown good outcomes. We report here on our early experience with the Edwards $MC^3$ annuloplasty system (Edwards LifeSciences, Irvine, CA). Material and Method: From November 2004 to July 2006, 72 patients with tricuspid annular dilatation and TR underwent tricuspid valvuloplasty with using the Edwards $MC^3$ annuloplasty ring. Sixty-eight patients were operated on via median sternotomy and four patients were operated on using robotic assisted minimal invasive thoracotomy. The patient population included 21 males and 51 females and their mean age was $53.9{\pm}12.3$. The mean grade of TR, as assessed by the preoperative echocardiography, was $2.2{\pm}1.0$. The mean NYHA functional class was $3.1{\pm}0.8$. The mean left ventricular ejection fraction was $57.0{\pm}9.9$%. Result: The TR and NYHA functional class, as assessed by postoperative echocardiography, was significantly reduced (mean=$0.4{\pm}0.6$ and $2.0{\pm}0.7$, respectively p<0.001). There was one case of hospital mortality. One patient required permanent pacemaker insertion for third degree atrioventricular block. Conclusion: Our study shows that the Edwards $MC^3$ remodeling ring is easy to implant and it effectively corrects functional TR with excellent clinical and echocardiographic outcomes. Further follow-up and a larger clinical series are required to establish the long-term stability of this repair technique.

• Korean Journal of Psychosomatic Medicine
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• v.7 no.1
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• pp.103-115
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• 1999

Objectives : A large of studies have found an association between premenstrual syndrome and affective disorder, in particular, depression. Some studies have reported that women with depressive disorders may experience menstrual cycle-associated changes in the severity of their symptoms. This study was designed to compare the characteristics of premenstrual changes between control group and affective patient group, and to assess possible risk factors for premenstrual changes in patients. Methods : Eighty normal controls and eighty outpatients given maintenance therapy with fixed dose for at least more than four weeks were asked to complete questionnaires on menstrual history, obstetric-gynecological history, and functional impairment. In addition, to compare the characteristics of premenstrual changes, 16 items based on DSM-IV criteria A for premenstrual dysphoric disorder were rated on the following scale : 0(no change), 1(mild), 2(moderate), 3(severe). Moderate or severe change in each item was considered as premenstrual change and the subjects who reported more than one premenstrual change were defined as premenstrual change group. Results : The results were as follows : 1) The percentage of premenstrual change group was 32.6% in patient group and 50% in control group. 2) Frequently reported premenstrual changes were as follows in control group : breast tenderness; anger ; affective liability ; lethargy, easy fatigability, or marked lack of energy ; abdominal pain or discomfort. In patients, the mood or behavioral changes were frequently reported. The changes were as follows : lethargy, easy fatigability, or marked lack of energy ; change in appetite; affective liability ; sense of difficulty in concentrating : hypersomnia or insomnia. 3) In the premenstrual change group, the patients with only mood or behavioral changes were significantly more than those with only physical changes or both changes. 4) The severity of functional impairment was significantly correlated with the frequency of mood or behavioral changes in patients. 5) There were no significant differences in menstrual characteristics between patients with premenstrual changes and patients without them except the severity of dysmenorrhea. And the severity of dysmenorrhea was correlated with the frequency of premenstrual change. Conclusion : The proportion of patients with affective disorder, who reported moderate-to-severe premenstrual changes, experiencing mood or behavioral changes larger than those experiencing physical changes during premenstrual period. It is possible that some patients with affective disorder, who reported premenstrual mood or behavioral changes, suffer from coexisting premenstrual syndrome with affective disorder or premenstrual exacerbation of affective disorder. Since the more premenstrual changes, the severer functional impairment, the patients reporting mood or behavioral disturbance in premenstrual period should be carefully evaluated, and appropriate therapeutic stategies might be considered.

• Journal of Yeungnam Medical Science
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• v.16 no.1
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• pp.94-100
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• 1999

The aim of this retrospective study was to determine whether a nephron sparing surgery might be feasible in patients with a small solid renal tumor. Materials and methods: Between 1988 and 1999, 21 patients with a radiologically detectable small solid renal tumor underwent enucleoresection, wedge resection and polar segmental nephrectomy. The mean age of the 11 men and 10 women in this study was 43 years (range 14 to 68). According to the preoperative radiological diagnosis, 15 among the 21 patients were considered to have renal cell carcinoma, 4 were considered to have angiomyolipoma, and in the remaining 2 patients, radiological differentiation of renal tumors was difficult. Among 15 patients considered to have renal cell carcinoma, 14 were found to have renal cell carcinoma and the remaining one patient was diagnosed as having oncocytoma on pathologic examination. Radiological determination of angiomyolipoma in four patients was confirmed to be correct on pathological examination. The 2 patients whose radiological diagnose was difficult were found to have cavernous hemangioma and angiomyolipoma. One patient with renal cell carcinoma developed arteriocaliceal fistula, the only immediate complication in this series and underwent nephrectomy on postoperative 10th day. The mean follow up duration for the 14 patients with renal cell carcinoma was 18.6 months (range:1-103). There was no other tumor involvement in the resection margins following the nephron sparing surgery. These results suggest that nephron sparing surgery provides an effective treatment for patients with a single, small, unilateral, localized renal tumor. Longer follow-up is suggested for more definite verification of the role of nephron sparing surgery.

• Korean Journal of Psychosomatic Medicine
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• v.20 no.2
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• pp.75-81
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• 2012

Objectives : Thyroid cancer patients may experience emotional distress during cancer treatment including surgical operation and radioactive iodine treatment. The aims of this prospective study were to investigate changes of anxiety and depressive symptoms in patients with differentiated thyroid cancer(DTC) under preoperative, postoperative and short-term hypothyroidism state. Methods : Using the Hospital Anxiety and Depression scale(HAD) and the Distress Thermometer, we sequentially assessed the levels of anxiety, depression and distress in 41 DTC patients at 3 time points such as preoperative state, postoperative state and short-term hypothyroidism state. Results : The HAD-anxiety score was significantly higher in preoperative state($6.93{\pm}3.97$) than postoperative state($4.22{\pm}2.92$) and short-term hypothyroidism state($4.93{\pm}3.64$). Any other significant change in depression or distress thermometer score was not observed. Especially, difference of HADS score between the distress and none-distress groups was significant in preoperative state and post-operative state, but the difference become not significant in the short-term hypothyroidism state. Conclusions : Induced thyroid hormone deficiency during cancer treatment does not significantly affect emotional distress in patient with DTC. Anxiety and depression in these patients may be associated with distress of the patient before active cancer treatment.

• Korean Journal of Psychosomatic Medicine
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• v.25 no.2
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• pp.176-184
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• 2017

Objectives : Middle aged women with depression often experience hot flush symptoms. It is still unclear about the association between depression and hot flush symptoms. Therefore, we investigated hormonal profile, functional somatic symptoms, coping styles and attitude for menopause between depressed women with hot flush and those without hot flush. Methods : This study included 33 depressed patients with hot flush symptoms and 33 depressed patients without hot flush symptoms. Hot flush was confirmed through prospective daily symptom ratings for a week. Subjects' coping styles were assessed by the stress coping checklist. Somatic symptoms were assessed by the Patient Health Questionnaire-15(PHQ-15). Sex hormonal levels were assayed by a radioimmunoassay. The Brief World Health Organization Quality of Life Assessment Instrument(WHOQOL-BREF) was used to evaluate quality of life. Results : In coping style, depressed women with hot flush symptoms used less 'problem-centered coping'($13.15{\pm}3.17$) and 'search for social support'($11.83{\pm}2.84$) than those without hot flush symptoms($15.17{\pm}3.1$, p=0.028 ; $14.25{\pm}3.22$, p=0.009 ; respectively). Depressed women with hot flush symptoms showed more negative attitude toward post-menopause, but its statistical significance was marginally insufficient(p=0.059). We did not find any group differences in sex hormonal levels and somatic complaints assessed by the PHQ-15. The score of social relationship domain of WHOQOL-BREF was significantly lower in subjects with hot flush symptoms($8.62{\pm}2.04$) than subjects without hot flush symptoms($9.71{\pm}1.65$ ; p=0.044). Conclusions : Among middle aged women with depression, the manifestation of hot flush symptoms was associated with coping styles and attitude for menopausal transition. Hot flush symptoms in depressed women negatively influence quality of life, so clinicians actively perform therapeutic approach in case of depressed patients with hot flush symptoms. In case of depressed patients who present hot flushes, cognitive behavior therapy or stress management might be an effective treatment option in company with antidepressants or hormonal treatment. Later, longitudinal study will be needed to evaluate risk factor, cause and effect associated with hot flush and depression.