• Childhood Kidney Diseases
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• v.3 no.2
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• pp.196-202
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• 1999

Purpose : When the mature kidney fails to reach its norml location in the renal fossa, the condition is known as ectopic kidney. Presenting symtoms can be various and it generally depend on the associated anomaly. Beside urologic anomalies such as hydronephrosis and vesicoureteral reflux, various anomalous vascular net work, skeletal anomaly or genital anomaly can be observed in this condition. Methods : Sixteen children with ectopic kidney was studied retrospectively to analyse initial presentation, accompanied anomaly and prognosis. Results : 56% of the children were accompanied with other urologic anomalies such as true incontinence and vesicoureteral reflux that required surgical treatment. 31% of children were either diagnosed incidentally during evaluation of other non-urologic disease or during follow-up evaluation of abnormal antenatal renal sonogram. Conclusion : Ectopic kidney can be often misdiagnosed as tumorous condition or as a surgical condition depend on the abnormal location of the kidney. Careful evaluation using abdominal sonogram, DMSA, VCUG and abdominal CT scan should be performed in order to search for associated anomalous condition and for proper management.

• Clinical and Experimental Pediatrics
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• v.51 no.10
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• pp.1047-1051
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• 2008

Purpose : This study aims to evaluate the efficacy and safety of sedatives for pediatric patients using noninvasive procedures. Methods : We performed a prospective study in 446 (aged 1 month-21 y) consecutive pediatric patients undergoing sedation to study noninvasive sedation techniques from February to August 2007. We reviewed demographic data, sedative drugs, dosage, complications, and successful rates of sedation according to the underlying diseases. Results : The overall successful rate of sedation was 435/446 (97.5%). The overall rate of successful sedation using chloral hydrate was 99.1% (420/424), and was 70.6% (12/17) and 60.0% (3/5) with ketamine and midazolam, respectively. Of the neurologic patients (n=172, aged 1 month to 21 years), 136 patients were sedated for EEGs, 5 patients for renal scans, and 31 patients for neuroimaging studies such as brain CT or MRI. All non-neurological patients (n=274, aged 1 month to 5 years) were diagnosed with urinary tract infection and sedated for renal scan. The overall success rate of sedation for this group was 99.6% (273/274). A total of 14 adverse events were observed (3.1%). Most adverse reactions were mild in severity and clinically insignificant. Conclusion : Using chloral hydrate alone has enough effect to sedate non-neurologic patients. However, neurologic patients in the severe course group, especially those suffering from intractable epilepsy, autism, or severe cerebral palsy, must be medicated with chloral hydrate 2 times at most; instead, injections of ketamine or midazolam in the early stage may result in a more promising outcome.

• Radiation Oncology Journal
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• v.6 no.2
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• pp.269-276
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• 1988

Eight patients with intracranial tumors or arteriovenous malformation (AVM)s which were less than 3 cm in diameter were treated by a technique of stereotactic radiotherapy during the 4months period from July 1988 through October 1988 at the Division of Radiation Therapy, Kang-Nam St. Mary's Hospital, Catholic University Medical College. The patients were diagnosed as AVMs in 3 cases, acoustic neurinoma, craniopharyngiom (recurrent), hemangioblastoma, pineocytoma, and pituitary microadenoma in each case. There are several important factors in this procedure, such as localization system, portal, field size, radiation dose, and perioperative supportive care. It is suggested that stereotactic radiotherapy may be peformed safely with a radiation dose of 12-30 Gy. So this nonivasive procedure can be used to treat unresectable intracranial tumors or AVMs. Of these, clinical symptoms had been regressed in AVMs in 2 cases at 3 months and 2 months after Stereotactic radiotherapy, one of whom was confirmed slightly regressed on the follow-up angiogram. And also craniopharyngioma and pineocytoma was minimally regressed on 3 month follow-up CT.

• Clinical and Experimental Pediatrics
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• v.52 no.9
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• pp.1015-1020
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• 2009

Purpose:The aim of this study is to explore the effect of the Toll-like receptor 9 (TLR9) expressed in plasmacytoid dendritic cells (pDCs) that respond to antigen to Th2 immune deviation in allergic patients. Methods:Subjects consisted of 19 allergic patients and 17 healthy volunteers. Skin prick tests and nasal provocation tests were performed for the two groups. Peripheral blood mononuclear cells (PBMCs) were collected from subjects and analyzed for the Lineage Cocktail (CD3, CD14, CD16, CD19, CD20, CD56) (-), HLA-DR (+), and CD123 (+) using flow cytometry. In addition, we analyzed TLR9 mRNA by reverse transcriptase-polymerase chain reaction. The level of $interferon-{\alpha}$ ($IFN-{\alpha}$) of the PBMCs following stimulation with the TLR9 ligand CpG-ODN 2216 was also evaluated. Results:Analyses of CD123 (+) revealed a nearly similar distribution for the classical pDC markers in the allergic group ($0.1%{\pm}0.04%$) and in the controls ($0.25%{\pm}0.23%$). The mRNA levels of TLR9 on PBMCs were not different between the allergic group and the controls ($1.29{\pm}0.41$ vs. $1.25{\pm}0.23$, respectively). Additionally, the level of $IFN-{\alpha}$ in PBMCs exposed to stimuli of the TLR9 ligand CpG-ODN 2216 was not significantly different between the two groups ($911{\pm}829$ vs. $1,095{\pm}888pg/mL$, respectively). Conclusion:We found no evidence that TLR9-dependent immune responses in human pDCs are associated with allergic status.

• Clinical and Experimental Pediatrics
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• v.49 no.11
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• pp.1194-1201
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• 2006

Purpose : The comatose mentality can be catastrophic, especially if the condition is severe or the duration is prolonged. Therefore, delayed diagnosis can result in a poor outcome or death. The best radiologic modality to differentiate from cerebral lesions in patients suffering from cerebral diseases is magnetic resonance imaging (MRI) rather than computed tomography (CT). Special apparatuses with metal materials such as ventilators, and cardiac pacemakers belonging to patients cannot be located in the magnetic field. We aimed to exhibit the possibility of examining MRI, maintaining ventilation at a relative long distance by means of modified $Ambu^{(R)}$. Methods : Self-inflating bags as a sort of a manual ventilator, connected with relatively long extension tubes instead of mechanical ventilators, were adopted to obtain MRI. PVC (polyvinyl chloride) extension tubes had different lengths and diameters. Lengths were 1, 2, and 3 cm and diameters were 15, and 25 mm. The work of breathing and expiratory changes of expiratory tidal volume (TVe), minute volume of expiration (MVe), peak inspiratory pressure (PIP) were measured by use of the mechanical ventilator, $Servoi^{(R)}$, as the alteration of TVi (inspiratory tidal volume), extension tube lengths and diameters with other values fixed. Results : Measured TVe and MVe by ventilator were the same values with control at every TVi, regardless of extension tube lengths and diameters, but PIP were increased with the rise of TVi, tube lengths, with decline of tube diameters, these were statistically significant. Conclusion : MRI examination can be carried out with a self-inflating bag connected with an extension tube at a long distance in patients who need artificial ventilation.

• Clinical and Experimental Pediatrics
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• v.46 no.12
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• pp.1230-1234
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• 2003

Purpose : The aim of this study is to evaluate the value of lung biopsies for the management of children with lung disease. Methods : We retrospectively reviewed 19 lung biopsies done at Asan Medical Center, Seoul between 1993 and 2001. Data gathered included demographic information, underlying conditions, diagnosis before biopsy, final diagnosis, change in therapy, morbidity and mortality. Results : Nineteen patients underwent lung biopsy. Among them, 13 patients were male and six patients were female; the median age was 3.6 years(0.8 to 8.6 years). Twelve patients underwent open lung biopsies and seven patients had thoracoscopic biopsies. The overall diagnosis rate was 95 %. The most common diagnosis was interstitial lung disease(12 patients, 64%) and infection was detected in four patients(21%). The biopsy-proven bronchiolitis obliterance was confirmed in two of seven patients suspected by CT findings. Specific treatment was changed after biopsy in 16 patients (85%). The morbidity & overall mortality rates of the patients were 5%(one patient) and 21%(four patients) respectively. Only one complication was seen : empyema. The causes of death were acute respiratory distress syndrome(one patient), respiratory failure(two patients), and septicemia(one patient). Conclusion : The lung biopsy is a safe procedure and it contributes to more accurate diagnosis and proper management of pediatric lung diseases. We recommend lung biopsies should be considered more positively in the diagnosis of pediatric lung diseases.

• Radiation Oncology Journal
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• v.21 no.1
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• pp.100-106
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• 2003

Purpose : To develop a patients' setup verification tool (PSVT) to verify the alignment of the machine and the target isocenters, and the reproduclbility of patients' setup for three dimensional conformal radiotherapy (3DCRT) and intensity modulated radiotherapy (IMRT). The utilization of this system is evaluated through phantom and patient case studies. Materials and methods : We developed and clinically tested a new method for patients' setup verification, using digitally reconstructed radiography (DRR), simulation, porial and digital images. The PSVT system was networked to a Pentium PC for the transmission of the acquired images to the PC for analysis. To verify the alignment of the machine and target isocenters, orthogonal pairs of simulation images were used as verification images. Errors in the isocenter alignment were measured by comparing the verification images with DRR of CT Images. Orthogonal films were taken of all the patients once a week. These verification films were compared with the DRR were used for the treatment setup. By performing this procedure every treatment, using humanoid phantom and patient cases, the errors of localization can be analyzed, with adjustments made from the translation. The reproducibility of the patients' setup was verified using portal and digital images. Results : The PSVT system was developed to verify the alignment of the machine and the target isocenters, and the reproducibility of the patients' setup for 3DCRT and IMRT. The results show that the localization errors are 0.8$\pm$0.2 mm (AP) and 1.0$\pm$0.3 mm (Lateral) in the cases relating to the brain and 1.1$\pm$0.5 mm (AP) and 1.0$\pm$0.6 mm (Lateral) in the cases relating to the pelvis. The reproducibility of the patients' setup was verified by visualization, using real-time image acquisition, leading to the practical utilization of our software Conclusions : A PSVT system was developed for the verification of the alignment between machine and the target isocenters, and the reproduclbility of the patients' setup in 3DCRT and IMRT. With adjustment of the completed GUI-based algorithm, and a good quality DRR image, our software may be used for clinical applications.

• Journal of Oral Medicine and Pain
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• v.37 no.1
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• pp.33-45
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• 2012

This study was designed to assess follow-up study of condylar bone changes using cone beam computed tomography in patients with osteoarthritis. The author performed clinical examination for osteoarthritis patients who visited Orofacial Pain Clinic, Department of Oral Medicine, Pusan National University Hospital. CBCT(Cone beam computed tomography) was taken for 228 joints in 114 subjects. After average 10 months, CBCT was retaken. A Oral medicine and Oral radiologist evaluated CBCT each other. Condyle bone changes were classified by no bone change, flattening, erosion, osteophyte and sclerosis. The obtained results were as follow. 1. The condylar bone changes of osteoarthritis in temporomandibular disorder were as follow: 1) The transitions of each types of condylar bone changes was maintained at the initial state of the majority. 2) The transition of erosion was distributed erosion, flattening, sclreosis, osteohyte in order. 3) The transition of flattening was distributed flattening, osteohyte, normal, sclreosis in order. 4) The transition of osteohyte was distributed osteohyte, erosion, sclreosis, flattening in order. 5) The transition of sclreosis was distributed sclreosis, osteohyte, erosion, normal in order. 2. The signs and symptoms according to transition of each types of condylar bone changes were as follow 1) In the transition of condylar bone changes from erosin to erosion, pain, noise, LOM and MCO had symptomatic improvement. In the transition of condylar bone changes from erosin to flattening, pain, LOM, MCO had symptomatic improvement. In the transition of condylar bone changes from erosin to no bony change, pain, noise, LOM had symptomatic improvement. In the transition of condylar bone changes from erosion to flattening than the maintenance of eosion, MCO had symptomatic improvement. 2) In the transition of condylar bone changes from flattening to flattening, pain, noise and MCO had symptomatic improvement. In the transition of condylar bone changes from flattening to sclerosis, LOM had symptomatic improvement. 3) In the transition of condylar bone changes from osteophyte to osteophyte, pain, LOM and MCO had symptomatic improvement.

• Tuberculosis and Respiratory Diseases
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• v.39 no.3
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• pp.236-241
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• 1992

Background: As well as fiberoptic bronchoscopy, chest computerized tomographic scan can now differentiate the benign from malignant causes and the obstructive from non-obstructive causes of lung collapse. This study was designed to evaluate the usefulness of chest CT scan and fiberoptic bronchoscopy in the diagnosis of middle lobe syndrome. Method: We reviewed the clinical features, roentgenographic changes, pathologic findings and bronchoscopic findings in 16 patients with middle lobe syndrome who were admitted to Severance Hospital during period of January, 1987 through January, 1992. Results: The male to female ratio was 1:1. The most common symptoms were cough and sputums. Crackle was the most common physical finding. Underlying disease was lung cancer, pulmonary tuberculosis and endobronchial tuberculosis in 3 each other, benign stenosis in 2, lung abscess, broncholithiasis, bronchial chondroma, pneumonia and nonspecific inflammation in 1 each other. Conclusion: We conclude that the combination of chest computerized tomogram and fiberoptic bronchoscopy was most desirable for the diagnosis of middle lobe syndrome.

• Tuberculosis and Respiratory Diseases
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• v.43 no.1
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• pp.54-62
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• 1996

Background: $^{99m}Tc$ MIBI(Methoxyisobutylisonitrile complex), a member of the isonitrile class of coordination compounds, is a lipophilic cation presently under investigation for clinical use as myocardial perfusion imaging agent and is widely used to detect myocardial infarction. Preliminary reports indicate that $T_1$-201 accumulate in human neoplasm and several authors reported $^{99m}Tc$ MIBI may also localized in primary malignant tumor and metastatic deposits from lung cancer. We evaluated the uptake of $^{99m}Tc$ MIBI in lung cancer and localization of mediastinal and other site metastasis, and compared the benign lesion of the lung. Method: Thirty four patients of lung cancer and ten patients of benign lung lesion were studied with chest CT and $^{99m}Tc$ MIBI Lung SPECT. $^{99m}Tc$ MIBI uptake ratio was assessed by TR/NL(Lung lesion/ Normal area), HT/NL (Heart/Normal area) and HT/TR(Heart/Lung lesion). Results: 1) All lung cancer patients showed increased uptakes of $^{99m}Tc$ MIBI in malignant lung lesion and Tc-99m MIBI uptake was also increased in mediastinal and lymph node metastasis except two cases. 2) There was significant different ratio of TR/NL between malignant and benign lesion, $3.79{\pm}1.82$ and $1.67{\pm}0.63$ on planar images, respectively(p<0.001). 3) There was no significant difference of $^{99m}Tc$ MIBI uptake ratio between squamous cell carcinoma, small cell carcinoma and adeno carcinoma($3.64{\pm}1.66$, $3.57{\pm}0.72$, $4.31{\pm}2.28$ respectively). Conclusion: $^{99m}Tc$ MIBI lung SPECT was useful in the localization of tumor and mediastinal or other site metastatic lesion in lung cancer and also in the differential diagnosis between benign and malignant lesion.