• The Korean Journal of Nuclear Medicine
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• v.16 no.2
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• pp.71-80
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• 1982

In the present communication, the results will be reported on a clinical study of how well scintigraphic visualization of the hepatobiliary elements and several commonly used clinical liver function tests correlate each other in various diseases oft hepatobiliary system. The demonstrability of the biliary tract, gallbladder (GB) and duodenum was rather closely paralleled to serum bilirubin level and less closely to alkaline phosphatase and rather poorly to SGOT and SGPT. The biliary tree could not be visualized scintigraphically when bilirubin exceeded 10.5mg/dl. The usefulness of Tc-99m EHIDA [N-(2,6-diethylacetanilido) iminodiacetic acid, made by Amersham, England] hepatobiliary scintigraphy (Tc EHIDA HBS) in settling diagnostic controversy and ambiguity raised by oral cholecystography, intravenous cholangiography and ultrasonography in many hepatobiliary diseases is well known. The purpose of this investigation was to semiquantitatively evaluate the scintigraphic demonstrability of the hepatobiliary tract, GB and duodenum following intravenous injection of Tc-99m EHIDA in normal subjects and in patients with a disturbed liver function from various hepatobiliary diseases. The hepatobiliary scintigraphy was performed in 10 normal subjects and 39 patients with various hepatobiliary diseases (Table 1) at the Dept. of Radiology, St. Mary's Hospital Catholic Medical College, Seoul, Korea during 2 years period from September 1979. Scintigraphic examination was started at end of 3 minutes after intravenous injection of Tc-99m EHIDA in the amount of $50{\mu}Ci/kg$ and was continued until after 30 minutes at 5 minutes interval. The imaging was usually terminated when the tracer could be seen in the duodenum. Late scintigrams were obatained at 1 1/2, 3, 4 and 6 hours when reeded. Scintigrams were analyzed in terms of promptness and clarity of visualization of the biliary tree, GB and duodenum and demonstrability of these anatomical landmarks was correlated with the values of liver function tests. The demonstrability of the common hepatic duct, common bile duct, GB and duodenum was closely paralleled to the level of serum bilirubin when it is less than 10.5 mg/dl as shown in figure 1. However when the bilirubin exceeded 10.5 mg/dl the time of visualization between protracted reaching a flat curve or plateau around 10.5 mg/dl. The biliary tract could not be visualized when the bilirubin was higher than 10.5 mg/dl. The correlability between scintigraphic demonstration and serum alkaline phosphatase was less strong and between scintigraphic demonstration and SGOT and SGPT was rather poor. The present clinical study confirmed the usefulness and limitation of Tc-99m EHIDA hepatobiliary scintigraphy in visulizing and diagnosing the biliary system and duodenum when radiogrpahy and ultrasonography failed to provide useful informations. Scintigraphy was very helpful in the diagnosis of neonatal hepatitis, biliary atresia, cholecystitis and extrahepatic biliary obstruction. The hepatobiliary system and duodenum were visualized when serum bilirubin level was less than 10.5 mg/dl, SGOT 135 units, SGPT 114 units and alkaline phosphatase 52.2 KAU.

• Journal of the korean academy of Pediatric Dentistry
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• v.31 no.4
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• pp.587-597
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• 2004

Over the past 20 years, great strides have been made in research regarding the mechanisms involved in the progression of carious lesions, but new equipment and research tools need to be developed to continue these advancements in caries research. Various methods have been applied to reduce the incidence of carious lesions, which have led to a significant decrease in the number of occlusal caries, but a concurrent increase in the proportion of proximal carious lesions. New diagnostic equipment has been developed to detect early stage carious lesions, and these have demonstrated excellent laboratory results and show promise in clinical applications. The research presented here examines the efficacy of the newly developed $DIFOTI^{TM}$ system in detecting proximal carious lesions compared to traditional intraoral exam and bitewing radiography, possible problems or deficiencies of using the system in clinic, possible improvements that can be made to the system, and the efficacy of detecting early, reversible carious lesions that can be remineralized by preventative fluoride applications. The subject pool consisted of 23 grammer school age patients just prior to entering the mixed dentition phase. Each patient was given a thorough oral examination, radiographic examination consisting of bitewing radiographs of the posterior teeth, and $DIFOTI^{TM}$ examination of the anterior and posterior teeth. Each examination was carried out two times by two examiners, and the data were statistically analyzed. The results are as follows: 1. The mean alpha value of reliability test of the visual oral examination was as follows; occlusal surface was 0.8470. mesial surface was 0.6430, distal surface was 0.5727. lingual surface was 0.2807 and distal surface was 0.2339. When the examination was limited to posterior teeth, the mean alpha value was as follows; occlusal surface was 0.8577, distal surface was 0.8211, lingual surface was 0.7728, buccal surface was 0.7152 and mesial surface was 0.6782. 2. The alpha value of reliability test of the radiographic analysis of carious lesions of the occlusal, mesial, and distal surfaces was 0.8500. 3. The alpha value of reliability test of the $DIFOTI^{TM}$ diagnostic analysis of carious lesions of the occlusal, buccal, lingual, mesial, and distal surfaces was determined to be 0.7917. 4. The $DIFOTI^{TM}$ diagnostic system was found to be the most accurate means of detecting occlusal, buccal, and lingual surface carious lesions (p<0.05), while mesial and distal proximal carious lesions were most accurately assessed using bitewing radiography (p<0.05).

• Clinical and Experimental Pediatrics
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• v.53 no.2
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• pp.262-266
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• 2010

Tumor necrosis $factor-{\alpha}$ ($TNF-{\alpha}$) is a major proinflammatory cytokine involved in the pathophysiology of juvenile rheumatoid arthritis. Etanercept is an effective inhibitor of $TNF-{\alpha}$ and has shown a beneficial effect in patients with JRA. However, the most important cause of concern related to etanercept administration is infection. We report a case of encephalitis in a JRA patient receiving long-term treatment with etanercept. The patient was a 4-year-old boy with refractory JRA, and he received etanercept subcutaneously at a dose of $0.4\;mg\;kg^{-1}\;day^{-1}$ twice a week for 14 months, along with non-steroidal anti-inflammatory drugs, methotrexate, oral steroids, and sulfasalazine. The patient presented with sudden fever, headache, vomiting, a generalized tonic seizure, and changes in mental status. We suspected a central nervous system infection, and simultaneously administered antibiotics, an antiviral agent, and steroids. After 2 days of hospitalization, his mental function returned to normal, and he showed no further seizure-like movements. Brain magnetic resonance imaging scan of the patient showed a multifocal cortical lesion on both sides of the temporoparietooccipital lobe, which indicated encephalitis. Although we were unable to identify the causative organism of encephalitis, we think that the encephalitis may be attributed to infection, and the use of etanercept may have increased the risk of severe infection. Therefore, etanercept was discontinued and the patient recovered shortly after. To the best of our knowledge, this is the first case of encephalitis in a juvenile rheumatoid arthritis patient treated with etanercept.

• The Journal of Korean Society for Radiation Therapy
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• v.32
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• pp.7-15
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• 2020

Purpose: In modern radiotherapy technology, several methods of image guided radiation therapy (IGRT) are used to deliver accurate doses to tumor target locations and normal organs, including CBCT (Cone Beam Computed Tomography) and other devices, ExacTrac System, other than CBCT equipped with linear accelerators. In previous studies comparing the two systems, positional errors were analysed rearwards using Offline-view or evaluated only with a Yaw rotation with the X, Y, and Z axes. In this study, when using CBCT and ExacTrac to perform 6 Degree of the Freedom(DoF) Online IGRT in a treatment center with two equipment, the difference between the set-up calibration values seen in each system, the time taken for patient set-up, and the radiation usefulness of the imaging device is evaluated. Materials and Methods: In order to evaluate the difference between mobile calibrations and exposure radiation dose, the glass dosimetry and Rando Phantom were used for 11 cancer patients with head circumference from March to October 2017 in order to assess the difference between mobile calibrations and the time taken from Set-up to shortly before IGRT. CBCT and ExacTrac System were used for IGRT of all patients. An average of 10 CBCT and ExacTrac images were obtained per patient during the total treatment period, and the difference in 6D Online Automation values between the two systems was calculated within the ROI setting. In this case, the area of interest designation in the image obtained from CBCT was fixed to the same anatomical structure as the image obtained through ExacTrac. The difference in positional values for the six axes (SI, AP, LR; Rotation group: Pitch, Roll, Rtn) between the two systems, the total time taken from patient set-up to just before IGRT, and exposure dose were measured and compared respectively with the RandoPhantom. Results: the set-up error in the phantom and patient was less than 1mm in the translation group and less than 1.5° in the rotation group, and the RMS values of all axes except the Rtn value were less than 1mm and 1°. The time taken to correct the set-up error in each system was an average of 256±47.6sec for IGRT using CBCT and 84±3.5sec for ExacTrac, respectively. Radiation exposure dose by IGRT per treatment was measured at 37 times higher than ExacTrac in CBCT and ExacTrac at 2.468mGy and 0.066mGy at Oral Mucosa among the 7 measurement locations in the head and neck area. Conclusion: Through 6D online automatic positioning between the CBCT and ExacTrac systems, the set-up error was found to be less than 1mm, 1.02°, including the patient's movement (random error), as well as the systematic error of the two systems. This error range is considered to be reasonable when considering that the PTV Margin is 3mm during the head and neck IMRT treatment in the present study. However, considering the changes in target and risk organs due to changes in patient weight during the treatment period, it is considered to be appropriately used in combination with CBCT.