Comparison of Clinical Usefulness between N-13 Ammonia PET/CT and Tc-99m Sestamibi SPECT in Coronary Artery Disease / 핵의학분자영상

PURPOSE: N-13 ammonia uptake and retention in the myocardium is related to perfusion and metabolism. There are several potential advantages of N-13 ammonia positron emission tomography (PET) to detect myocardial ischemia, such as higher spatial resolution, greater counting efficiencies, and robust attenuation correction. But there are few reports comparing Tc-99m myocardial perfusion single photon emission tomography (MPS) and N-13 ammonia PET. We thus compared adenosine stress N-13 ammonia PET/CT and Tc-99m sestamibi MPS in patients with suspected coronary artery stenosis. MATERIALS AND METHODS: Seventeen patients (male 13 : 63+/-11 years old) underwent adenosine stress N-13 ammonia PET/CT (Discovery ST, GE), Tc-99m sestamibi MPS (dual head gamma camera, Hawkeye, GE) and coronary angiography within 1 week. N-13 ammonia PET/CT and Tc-99m sestamibi MPS images were assessed with a 20-segment model by visual interpretation and quantitative analysis using automatic quantitative software (Myovation, GE). RESULTS: Both sensitivities and specificities of detecting an individual coronary artery stenosis were higher for N-13 ammonia PET/CT than Tc-99m sestamibi MPS (PET/CT: 91%/ 89% vs MPS: 65%/ 82%). N-13 ammonia PET/CT showed reversibility in 52% of segments that were considered non-reversibile by Tc-99m sestamibi MPS. In the 110 myocardial segments supplied by the stenotic coronary artery, N-13 ammonia PET/CT showed higher count densities than Tc-99m MPS on rest study (p<0.01), and the difference of count density between the stress and the rest studies was also larger on N-13 ammonia PET/CT. CONCLUSION: Adenosine stress N-13 ammonia PET/CT had higher diagnostic sensitivity and specificity, more reversibility of perfusion defects and greater stress/rest uptake differences than Tc-99m sestamibi MPS. Accordingly, N-13 ammonia PET/CT might offer better assessment of myocardial ischemia and viability.

Comparison of the Morbidity between Intrapleural and Extrapleural Approach in Thoracoabdominal Incision for Radical Nephrectomy in Patients with Renal Cell Carcinoma / 대한비뇨기과학회지

Purpose: A thoracoabdominal incision using the intrapleural approach provides optimal exposure for radical nephrectomy, especially in large tumors or tumors in the upper pole of the kidney. Intuitively it is perceived that the morbidity of this type of incision is greater. In this study, the morbidity between the intrapleural and extrapleural approach in a thoracoabdominal incision for radical nephrectomy in renal cell carcinoma were compared. MATERIALS AND METHODS: Among the 62 patients undergoing thoracoabdominal radical nephrectomy for renal cell carcinoma, 20 patients underwent nephrectomy by the intrapleural approach (group I) due to an upper pole lesion (group IA, n=10) or a large tumor (group IB, n=10). Forty-two patients underwent nephrectomy by the extrapleural approach (group II). The operation time, the quantity of blood transfused during surgery, the postoperative hospital stay, the severity of pain and postoperative complications were assessed in order to compare the morbidity among the groups. RESULTS: With regard to the mean operation time, there were only statistically significant differences between group IB and II (p=0.005). There were no statistically significant differences in terms of the intraoperative transfusion amount, postoperative hospital stay, pain severity, and complications between group I and II. CONCLUSIONS: The intrapleural thoracoabdominal approach was comparable to the extrapleural approach in terms of the operation time except for large tumors, intraoperative transfusion amount, postoperative length of hospital stay, pain severity, and complications. Therefore, for radical nephrectomy, an intrapleural thoracoabdominal incision could be used without increasing the risk of morbidity in large tumors or tumors in the upper pole of the kidney.

Clinical Usefulness of Measurement of Reticulated Platelets by Thiazole Orange in Idiopathic Thrombocytopenic Purpura / 대한임상병리학회지

BACKGROUND: Reticulated platelets (RP) are young platelets with a high mRNA that are newly produced from the bone marrow. Thiazole orange (TO) has been a RNA staining fluorescent dye for reticulocyte, and used for RP recently. The increased percentage of RP (RP%) reflects immaturity and hematopoietic activity of platelets, therefore it may be useful for the diagnosis of idiopathic thrombocytopenic purpura (ITP). METHODS: To assess the usefulness of RP in diagnosing ITP, we compared with RP%s of 50 ITP patients, 35 thrombocytopenic patients due to impaired production and 87 heathly normal controls. Platelets were stained with TO dye, followed by flowcytometric analysis. Platelet associated IgG (PAIgG) was also measured with the same samples. The standard gate was used as a reference with the unstained sample from a normal subject and the RP% was expressed as the percentage of TO positive cells of platelets. RESULTS: The RP% of patients with ITP was significantly higher than those of thrombocytopenia due to impaired platelet production and healthy controls (24.4+/-14.3% vs 8.6+/-5.2% and 8.0+/-5.1%, respectively). There was negative correlation between the platelet count and RP%, and positive correlation between MPV and RP%. In diagnosing for ITP, the sensistivity and specificity of RP% were 81% and 92%, respectively, and more valuable than those of PAIgG test. Using RP% and PAIgG at the same time, the diagnostic efficiency for ITP was not improved. The RP% of an ITP patient was changed to correspond with the disease progression, and that of an AML patient following chemotherapy was increased to precede the rising of the platelet count. CONCLUSION: It suggest that the measurement of reticulated platelets is a very useful test for diagnosis of ITP, furthermore it can be used to estimate the thrombopoietic activity before bone marrow examination.

The Amount of Hematopoietic Stem Cell and the Distribution of HLA in Human Cord Blood: Basic Study for the Development of Cord Blood Bank / 대한혈액학회지

BACKGROUND: Because there are lower incidence of graft versus host disease in HLA mismatched cord blood transplantation compared to bone marrow transplantation, development of smaller scale cord blood bank could be possible. So we analysed the content of hematopoietic stem cell in cord blood and the distribution of HLA as a basic study for cord blood bank. METHODS: Seventy eight cord bloods were collected in heparinized bottle immediately after caesarian section. After expulsion of placenta, additional cord blood and placental blood were collected with heparinized syringe. Fifteen mL was sent to the laboratory for analysis and the rest was cryopreserved. RESULTS: The mean collected cord blood volume was 96.8mL (range, 55~163mL). And mean 81.8mL (range, 40~148mL) was cryopreserved. It contained mean 7.4x108 (range, 2.8x108~12.2x108) nucleated cells. In 2x105 mononuclear cells, 85 +/- 48 BFU-E, 19 +/- 17 CFU-E, 107 +/- 73 CFU-GM and 124 +/- 113 CFU-GEMM were present. With dextran/albumin thawing media, the viability of cryopreserved cord blood mononuclear cell was better than usual washing method with IMDM (82.3% vs. 74.6% P=0.004). Each cord blood could findHLA full matched, 5 loci matched and 4 loci matched cord blood in the remainders with the probability of 0, 11.9% and 58.4%. CONCLUSION: Development of more smaller scale cord blood bank could be possible compared to bone marrow bank.

A Study on Food Intake of a Rural Community Housewives with the Related Factors and Nutrition Education-Index / 예방의학회지

This study is aimed at developing a nutritional task of a community as public health activities of Su-Dong Myun, Demonstration Project area of Ewha Womans University. The content of this study is the points of nutritional diagnosis for the residents nutritional evaluation, the analysis of the related factors and the educational material with Nutrition Education-Index. Two hundreds housewives were examined during the period of Jan. 30 in 1989. 1. In terms of the housewives' age, those aged 30 to 39 were 32.5% which was the highest and educational level, graduation of primary school was 31.5% which was the highest. The housewives who had no job were 60.6% and those who participated in community activities were 56.5%. 2. In terms of the points of nutritional diagnosis, 50 to 74 points were 51.5% which was the highest and total average was 65.1 +/- 15.0. 3. As for the points of nutritional knowledge, the average was 54.9 points, attitude was 77.4 points and eating practice was 70.8 points. 4. The number of clinical symptoms of nutritional deficiency was 16.1 ones per person. 5. As for the relation which nutritional knowledge, attitude, eating practice exert on one another, nutritional knowledge had negative correlation with eating practice(-0.04) and attitude has some correlation with eating practice(0.17). 6. The variable having to do with the points of nutritional diagnosis showed the highest correlation coefficient(0.55) as the points of nutritional knowledge. 7. As for the variable having to do with the number of the symptoms of nutrition deficiency, the higher points of knowledge(-0.05) is, the higher the total average points of nutritional diagnosis(-0.09) is, negative correlation was appeared. 8. The result in which the variant having to do with the number of clinical symptoms of nutritional deficiency was analyzed by multiple regression analysis showed that the lack of time for preparing meals in non agricultural households made the greatest contribution (9% explained) and the households having vegetable garden made the second greatest contribution (3% explained).

A Study of Relation Between Number of Daily Food Intake and Nutritional Balance / 예방의학회지

During the period of May 10 to June 6, 1987, we have conducted the survey about the number of the food daily taken and the in take of nutrition of the 83 pregnant women who have registered at Sudong Myun and Mikum-myun, Yangchu-gun which are demonstration are of the public health and medicine of the College of Medicine, Ewha Women's University, and of the 100 pregnant women who have been to the University Hospital attached to the above School. The result of the survey is as follows: 1) Among the above pregnant women, primigravida constituted 91 women and multigravida 92 women. As for the month of pregnancy, those who have been pregnant for ten months numbered 43 women (23.5%), which was the highest number. As for age, those who were 25 to 29 years old constituted 63.9%, which was the highest in percentage. 2) As for the level of education, those who graduated from high school constituted 49.2%, which was the highest in percentage. As for occupation, those who were entirely in charge of household affairs as housewives were 89.6%, which comprised most of the jobs held by the above women. 3) As for the composition of a family in environmental food and nutrition, one generation was 68.3%, and two member family was 42.6% which was the highest. As for those taking care of cooking and serving meals, housewives constituted 95.1%. 4) As for the economic situation of dietary life, those who were in the highest level (A level), were 47.0% in an urban area and 41.0% in rural area, which were the highest in percentage. 5) The food which the above people selected after being pregnant was fruit not only in an urban area, but also in a rural area. And in terms of the percentage of fruit, and urban area and a rural area showed 44.0% and 54.2% respectively. As for milk, and urban area and a rural area showed 28.0% and 8.4% respectively, which disclosed that the rate of a rural area was much lower than that of an urban area. 6) As for the number of food intake, 10-14 was 54.0% in an urban area, which was the highest. And 5-9 was 73.5% in a rural area, which was the highest. 7) As for the composition of food taken according to the number of food taken, meat showed the lowest rate in 5-9 group. (P<0.05) As the number of food taken increased, the rate of food taken(Points) increased (2.4). Milk and milk products showed al low rate in 5-9 group and 15-19 group (P<0.05). Fruit intake showed a similar rate in all groups. As for vegetables, the rate of intake was high, as the number of food taken increased. Cereals showed a similar rate in all troups. And the points of intake was high. As for fat, hte rate of intake was high, as the number of food taken increased. 8) In 5-9 group in the number of food intake, energy was 79.9% of RDA, protein was 64.9%, fat was 90.0%, carbohydrate was 81.6%, iron was 83.0%, calcium was 71.1%, vitamin A was 94.3%, vitamin B1 was 77.8%, vitamin B2 was 79.2%, and vitamin C was 88.2%, so that it showed the lowest sufficiency rate of RDA. 15-19 group maintained the balance in energy and all nutrients nearly. In 20-24 group, fat was 142.4%, vitamin B2 was 105.6% and vitamin C was 102.2%, so that it exceeded RDA.

A Study on Sickness and the Status of Medical Care in a Rural Area / 예방의학회지

This survey was made to determine the overall health situation on (1) the status of sickness; (2) the medical care utilization; (3) the medical cost in Mi-Kum Myun, Nam Yang Ju Gun, Kyung_Gi Do. The survey with questionnaire was carried out with 2,840 peoples in 560 households from August 9th to 16th, 1979. The findings from the survey were as follows; 1. Annul morbidity rate of the prolonged ill cases was 97.2 per 1,000 population (male 94.7, female 99.6). The highest age specific morbidity rate was 274.5 of the 45-to 64-year group and the lowest was 21.9 of the 5-to 14-year group. 2. Annul morbidity rate of the new patients was 777.5 per 1,000 population(male 644.5, female 909.5). 3. The chief complaints distribution of the prolonged ill cases was: local pain 36.6%, indigestion 22.4%, and coughing 7.3%, respectively. In terms of age and sex distribution, a large number of female of the 45-to 64-year group complained of local pain or general pain a large number of both sexes of the 25-to 44-year group complained of indigestion. 4. The major diseases of the new patients which classified with International Classification of Disease (I.C.D) were disease of the respiratory system, disease of the digestive system, and disease of the musculo-skeletal system and connective tissue for male, disease of the respiratory system, disease of the digestive system, and accident, poisoning, violence for female. 5. Total ill days of the 92 new patients were 536 days and average ill days per were 6+/-38.3 days. 6. The rate of receiving treatment in the prolonged ill case was 82.2%(medical facilities 46.4%, drug stores 27.5%, herb medicine 8.3%). 7. The rate of receiving treatment by first choice of the new patients was 88.0% (drug stores 57.%, medicine facilities 28.2%, and herb medicine 2.2%), and the rate of receiving treatment by second choice was 30.9% of first treatment cases (medicine facilities 44.0%, drug store 44.0% and herb medicine 12.0%). 8. Annul hospitalization rate per 1,000 population was (male 12.0, female 11.9). 9. The locations of medical facilities utilized by out-patients were: in the prolonged ill cases Seoul or other places 66.4%, Nam Yang Ju Gun 33.6%, in cases of the new patients Seoul or other places 35.1% and Nam Yang Ju Gun 64.9% respectively. 10. The satisfaction rate of the new patients by mode of receiving treatment was: in cases of primary utilization by first choice herb medicine 100.0%, medical facilities 88.5%, and drug stores 69.8%, in cases of secondary utilization medical facilities 100.0%, herb medicine 100.0%, and drug stores 72.7% respectively. 11. The medical cost per utilized facilities was as follows; in average medical fee per case out-patient 8,947 won, in-patient 266,000 won, drug stores 1,532 won, and herb medicine 15,607 won, in average medical fee per day out-patient 4,829 won, in patient 14,178 won, drug stores 891 won, and herb medicine 4,906 won respectively. 12. The sources of the hospital changes paid out were: there own expense 50.0%, debt 35.3%, and security of medical care 14.7% respectively.