PURPOSE: We conducted this study to evaluate the efficacy of Doppler study by examining obstruction at the site of anastomosis in patients with total anomalous pulmonary venous return(TAPVR). METHODS: Retrograde analysis of the postoperative echocardiography results was done in 14 patients with simple TAPVR, who were operated at Dong-A University Hospital from January 1993 to July 1998. The peak systolic velocities, peak diastolic velocities and flow patterns of the 14 patients were compared with those of 9 control cases. Among the 14 patients, 2 cases showed evidence of obstruction at the anastomosis site. RESULTS: Pulmonary venous flow patterns of normal infants were biphasic, varying with the cardiac cycle. The peak velocities during systole and diastole were 40 to 60cm/sec(mean 51+/-9cm/sec) and 45 to 78cm/sec(mean 59+/-9cm/sec), respectively. The flow patterns of patients without postoperative stenosis were also biphasic. The peak velocities during systole and diastole was 38 to 115cm/sec(mean 71+/-27cm/sec) and 55 to 140cm/sec(mean 111+/-28cm/sec), respectively. The diastole peak velocity was significantly higher than normal(P=0.0002). The flow patterns of patients with postoperative stenosis was continuous, non-phasic or increased peak velocity even though it was phasic. CONCLUSION: Postoperative Doppler echocardiographic evaluation of pulmonary venous return in patients with TAPVR is useful in examining obstruction at the site of anastomosis. But a study on the Doppler echocardiographic normal range of postoperative patients will be needed.
Constriction, Pathologic ; Diastole ; Echocardiography* ; Echocardiography, Doppler ; Humans ; Infant ; Reference Values ; Scimitar Syndrome* ; Systole

PURPOSE: We conducted this study to evaluate the efficacy of Doppler study by examining obstruction at the site of anastomosis in patients with total anomalous pulmonary venous return(TAPVR). METHODS: Retrograde analysis of the postoperative echocardiography results was done in 14 patients with simple TAPVR, who were operated at Dong-A University Hospital from January 1993 to July 1998. The peak systolic velocities, peak diastolic velocities and flow patterns of the 14 patients were compared with those of 9 control cases. Among the 14 patients, 2 cases showed evidence of obstruction at the anastomosis site. RESULTS: Pulmonary venous flow patterns of normal infants were biphasic, varying with the cardiac cycle. The peak velocities during systole and diastole were 40 to 60cm/sec(mean 51+/-9cm/sec) and 45 to 78cm/sec(mean 59+/-9cm/sec), respectively. The flow patterns of patients without postoperative stenosis were also biphasic. The peak velocities during systole and diastole was 38 to 115cm/sec(mean 71+/-27cm/sec) and 55 to 140cm/sec(mean 111+/-28cm/sec), respectively. The diastole peak velocity was significantly higher than normal(P=0.0002). The flow patterns of patients with postoperative stenosis was continuous, non-phasic or increased peak velocity even though it was phasic. CONCLUSION: Postoperative Doppler echocardiographic evaluation of pulmonary venous return in patients with TAPVR is useful in examining obstruction at the site of anastomosis. But a study on the Doppler echocardiographic normal range of postoperative patients will be needed.
Constriction, Pathologic ; Diastole ; Echocardiography* ; Echocardiography, Doppler ; Humans ; Infant ; Reference Values ; Scimitar Syndrome* ; Systole

There remains controversy regarding the appropriate surgical treatment for coarctation of the aorta because of relatively high rate of recoartation and high mortality in the cases associated with complex anomalies. We evaluated 31 consecutive patients who underwent surgical repair of coarctation of the aorta from May 1992 through June 1996. Nineteen patients(61.3%) were neonates and 26(83.9%) were under three months. Nine patients did not have major associated anomalies(Group I), 15 patients had ventricular septal defect(Group II), and 7 patients had major complex anomalies(Group III). 35.5% of the patients had arch hypoplasia. Surgical procedures performed were as follows: extended end-to-end anastomosis in 17 patients, combined resection-flap procedure in 7 patients, and subclavian flap aortoplasty in 7 patients. Residual coarctation occurred in 7(25%) of 28 patients; 2 after subclavian flap aortoplasty(2/6, 33.3%), none after combined resection-flap procedure(0/7, 0%)), and 5 after extended end-to-end anastomosis(5/15, 33.3%). Higher incidence of residual coarctation was noticed in the group with arch hypoplasia. The incidence of postoperative coarctation at a mean follow-up of 20.5 months in survivals was 12.0%(3/25); 2 cases after subclavian flap aortoplasty(2/6, 33.3%), none after combined resection-flap procedure(0/7, 0%), and one after end-to-end anastomosis(1/12, 8.3%). The mortality rate related to coarctation repair was 9.7%(3 patients, all in Group III). This study revealed that isolated coarctation of aorta and coarctation with ventricular septal defect(groups I and II) can be repaired with low mortality, but repair of coarctation with complex anomaly had a high operative mortality. Also the patients with arch hypoplasia had higher incidence of post-operative residual coarctation.
Aortic Coarctation* ; Follow-Up Studies ; Humans ; Incidence ; Infant, Newborn ; Mortality

BACKGROUND: Malassezia yeasts are normal skin flora of humans. But skin colonization appear to be controversial during neonate. OBJECTIVE: We prospectively studied the distribution of Malassezia yeasts on clinically normal skin of neonates and infants for providing the basic data for proving the relationship of Malassezia yeasts and pathogenesis of the diseases of neonates and infants. METHODS: A total of 200 subjects were studied using the direct smear test with 20% Parker ink/KOH solution. The numbers of the Malassezia yeasts per high power field were counted according to a bacterial index of lepra bacilli in patients of leprosy. In order to identify risk factors for the distribution of Malassezia yeasts, we compared sex, mode of delivery, gestational age, birthweight during the first week of life by statistical method of the logistic regression. RESULTS: Of the 200 neonates and infants under 12 weeks, 121 (60.5%) revealed Malassezia yeasts in at least a part of five examined sites. The prevalence of Malassezia yeasts was increased according to the age. No association was found between the incidence of Malassezia yeasts and sex, mode of delivery, gestational age, birth weight. CONCLUSION: We conclude that Malassezia yeasts colonize on the skin of neonates and infants.
Birth Weight ; Colon ; Gestational Age ; Humans ; Incidence ; Infant* ; Infant, Newborn* ; Leprosy ; Logistic Models ; Malassezia* ; Prevalence ; Prospective Studies ; Risk Factors ; Skin* ; Yeasts*

PURPOSE: The arterial switch operation (ASO) has become the preferred procedure for the surgical management of transposition of the great arteries (TGA). We conducted a retrospective evaluation of our experience in 30 patients seen from January 2003 to July 2008, in order to determine outcomes and related risk factors after the arterial switch operation. METHODS: Patients charts, surgical reports, and echocardiograms were retrospectively reviewed. And they were analyzed in 2 different groups: complex (n=16) versus simple TGAs (n=14). Complex TGAs are TGAs with VSD or the Taussig-Bing anomaly with or without aortic arch anomalies. Simple TGAs are defined as TGAs with intact ventricular septum having no such anomalies. Median follow-up time was 44 months (3-63 months). RESULTS: Hospital mortality was 0%. However, follow-up echocardiographies revealed potential complications, including stenosis of the branch pulmonary arteries, neo-aortic and/or neo-pulmonary valvar regurgitation, and right or left ventricular outflow tract obstructions. Great arterial relationship (side-by-side), association of aortic arch anomalies, and the existence of the Taussig-Bing anomaly were assessed as significant risk factors of neo-aortic and/or neo-pulmonary valvar regurgitation in this series. On the other hand, right or left ventricular outflow tract obstructions were more frequently found in patients demonstrating VSD, side-by-side positioned great arteries, or associated coronary anomalies. CONCLUSION: The ASO is the procedure of choice in the treatment of TGA. However, special attention and follow-ups are needed to detect residual problems like the stenosis of the branch pulmonary arteries, neo-aortic and/or neo-pulmonary valvar regurgitation, as well as ventricular outflow tract obstructions.
Aorta, Thoracic ; Arteries ; Constriction, Pathologic ; Double Outlet Right Ventricle ; Follow-Up Studies ; Hand ; Hospital Mortality ; Humans ; Postoperative Complications ; Pulmonary Artery ; Retrospective Studies ; Risk Factors ; Transposition of Great Vessels ; Ventricular Septum

Interrupted aortic arch with concomitant intracardiac defects is a rare congenital anomaly that has an unfavorable natural course. We report a successful staged operation of interrupted aortic arch with apical muscular ventricular septal defect associating esophageal atresia with tracheoesophageal fistula in a 3-day-old neonate weighing 2.6 kg. We repaired esophageal atresia through the right thoracotomy and subsequently performed extended end-to-end anastomosis of the aortic arch with pulmonary artery banding through the left thoracotomy at same operation. The apical muscular VSD was repaired 87 day after first operation. The patient required multiple additional interventions before closure of the apical muscular ventricular septal defect, such as pyloromyotomy for idiopathic hypertrophic pyloric stenosis, anterior aortopexy for airway obstruction, and balloon aortoplasty for residual coarctation. She is now doing well.
Airway Obstruction ; Aorta, Thoracic* ; Esophageal Atresia* ; Heart Septal Defects, Ventricular* ; Humans ; Infant, Newborn ; Pulmonary Artery ; Pyloric Stenosis, Hypertrophic ; Thoracotomy ; Tracheoesophageal Fistula*

Bovine viral diarrhea virus (BVDV) is an RNA virus belonging to Pestivirus in the family Flaviviridae. BVDV has economic significance for the livestock industry because of its association with acute disease, fetal loss, and birth of persistently infected (PI) animals. This study aimed to investigate the BVDV infection rates in Korean native cattle farms in Jeju for further planning of a BVDV control program in the Jeju Province. BVDV antibodies and antigens were tested in 15,842 sera collected from 302 Korean native cattle herds between January 2014 and June 2017 using enzyme-linked immunosorbent assay (ELISA). Viral antigen was detected by reverse transcription-polymerase chain reaction from 60 sera that were antigen ELISA-positive. BVDV antibodies were found in 90.7% (274/302) herds and 61.1% (9,678/15,842) cows. BVDV antigens were found in 13.2% (40/302) herds and 0.4% (61/15,842) cows. The oldest animal group (> 8 years) exhibited the highest sero-positive rates (91%), while the youngest animal group (< 1 years) had the highest antigen positivity rates (0.52%). Of the 60 antigen-positive sera, BVDV types 1 and 2 were found in 36 and 12 sera, respectively. Additionally, six animals were considered to be PI as BVDV was continually detected in annual examination.

Computational three-dimensional (3D) models of a dental structure generated from 3D dental computed tomography (CT) images are now widely used in digital dentistry. To generate precise 3D models, high-resolution imaging of the dental structure with a dental CT is required. However, a small head motion of the patient during the dental CT scan could degrade the spatial resolution of CT images to the extent that digital dentistry is no longer possible. A bench-top micro-CT has been built to evaluate the head motion effects on the dental CT images. A micro-CT has been built on an optic table with a micro-focus x-ray source and a flat-panel detector. A rotation stage, placed in between the x-ray source and the detector, is mounted on two-directional goniometers that can rotate the rotation stage in two orthogonal directions while the rotation stage is performing the CT scan. The goniometers can make object motions of an arbitrary waveform to simulate head tilting or head nodding. CT images of a phantom have been taken with and without introducing the motions, and the motion effects on the CT images have been evaluated. Object motions parallel to the detector plane have greater effects on the CT images than those against the detector plane. With the bench-top micro-CT, the motion effects have been visually seen at a tiny rotational motion as small as 0.3°. The bench-top micro-CT can be used to evaluate head motion effects on the dental CT images. The projection data, taken with the motion effects, would be used to develop motion artifact correction methods for a high-resolution dental-CT.
Artifacts ; Dentistry ; Head* ; Humans ; Tomography, X-Ray Computed

BACKGROUND: Diabetes mellitus is often accompanied by complicated microangiopathy, such as, retinopathy, nephropathy, peripheral neuropathy, cardiovascular autonomic neuropathy or macroangiopathy, as well as by coronary artery disease and cerebrovascular disease. However, there have been few reports concerning the pulmonary involvement of diabetes. Recently, capillary basement membrane thickening, nonenzymatic glycosylation of tissue proteins, abnormalities of endothelial cells and increased damage by free radicals were reported as the underlying basis for the reduced lung permeability. 99mTc-DTPA aerosol scintigraphy is a noninvasive, accurate method, which evaluates the permeability of lung epithelial membranes. The clearance rate of 99mTc-DTPA in lungs may correlate inversely with the lung's epithelial permeability. We investigated the relationship between microangiopathies and the lung epithelial permeability in patients with diabetes using 99mTc-DTPA aerosol scintigraphy. METHODS: The study group comprised of 33 patients with type 2 diabetes mellitus, with no clinical evidence of past or present respiratory disease. The patients were divided into two groups in relation to the complications. Group 1: 16 patients with more than one of the complications of retinopathy, nephropathy, cardiovascular autonomic neuropathy and/or peripheral neuropathy, and comprised of 3 males and 13 females, with a mean age of 52.9 +/- 9.6 years. Group 2: 17 patients with no complications, and comprised of 5 males and 12 females with a mean age of 52.8 +/- 11.5 years. Group 3: as a control group, comprised of 11 healthy people: 4 males 4 and 7 females with a mean age of 44.2 +/- 12.5 years. 99m-Tc-DTPA aerosol scintigraphy was performed in the subjects by inhalation of 30 mCi 99mTc-DTPA aerosol and oxygen (9 l/min) using an aero-vent jet nebulizer as the lung delivery system. To evaluate the diabetic complications, CAN (Cardiovascular Autonomic Neuropathy), and NCV (Nerve Conduction Velocity) tests for peripheral neuropathy, fundoscopy for retinopathy and 24 hours urine microalbumin for nephropathy were performed. RESULTS: The mean durations of diabetes in Groups 1 and 2 were 11.1 +/- 4.7 years and 3.8 +/- 2.1 years, respectively (p<0.05). The mean clearance rates of 99mTc-DTPA were found to be 72.1 +/- 19.5min, 52.6 +/- 19.7 min, and 47.1 +/- 10.9 min for Groups 1, 2, and 3, respectively. The mean clearance rate of Group 1 was significantly longer than for Groups 2 and 3 (p<0.05). In other words, the pulmonary epithelial permeability was reduced in diabetic patients with complications compared to the patients without complication and/or the normal controls. Significant positive correlation was found between the pulmonary clearance rate of 99mTc-DTPA, and peripheral neuropathy and cardiovascular autonomic neuropathy (p<0.05). Conclusions: The lungs may be a target organ for diabetes, and impaired pulmonary epithelial permeability seems to be closely related to other diabetic microangiopathies. Therefore, we recommend that 99mTc-DTPA aerosol scintigraphy be used as a technique for assessing lung injury in diabetic patients.
Basement Membrane ; Capillaries ; Coronary Artery Disease ; Diabetes Complications ; Diabetes Mellitus ; Diabetes Mellitus, Type 2* ; Diabetic Angiopathies ; Endothelial Cells ; Female ; Free Radicals ; Glycosylation ; Humans ; Inhalation ; Lung Injury ; Lung* ; Male ; Membranes ; Nebulizers and Vaporizers ; Oxygen ; Peripheral Nervous System Diseases ; Permeability* ; Radionuclide Imaging*

PURPOSE: To evaluate the treatment results in early stage non-small cell lung cancer patients who have undergone fiducial-less CyberKnife radiosurgery (CKRS). MATERIALS AND METHODS: From June 2011 to November 2013, 58 patients underwent CKRS at Asan Medical Center for stage I lung cancer. After excluding 14 patients, we retrospectively reviewed the records of the remaining 44 patients. All analyses were performed using SPSS ver. 21. RESULTS: The median age at diagnosis was 75 years. Most patients had inoperable primary lung cancer with a poor pulmonary function test with comorbidity or old age. The clinical stage was IA in 30 patients (68.2%), IB in 14 (31.8%). The mean tumor size was 2.6 cm (range, 1.2 to 4.8 cm), and the tumor was smaller than 2 cm in 12 patients (27.3%). The radiation dose given was 48-60 Gy in 3-4 fractions. In a median follow-up of 23.1 months, local recurrence occurred in three patients (2-year local recurrence-free survival rate, 90.4%) and distant metastasis occurred in 13 patients. All patients tolerated the radiosurgery well, only two patients developing grade 3 dyspnea. The most common complications were radiation-induced fibrosis and pneumonitis. Eight patients died due to cancer progression. CONCLUSION: The results showed that fiducial-less CKRS shows comparable local tumor control and survival rates to those of LINAC-based SABR or CKRS with a fiducial marker. Thus, fiducial-less CKRS using Xsight lung tracking system can be effectively and safely performed for patients with medically inoperable stage I non-small cell lung cancer without any risk of procedure-related complication.
Carcinoma, Non-Small-Cell Lung* ; Chungcheongnam-do ; Comorbidity ; Diagnosis ; Dyspnea ; Fibrosis ; Fiducial Markers ; Follow-Up Studies ; Humans ; Lung ; Lung Neoplasms ; Neoplasm Metastasis ; Pneumonia ; Radiosurgery* ; Recurrence ; Respiratory Function Tests ; Retrospective Studies ; Survival Rate