• Tuberculosis and Respiratory Diseases
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• v.41 no.5
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• pp.537-545
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• 1994

Background: In 1987, the British Thoracic Society (BTS) subjected an extensive list of patient variables to statistical analysis in a prospective study of prognosis in 453 adults with community-acquired pneumonia and, subsequently published guidelines for management of severe community acquired pneumonia. It was hoped that those at risk of dying from community acquired pneumonia could be easily identified and treated appropriately, thereby reducing mortality. To date, severe community acquired pneumonia has not been well studied in Korea. Therefore, we studied retrospectively 10 patients dying of severe community acquired pneumonia in Dongsan Hospital to see clinical manifestations of dying of severe community-acquired pneumonia. Methods: Between July 1987 and july 1993, 498 patients were admitted to Keimyung University Dongsan Hospital with community acquired pneumonia, and 77 of them received intensive care. Of the 77 patients, 10 patients died. We reviewed medical records of these patients. Results: 1) The mean age of the patients was 56.2 years(range, 25 to 75 years). There were 7 men and 3 women. Seven patients(70%) were older than 60years of age. 2) The clinical features on admission were as follows: tachypnca, hypoxemia, mental change, cyanosis, leukopenia, leukocytosis, azotemia, hypotension, hypoalbuminemia in order of frequency. Three patients had one abnormal physical finding, 3 patients had 2, 2 patients had 3, and 2 patients had none of these abnormal physical findings. All patients had at least one of the abnormal laboratory findings. 3) A potential bacterial pathogen was isolated in sputum culture from 2 patients. One was E.coli, the other Enterobacter species. Sputum stain were positive in eight cases (G(+)cocci in six, G(+) cocci and G(-)bacilli in two). 4) Features of respiratory failure were the main reasons for ICU transfer, but two patients were transferred only following a cardiac or respiratory arrest in the general ward. 5) The mean of 2.7 different antibiotics were given to the patients. The aminoglycoside and first generation cephalosporin were the most frequently prescribed antibiotics, followed by the third generation cephalosporin and vancomycin. The most frequently prescribed antibiotics combination was a 1st generation cephalosporin plus an aminoglycoside. 6) Seven patients death(70%) occured after admission within the first five days, and a mean duration of hospitaliztion was 11.2 days. Conclusion: As the results show most death occured within the first five days after admission and aged patients; consequently, an aggressive intensive treatment should be provided early to the patients with severe community acquired pneumonia, and we should pay more attention to the aged patients.

• Tuberculosis and Respiratory Diseases
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• v.59 no.4
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• pp.380-388
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• 2005

Background : Acute drug intoxication has recently become an important issue in the social and clinical areas. There are various complications associated with acute drug intoxication such as pneumonia, but the process is was not fully understood. The aim of this study was to analyze our cases of pneumonia associated with acute drug intoxication and to determine the associated risk factors. Methods : Forty four cases out of 237 patients, who were acute drug intoxicated from May 2000 to Feb. 2005, were diagnosed with pneumonia at the Konyang University hospital. These cases were analyzed by a retrospective review of their medical records. Results : The incidence of pneumonia in acute drug intoxication was 18.6%. There was no gender difference in terms of the incidence, but the age group with the highest incidence was in the $5^{th}$ decade (22.5%) followed by the $7^{th}$ decade (17.9%). Most common drug of associated with pneumonia was organophosphate insecticides, and the others were herbicides. Suicidal attempts were the most common motive of intoxication. The incidence of pneumonia was increased in old age (${\beta}=0.128$, p<0.05). A drowsy or comatous mental status was an independent risk factors of pneumonia (${\beta}=-0.209$, p=0.006). A longer hospital duration was also a risk factor for pneumonia (${\beta}=0.361$, p<0.001). The intubated state, intensive care unit care and longer duration of admission correlated with the course of pneumonia in acute drug intoxicated patients (p<0.05). The culture study revealed MRSA to be most common pathogen. Conclusion : The incidence of pneumonia associated with acute drug intoxication was higher in the older aged patients, those with a decreased initial mental status and a longer hospital duration. The number of days in the intensive care unit and intubation were associated prognostic factors for pneumonia in acute drug intoxication patients.

• Journal of Digestive Cancer Research
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• v.9 no.1
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• pp.1-7
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• 2021

The length, the frequency, and the methods of surveillance for intraductal papillary mucinous neoplasm (IPMN) of the pancreas are still debating. According to the recent guidelines, IPMN is stratified into "high-risk stigmata" or absolute indication and "worrisome features" or relative indication as a guide in managing these patients, either those with resection of the lesion or those under surveillance. The risk of malignant transformation was quite low for branch duct-IPMNs without worrisome features or high risk stigmata. However, because the incidence rate of pancreatic cancer in these patients increase linearly with time, continued long-term surveillance is therefore important for patients with low-risk, as well as higher-risk, IPMN. Considering the high prevalence of malignancy, main duct-IPMN should be treated by surgical resection. Among patients with these type IPMNs, segmental dilatation of the main pancreatic duct without any mural nodules and larger than 10 mm of main pancreatic duct might not be immediately resected and need very careful examination and observation. The risk related to a major pancreatic resection must balance the risk of surveillance in patients with IPMN of the pancreas who have co-morbidity and are elderly.

• Clinical and Experimental Reproductive Medicine
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• v.34 no.3
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• pp.189-196
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• 2007

Objectives: The purpose of this study is to investigate the clinical significance of age and basal serum FSH in predicting the outcomes of in vitro fertilization (IVF) in patients with poor-ovarian response. Methods: From January 2000 to December 2004, 85 second IVF cycles of 85 poor-ovarian response patients under the age of 42 with a back-ground of the first IVF cycles at our infertility center and 5 or less oocytes were retrieved and their basal serum FSH levels of 15$\sim$25 mIU/ml were enrolled in this study. Exclusion criteria were patients with a male factor for the etiology of infertility and undergoing genetic diagnosis of embryo such as PGD. Flare-up protocol was used for ovarian stimulation in all cases. Results: When we stratified the study groups by patient's age, the younger age group (age<35, n=35) showed significantly higher implantation rate (19.0% versus 4.0%, p<0.05) and higher ongoing pregnancy rate (100% versus 14.3%, p<0.05) than the older age group (age$\geq$35, n=50). And then, when we stratified the study populations by basal serum FSH level, the lower FSH group (basal serum FSH<20 mIU/ml, n=58) showed significantly higher number of retrieved oocytes (4.6$\pm$0.7 versus 2.2$\pm$0.5, p<0.05) and lower cancellation rate (19.0% versus 55.6%, p<0.05) than higher FSH group (basal serum FSH$\geq$20 mIU/ml, n=27). Conclusions: In conclusion, it was suggested that the patient's age could predict the IVF outcomes in respect to its potency of pregnancy and ongoing pregnancy. Serum basal FSH levels could predict more accurately the ovarian response of cycle, but not clinical outcomes.

• Journal of Chest Surgery
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• v.42 no.4
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• pp.532-536
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• 2009

Bypass surgery is performed for insuring continuity of a blood supply that is restricted due to obstruction of the native blood supply. Two types of surgery are commonly carried out: one is anatomic bypass and the other is extraanatomic bypass. Especially, extraanatomic bypass surgery is performed in patients who are a high risk for performing anatomical bypass surgery. The risk factors for anatomical bypass surgery are old age, infection, previous surgery and trauma. A 96-year-old patient underwent extraanatomic bypass surgery from the right femoral artery to the left femoral artery due to total occlusion of the left iliac artery, and 7 years after that operation, a pseudoaneurysm abruptly and spontaneously appeared from the bypass suture site without any predisposing factor. The lesion was revealed to be an organizing thrombus.

• Journal of Chest Surgery
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• v.29 no.9
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• pp.1010-1016
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• 1996

Thymectomy is an accepted therapeutic modality for patients with myasthenia gravis. The selection of patients for operation, the timing of operation and the surgical approach are still controversial. We reviewed 82 patientsraged 13 to 66 years; mean age, 37.7 years treated with transsternal thymectomy between January 1983 and December 1994. Patients were symptomatically staged according to the modified Osserman's classification. There was one hospital death and postoperative follow-up was obtained on 75 patients. During a mean follow up of 56.9 months, 64 patients (85.3%) benefited from the operation with complete remis ion achieved in 28(37.3%). The thyroid disease was present in 8 patients, of whom 7(87. 5%) achieved complete remission in contrast to 21 (31.3%) of the 67 patients without thyroid disease. The disease duration less than 2 years in 32 patients was associated with complete remission in 16 (50%) in contrast to remission in 12(27.4%) of the 43 patients whose disease duration was more than 2 years. In conclusion, the complete remission rate after transsternal thymectomy was affected by the presence of thyroid disease and disease duration. Myasthenia gravis with late onset(>40 years), thymoma pathology, old age and male gender appear to decrease the complete remission rate after transsternal thymectomy, although it was not statistically significant. There was no difference of complete'remission rate between normal and hyperplasia of thymus. Transsternal thymectomy was found to be beneficial in most patients with myasthenia gravis, but the majority of patients with ocular disease did not b nefit from the operation.

• Journal of Dental Rehabilitation and Applied Science
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• v.31 no.4
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• pp.283-293
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• 2015

Purpose: The aims of this study are to analyze and to visualize distribution of patients visiting at a dental college hospital, using geographic information system (GIS). The visualized data can be utilized in patient care and treatment planning, ultimately leading to the assessment of risk evaluation and prevention of dental diseases. Materials and Methods: Patient information data was obtained from Dankook University Dental Hospital including the unit number, gender, date of birth, and address from 2007 to 2014. Patient distribution was visualized using GIS. Statistical analyses were performed using SAS 9.3 and ArcGIS 10.1. Five factors including proximity, accessibility, age, gender, and socioeconomic status were investigated as the explanatory variables of the patient distribution. Results: The visualized patient data showed a nationwide scale of the patient distribution. There was a little difference in characteristics for each department. As closer at Dankook University Dental Hospital, visitors increased. And it strongly showed that elderly patients in rural areas tend to visit more. Conclusion: The distribution of patients has been shown to be significantly affected by the proximity, accessibility, age, gender and socioeconomic status. The underlying reason remains to be further studied.

• Journal of Chest Surgery
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• v.41 no.2
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• pp.229-238
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• 2008

Background: Protection of the brain is a major concern during thoracic aortic surgery using hypothermic circulatory arrest (HCA). This study compares the surgical outcomes of two different cerebral protection methods in thoracic aortic surgery using HCA: retrograde cerebral protection (RCP) and antegrade cerebral protection (ACP). Material and Method: We retrospectively reviewed data on 146 patients who underwent thoracic aortic surgery from May 1995 to February 2007 using either RCP (114 patients, Group 1) or ACP (32 patients, Group 2) during HCA. There were 104 dissections (94 acute and 10 chronic) and 42 aneurysms (41 true aneurysms and 1 pseudoaneurysm), and all patients underwent ascending aortic replacement. There were 33 cases of hemiarch replacement, 5 of partial arch replacement, and 21 of total arch replacement. Result: The two groups were similar in preoperative and operative characteristics, but Group 2 had more elderly (over 70 years old) patients (34.4% vs. 10.5%), more coronary artery diseases (18.8% vs. 4.4%), more total arch replacements (46.9% vs. 5.3%) and longer HCA time ($50{\pm}24$ minutes vs. $32{\pm}17$ minutes) than Group 1. The operative mortality was 4.4% (5/114) and 3.1% (1/32), the incidence of permanent neurologic deficits was 5.3% (6/114) and 3.1% (1/32), and the incidence of temporary neurologic deficits was 1.8% (2/114) and 9.4% (3/32) in Groups 1 and 2, respectively. There were no statistical differences between the two groups in operative mortality, postoperative bleeding, or neurologic deficits (permanent and temporary). Conclusion: The early outcomes of aortic surgery using HCA were favorable and showed no statistical difference between RCP and ACP. However, the ACP patients endured longer HCA times and more extended arch surgeries. ACP is the preferred brain protection technique when longer HCA time is expected or extended arch replacement is needed.

• Journal of Chest Surgery
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• v.38 no.9 s.254
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• pp.616-621
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• 2005

Background: In the resection of lung cancer, pneumonectomy occupied $20 {\~}35\%$ of all resections, and significantly high operative mortality is reported in right pneumonectomy ($10{\~}25\%$). The aim of this study is to identify the characteristics of morbidity, operative mortality and factors affecting operative mortality after pneumonectomy. Material and Method: This study recruited the database which performed pneumonectomy for lung cancer in Korea Cancer Center Hospital from Aug 1987 to Apr 2002. Result: Total of 386 pneumonectomies were peformed in that period. Sidedness were left in 238, right in 148; and the procedures were standard resection in 207, and extended resection in 179. Morbidity occurred in 115 cases ($29.8\%$, 115/386). Mortality occurred in 12 cases ($3.1\%$, 12 in 386). This mortality rate was similar to that of lobectomy ($2.1\%$, 13 in 613) during the same period. Morbidity consisted of 42 hoarseness, 17 (9) pneumonia and ARDS, 8 empyema, 5 (1) broncho-pleural fistula, 5 reoperation for bleeding, 5 (1) arrhythmia, 1 (1) pulmonary edema, and 25 others (The number in the parenthesis is the number of mortality case for that morbidity). Several factors affecting the operative mortality were evaluated. At first, extended procedure ($3.3\%$, 6 in 179) affected the operative mortality similar to the standard procedure ($2.9\%$, 6 in 207)(p=0.812). Second, the rate of operative mortality in an elderly group over 60 years ($5.5\%$, 10 in 182) was significantly higher than the younger group under 60 years ($1\%$, 2 in 204)(p=0.016). Third, sidedness of resection affects to operative mortality. Right pneumonectomy ($6.8\%$, 10 in 148) showed higher operative mortality than that of left pneumonectomy ($0.8\%$, 2 in 238)(p=0.002). The group over 60 years showed higher incidence of respiratory morbidity ($11.0\%$, 20 in 182) than that of the group under 60 years ($3.4\%$, 7 in 204)(p=0.005). Right pneumonectomy also showed significantly higher incidence ($11.5\%$, 17 in 148) than that of left pneumonectomy ($4.2\%$, 10 in 238)(p=0.008). Conclusion: Age and sidedness of pneumonectomy were the risk factors of operative mortality and respiratory complications, Therefore, careful selection of patients and more attention perioperatively were demanded in right pneumonectomy. However, because the operative mortality is acceptable, pneumonectomy could be done safely if the pneumonectomy is necessary for curative resection of lung cancer.

• Tuberculosis and Respiratory Diseases
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• v.59 no.1
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• pp.77-85
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• 2005

Background : According to the 2002 consensus report of the American Thoracic Society/European Respiratory Society (ATS/ERS), idiopathic pulmonary fibrosis (IPF) was classified as biopsy proven or probable IPF. Probable IPF is defined as those with distinctive features that allow for a confident diagnosis of IPF/usual interstitial pneumonia (UIP) within an appropriate clinical setting. The determination of the clinical course of probable IPF, as diagnosed by the ATS/ERS criteria, was studied. Methods : Between March 1995 and August 2002, 36 patients with probable IPF, from two tertiary referral hospitals, were enrolled in this study. The clinical characteristics, prognostic factors and treatment efficacy of these patients were retrospectively evaluated. Results : The mean age of the subjects was $65{\pm}6$ years. The one and 3 year survival rates were 82.4 and 50.3%, respectively, and a median survival period of 42.0 months. The total cell count of bronchoalveolar lavage was higher in the death than the survival group (p<0.05). No survival benefits were found in the cytoxan and steroid treatment groups compared with other treatment groups. Conclusion : These results suggest that the clinical course of probable IPF may be similar to that of biopsy-proven UIP. However, atypical patients must undergo an open lung biopsy for confirmation of the diagnosis.