Background: Thoracic trauma is one of the leading causes of morbidity and mortality in developing countries. A rib fracture that is secondary to blunt thoracic trauma is an important indicator of the severity of the trauma. The purpose of study was to determine the morbidity and mortality rates and the management of rib fractures. Material and Method: We performed a retrospective study that involved all the blunt trauma patients with rib fractures, excluding those that were transferred to other hospital within 3 days, that were seen at our hospital between May 2002 and December 2008. Of the 474 admitted patients, 454 met the inclusion criteria. There were 356 male and 98 females, and their overall mean age was 53 years (range: 5~90 years). The outcome parameters included the mechanism of injury, the number of fractured ribs, the length of stay in the ICU, the Injury Severity Score (ISS), the length of the hospital stay, the pulmonary complications and the mortality. Result: The mechanism of trauma included traffic accidents in 189 (41.7%) cases, slipping down in 103 (22.7%) cases, falls in 85 (18.7%) cases, cultivator accidents in 30 (6.6%) cases, industrial accidents in 32 (7.0%) cases and assault in 15 (3.3%) cases. Intrathoracic injury was noted such as hemothorax in 269 (59.3%) cases, pneumothorax in 144 (31.7%) cases, pulmonary contusion in 95 (20.9%) cases, subcutaneous emphysema in 29 (6.4%) cases and great vessel injury in 5 (0.1%) cases. Conservative treatment was administered to most of the patients. Tube thoracostomy was administered in 234 (51.5%) cases, whereas thoracotomy was performed in 18 (4.0%) cases. The mean duration of thoracostomy was $5.2{\pm}6.2$ days. Most of the cases with rib fracture were treated in wards and their mean duration of hospital stay was $22.5{\pm}20$ days. The mean Injury Severity Score (ISS) was $14.8{\pm}10.9$ (range: 3~75). The mortality rate was calculated to be 4.8% (n=22). The main factors correlated with an adverse outcome were the number of ribs fractured, the duration of thoracostomy and pulmonary disease. Industrial insurance affected the length of hospitalization. Pulmonary contusion and the Injury Severity Score (ISS) affected the mortality. Conclusion: Rib fractures are a indicator of severe injury. Because of the complication and associated injuries, we believe these patients should be admitted for evaluation and treatment. Recent studies on the impact of rib fractures after blunt trauma have shown that patients as young as 40 years of age demonstrate increased morbidity and mortality with similar injuries as compared to that of older patients. The ISS and pulmonary contusion influenced the mortality rate. Patients with isolated rib fractures should be hospitalized if the number of fractured ribs is one or more.
Journal of the Korean Society of Food Science and Nutrition
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v.43
no.6
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pp.916-925
/
2014
The purpose of this study was to compare dietary and lifestyle habits in middle-aged women based on their self-perceived health-related physical fitness (SPF) level as well as investigate the effects of dietary and lifestyle habits on SPF. The study subjects were divided into two groups, 'High' group (${\geq}3.2$, n=64) and 'Low' group (<3.2, n=69), based on average SPF value (3.2). Women in the 'High' group showed a greater lean mass (P<0.05), whereas women in the 'Low' group had higher triglycerides (P<0.05). In analyzing characteristics of lifestyle habits, it was found that the 'High' group showed significantly higher scores for 'vitality level (P<0.001)', 'self-rated health status (P<0.001)', 'regular medical checkups (P<0.05)', and 'regular exercise (P<0.05)'. The average score for dietary habits was significantly high in the 'High' group (P<0.05). Furthermore, ordinary dietary habits showed a significant positive correlation (P<0.001) with SPF in the regression analysis after adjusting for disturbance factors. From these results, ordinary desirable dietary habits were shown to be an important factors having positive effects SPF. Therefore, healthy dietary and lifestyle habits should be practiced to improve the SPF of middle-aged women. For this purpose, related educational programs should be developed for the middle-aged women to take interest in their dietary habits.
Yun, Sin Weon;Lee, Ho Seok;Kim, Dong Woon;Rhee, Kang Won;Jung, Young Soo
Clinical and Experimental Pediatrics
/
v.48
no.12
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pp.1370-1377
/
2005
Purpose : Delineation of serum lipid and lipoprotein values in children after Kawasaki disease(KD) is important because of the predilection of this disease for the coronary arteries. Methods : The KD group was composed of 51 patients who were hospitalized from Jan. 2002 to Dec. 2003. Control was 25 patients with non-KD febrile illness. The levels of total lipid, phospholipid, triglyceride, HDL-cholesterol(HDL-C), LDL-cholesterol, total cholesterol, apolipoprotein A1(apo A1), apolipoprotein B, and Lipoprotein(a) were measured and compared with Echocardiographic findings. Measurements were obtained in four time periods: acute febrile, subacute, convalescent phase and 1 year after KD. Results : HDL-C($33.64{\pm}7.49mg/dL$ vs $50.43{\pm}14.41mg/dL$, P<0.01) and apo A1($99.75{\pm}6.39mg/dL$ vs $113.34{\pm}11.35mg/dL$, P<0.05) were decreased more in the acute febrile period of KD than in the control, but these changes were not correlated with cardiac complications. All lipid profiles were markedly elevated in the subacute stage and normalized in the convalescent stage; there were no changes until 1-year follow up. There were no significant differences in the changes of lipid profiles, including Lp(a) and coronary dilatation, in any time periods. Conclusion : KD is associated with important abnormalities in lipid metabolism, but these changes were transient and appear to be due to the disease itself. These data lead us to infer that KD dose not cause such permanent changes in lipid abnormalities as to be considered a risk factor for atherosclerosis, beyond that caused by the disease itself.
Kim, Soo Yeon;Kim, Hyun Jung;Choi, Jun Seok;Huh, Jae Kyung
Clinical and Experimental Pediatrics
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v.52
no.3
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pp.364-369
/
2009
Purpose : Clinical and laboratory findings predict a severe outcome for mucocutaneous lymph node syndrome. This study aimed to define the clinical characteristics of Kawasaki disease (KD) patients with hyponatremia and to determine the factors associated with its development. Methods : Retrospective studies were performed on 114 KD patients who received an initial high-dose intravenous immunoglobulin (IVIG, single 2 g/kg/dose) within 10 days of fever onset from January 2006 to February 2008. These patients were divided into 2 groups. Group 1 consisted of 30 (26.3%) patients with hyponatremia, and group 2 consisted of 84 (73.6%) patients without hyponatremia. Clinical manifestations, laboratory results, and echocardiographic findings were compared between the groups. Results : Group 1 patients were more likely to have a coronary artery lesion (53.3% versus 20.2%, P=0.005) and suffered from diarrhea (41.3% versus 14.1%, P=0.007). There was a higher incidence of cardiovascular involvement in group 1 patients, including coronary dilatation (46.6%), valvular regurgitation (13.3%), pericardial effusion (6.7%) and medium-sized aneurysm (6.7%). There were no coronary aneurysms in group 2 patients. Serum C-reactive protein (CRP) was significantly higher in patients with hyponatremia ($12.2{\pm}7.79$ mg/dL versus $7.3{\pm}4.7$ mg/dL, P=0.003) and IVIG-resistant patients were more common in group 1 (13.3% versus 3.6%). Conclusion : These results indicate that hyponatremia in KD occurs in patients exhibiting severe inflammation and was significantly associated with the development of coronary disease. Further studies will be necessary to confirm the pathogenic mechanisms of hyponatremia in KD patients.
Purpose: To evaluate the association of subacromial bursa inflammation with acromial shape and shoulder pain in subacromial impingement syndrome. Materials and Methods: 24 cases with subacromial impingement syndrome were reviewed. Eighteen patines were males and six females(mean age: 58.3 yrs). During arthroscopic operation, the specimens were taken from subacromial bursa with arthroscopic knife($1{\times}1$ cm size). The shape of acromion were classified according to Bigliani grading system. The shoulder pain of patients was graded with visual analog scale (VAS). The grade of inflammation was classified to the pathological three grade system (mild, moderate, severe) by pathohistological 8 factors. Results: Of total 24 cases, 9 cases were the pathological grade I and 15 cases were grade II. None was grade III. In the 9 cases of pathological grade I, 6 cases were the radiologic grade II of acromial shape and 3 cases were grade III. In the 15 cases of pathological grade II, 5 cases were the radiologic grade II and 10 cases were grade III. The VAS was 7 point at pathological grade I and 8 point at grade II. As the statistical analysis, the pathological grade of subacromial bursa was associated with acromial shape (p<0.05), but not associated with pain of patient (p>0.05). Conclusion: Our study suggests that pathological grade of subacromial bursa inflammation was associated with acromial shape. But pathological grade of subacromial bursa inflammation was not associated with shoulder pain of patients.
Purpose: The aim of this study was to investigate the relationship between instant noodle intake and metabolic factors in Korean adults. Methods: Study subjects were 5,894 (male 2,293, female 3,601) aged 19~64 years who participated in the 2013~2014 KNHANES. Information on frequency and consumption of instant noodles was obtained by the food frequency questionnaires method in KNHANES (Korean National Health and Nutrition Examination Survey), and subjects were classified according to age, sex, and instant noodle consumption (INC). Results: The frequency and consumption of instant noodles was 1.2 times/week and 1.2 servings in subjects. High INC group (${\geq}1$ serving/week) was significantly younger in age compared with the low INC group (< 1 serving/week). However, the high INC group had significantly higher waist circumference, metabolic factors (triglyceride, cholesterol, and HDL-cholesterol), and dietary intake (energy intake, fat, and sodium density) compared with the low INC group. Hyperglycemia showed association with higher risk of highest quartile of INC after adjustments for multiple confounding factors, including age, gender, household income, education, smoking, and alcohol compared with the lowest quartile (OR: 1.4, 95% CI: 1.1-1.8). In female, abdominal obesity showed association with higher risk of highest quartile of INC after adjustments for multiple confounding factors compared with the lowest quartile (OR: 1.6, 95% CI: 1.2-2.2). Conclusion: Consumption of instant noodles was associated with increased prevalence of abdominal obesity and hyperglycemia in women. These findings suggest an association of instant noodle consumption status with metabolic risk.
Journal of the Korean Society of Food Science and Nutrition
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v.30
no.2
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pp.350-356
/
2001
The purpose of this study is to verify the relation among vegetarian diet, physical activity and the risk factors of cardiovascular disease. Two hundred and forty five buddhist nuns (age : 23~79 yrs) were selected as vegetarians. For control subjects, 235 healthy female adults (age : 23~79 yrs) were selected. Study period was from October 1996 to February 1997. The contents are consist of food consumption survey, anthropometric measurement, amount of energy expenditure, physical activity and clinical examination. Results were summarized as follows : The average ages of vegetarians were $44.2{\pm}17.3\;yrs$ and those of non-vegetarians were $40.5{\pm}18.4\;yrs$. Average body mass indices (BMI) of vegetarians and non-vegetarians were $22.5{\pm}2.7\;and\;21.1{\pm}2.5$, WHRs were $0.9{\pm}0.1\;and\;0.8{\pm}0.1$, and the average duration of vegetarian diet of the vegetarians was 13.1{\pm}12.9 years. All the nutrient intakes of both groups were over RDA's except calcium and vitamin A intakes of non-vegetarians that were below RDA's Fiber and vitamin C intakes of the vegetarians were significantly higher than those of non-vegetarians (p<0.01). Average energy intakes of vegetarians and non-vegetarians were $2177.1{\pm}420.6\;kcal/day\;and\;2103.2{\pm}534.9\;kcal/day$, total daily energy expenditure were $1789.9{\pm}325.8\;kcal/day\;and\;1703.8{\pm}344.8\;kcal/day$, those by physical activity were $507.8{\pm}360.9\;kcal/day\;and\;400.0{\pm}247.8\;kcal/day$. Serum lipid level, blood sugar, systolic blood pressure of vegetarians were significantly lower than those of non-vegetarians, but ratio of HDL-cholesterol/total-cholesterol was higher than those of non-vegetarians. Levels of total serum cholesterol of vegetarians and non-vegetarians were 161.4{\pm}33.3 mg/dL and 189.6{\pm}33.6mg/dL, HDL-cholesterol were $48.2{\pm}11.4\;mg/dL\;and\;50.8{\pm}12.2\;mg/dL$, LDL-cholesterol were $86.6{\pm}26.9\;mg/dL\;and\;111.1{\pm}17.0\;mg/dL$, atherogenic indice(AI) were $2.4{\pm}0.6\;and\;2.9{\pm}0.7$, fasting blood sugar were $90.8{\pm}14.3\;mg/dL\;and\;103.6{\pm}24.6\;mg/dL$, systolic blood pressure were $107.5{\pm}14.9\;mmHg\;and\;119.3{\pm}15.3\;mmHg$. Energy expenditure by physical activity was negatively correlated with levels of serum total-cholesterol and LDL-cholesterol and atherogenic indice(AI). Therefore, physical activity and vegetarian diet effectively helped reduce blood lipids related to cardiovascular disease.
Purpose : This study investigated the clinical significance of AN in children and adolescents with obesity induced metabolic complications. Methods : Forty-nine patients who had obesity induced metabolic complications were participated in this cross-sectional study. Obesity induced metabolic complications are as follows: hypertension, dyslipidemia, impaired fasting glucose (IFG), impaired glucose tolerance (IGT), nonalcoholic steatohepatitis (NASH), homeostasis model assessment of insulin resistance (HOMA-IR)>3.16. Clinical characteristics, such as, age, percentage-weight-for-height (PWH), pubertal status, blood pressure (BP), fasting plasma insulin level, fasting and post-oral glucose tolerance test 2-hour glucose levels, liver function test, lipid profile, HOMA-IR were compared according to the presence of AN. Results : Sixty-five percent of patients had AN, 57.1% NASH, 57.1% dyslipidemia, 55.1% hypertension, 46.9% IFG, 24.5% HOMA-IR>3.16 and 16.2% IGT. The patients who were moderately to severely obese with AN had higher incidence of IGT and HOMA-IR>3.16. The patients with AN had significantly higher diastolic BP ($79.4{\pm}6.9$ vs $75.4{\pm}5.6mmHg$), fasting levels of plasma insulin ($10.6{\pm}6.0$ vs $6.2{\pm}5.4{\mu}IU/mL$), HOMA-IR index ($2.6{\pm}1.4$ vs $1.4{\pm}1.3$) and PWH ($42.4{\pm}13.0$ vs $34.3{\pm}1.8%$). The increasing tendency for the presence of AN was significantly related to the cumulative number of obesity induced metabolic complications. Binary logistic regression analysis revealed that the presence of AN was significantly associated with fasting plasma insulin level, PWH and IFG. Conclusion : AN could be useful as a clinical surrogate of obesity induced metabolic complications.
Lee Myung Za;Chun Ha Chung;Kim Insoon;Chung Tejune
Radiation Oncology Journal
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v.15
no.2
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pp.113-119
/
1997
Purpose : Radical gastrectomy is main treatment of gastric cancer. But the result is not satisfactory with surgery alone. Most of pattern of failure remain locoregional recurrence. To improve 5 year survival postoperative chemotherapy with or without radiotherapy has been used. We analyzed patients with stage III and IV stomach cancer who had radical operation and received postoperative radiation therapy combined with or without chemotherapy retrospectively. Material and Method : From March 1985 to June 1993, 68 patients treated with curative resection and received postoperative adiuvant radiotherapy with 36Gy or more were evaluated. Median age was 60 years(range 28-66 yrs) . Patients were followed from 3 to 133 months with median follow up of 48 months. Thirty seven patients had non signet ring adenocarcinoma, 29 signet ring cell, 2 other cell. Patients with stage IIIA, IIIB, IV disease were 19, 25 and 24 respectively Chemotherapy was given to all patients except two. Results : Five-year overall survival and disease-free survival rate were 36.6% and 33.6%, respectively. Prognostic factor affecting survival were assessed. High ratio of jnvolved/dissected Iymph node, signet ring histology showed Poor Prognosis with statistical significance. Presence of residual tumor after surgery, stageIV. split course of radiation therapy, age, number of involved Iymph node, number of Iymph node dissection and grade of tumor affected survival without statistical significance, Type of chemotherapy did not affect survival. Recurrence was documented in 34 patients. High recurrence was seen in omentum and peritoneum with 23.5%, and remnant stomach, anastomosis site, A-loop and I-loop had also high recurrence with 13.2%. In field locoregional recurrence was 20.7% and total distant metastases were 39.7%. Total intraabdominal failure was 47.1% and extraabdominal failure was 13.2%. Treatment toxicity was considered to be acceptable. 22.1% of patients had grade 3 and only 1 patient had grade 4 leukopenia. Six Patients(8.8%) had weigh loss more than 10%. Conclusion : Treatment toxicity was acceptable with combined treatment with chemotherapy and radiotherapy. Locoregional recurrence was relatively low compared to distant failure with addition of irradiation. Peritoneal and omental seeding was high Five-rear surival was increased with combined modality. Radiation may eradicate minimal residual disease and improve survival, To evaluate role of radiation Prospective randomized study employing chemotherapy alone and chemotherapy plus radiation is necessary. Futhermore to reduce intraabdominal failure, role of intraabdominal chemotherapy in addition to combined chemotherapy plus radiation has to be explored.
Purpose : This study was performed to evaluate survival, failure patterns, and prognostic factors of MMR patients after radiation therapy. We also discussed the need for chemotherapy. Materials and Methods : A retrospective analysis was done for 23 patients with MMR who were treated with radiation therapy from June 1985 to November 1992. There were 19 male and 4 female patients, The patients' age ranged from 17 to 71 years (median 39 years). Systemic symptoms including fever, weight loss, or malaise were found in $30\%$ of the patients. The nasal cavity was most frequently involved No patients had nodal involvement at diagnosis. There were 2 patients with distant metastasis at presentation. Radiation therapy was delivered five times a week, 1.8 Gy daily, total $45\~54$ Gy (median 50.4 Gy) using 6 MV X-ray No patients received chemotherapy as initial treatment. Results : Overall 5-year and 10-year survival rates were $52.4\%$ and $44.1\%$, respectively. Seventy Percent(12/17) of the patients achieved complete response to radiotherapy, and $29.4\%$ (5/17) achieved partial response. The Patients with complete response showed a better 5-year survival rate than those with partial response ($66.9\%$ vs. $20\%$. p=0.004). Symptom duration before diagnosis, the presence of systemic symptom, and the number of primary sites had no influence on survival. The patterns of failure were as follows: local failure(1), failure in adjacent site(1), local and distant failure(1) distant metastasis(2). and conversion to malignant lymphoma(1). We could not find factors associated with the patterns of failure. Conclusion : The most important facto associated with survival was the response to radiotherapy. Seventeen percent of the patients had distant metastasis, and the salvage after distant metastasis was not successful. However. about $50\%$ of the patients could achieve long-term survival with local radiation therapy alone. Therefore, chemotherapy of MMR should be done after a prospective randomized study for the factors associated with distant metastasis.
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