• Journal of the Korean Society of Radiology
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• v.81 no.4
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• pp.945-952
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• 2020

True pancreaticoduodenal artery aneurysms are relatively rare, approximately 50% of which are associated with stenosis or occlusion of the celiac axis. It is imperative to treat the condition immediately after diagnosis, considering that its rupture has a mortality rate of approximately 50%. The current most commonly used method to treat pancreaticoduodenal artery aneurysms is transcatheter arterial embolization. Here, we report three cases of embolization of inferior pancreaticoduodenal artery aneurysm with celiac stenosis or occlusion along with a literature review.

• Tuberculosis and Respiratory Diseases
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• v.47 no.3
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• pp.365-373
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• 1999

Background: Despite widespread use of tracheostomy in intensive care unit, it is still controversial to define the best timing from endotracheal intubation to tracheostomy under prolonged mechanical ventilation. Early tracheostomy has an advantage of easy airway maintenance and enhanced patient mobility whereas a disadvantage in view of nosocomial infection and tracheal stenosis. However, there is a controversy about the proper timing of tracheostomy. Methods: We conducted a retrospective study of the 35 medical and 15 surgical ICU patients who had admitted to Ewha Womans University Mokdong Hospital from January 1996 to August 1998 with the observation of APACHE III score, occurrence of nosocomial infections, and clinical outcomes during 28 days from tracheostomy in terms of early (n=25) vs. late (n=25) tracheostomy. We defined the reference day of early and late tracheostomy as 7th day from intubation. Results: The number of patients were 25 each in early and late tracheostomy group. The mean age were $48{\pm}18$ years in early tracheostomy group and $63{\pm}17$ years in late tracheostomy group, showing younger in early tracheostomy group. The median duration of intubation prior to tracheostomy was 3 days and 13 days in early and late tracheostomy groups. Organs that caused primary problem were nervous system in 27 cases(54%), pulmonary 14(28%), cardiovascular 4(8%), gastrointestinal 4(8%) and genitourinary 1(2%) in the decreasing order. Prolonged ventilation was the most common reason for the purpose of tracheostomy in both groups. APACHE m scores at each time of intubation and tracheostomy were slightly higher in late tracheostomy group but not significant statistically. Day to day APACHE III scores were not different between two groups with observation upto 7th day after tracheostomy, Occurrence of nosocomial infections, weaning from mechanical ventilation, and mortality showed no significant difference between two groups with observation of 28 days from tracheostomy. The mortality was increased as the APACHE m score upto 7 days after tracheostomy increased, but there were no increment for the mortality in terms of the time of tracheostomy and the days of ventilator use before tracheostomy, Conclusion: The early tracheostomy seems to have no benefit with respect to severity of illness, nosocomial infection, duration of ventilatory support, and mortality. It suggests that the time of tracheostomy is better to be decided on clinical judgement in each case. And in near future, prospective, randomized case-control study is required to confirm these results.

• Clinical and Experimental Pediatrics
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• v.53 no.4
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• pp.495-502
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• 2010

Purpose : Sepsis is a significant cause of morbidity and mortality in the newborn, particularly in preterm. The objective of this study was to analyze the incidence rate, causative pathogens and clinical features of neonatal sepsis in one neonatal intensive care unit (NICU) for 6 years. Methods : This study was retrospectively performed to review the clinical and laboratory characteristics including sex, gestational age, birth weight, Apgar score, length of hospitalization, length of total parenteral nutrition, presence of central venous catheter, underlying diseases, laboratory findings, microorganisms isolated from blood culture, complications and mortality in 175 patients between January 2003 and December 2008. Results : 1) Sepsis was present in 175 of 3,747 infants for 6 years. There were more gram-positive organisms. 2) The gram-negatives were more prevalent in preterm. There were no significant differences of other clinical features between two groups. 3) Underlying diseases were found in 73.7%, and the most common disease was cardiovascular disease. The most common organisms of gram-positives and gram-negatives were methicillin resistant Staphylococcus aureus (MRSA) and Serratia marcescens. 4) There was statistically significant difference on platelet counts between two groups (P<0.05). 5) Complications were found in 18.3% and septic shock was the most common. MRSA was the most common pathogen in sepsis with complication. 6) The mortality rate was 7.4%. 7) There were differences in monthly blood stream infection/1,000 patient-days. Conclusion : The studies about the factors that can influence neonatal sepsis will contribute to decrease the infection rates in NICUs.

• Journal of agricultural medicine and community health
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• v.31 no.1
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• pp.9-20
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• 2006

Objectives: This study was aimed at investigating the ratio of medical aid over health insurance of age adjusted mortality rate of tuberculosis and related factors. And we want to compare the ratio of medical aid over health insurance of age adjusted mortality rate of tuberculosis and related factors among the provinces. Methods: In order to compare, the data was referred to National health insurance center for affirming the insurance type of the dead. And age adjusted mortality rate of tuberculosis of each insurance type was analyzed by whole country and the provinces. Related factors of the provinces were gathered from public statistic books. We analysed correlation study between the ratio of medical aid over health insurance of age adjusted mortality rate of tuberculosis and related factors among the provinces. Results: Major findings were as follows 1. The ratio of medical aid over health insurance of age adjusted mortality rate of tuberculosis was 5.6. And the ratio was relatively high at 40-60 ages. 2. The ratio of medical aid over health insurance of age adjusted mortality rate of tuberculosis by the province was varying. And the factors that were financial independence, crowdedness, percent of people on medical aid, population size served by each public health center, number of hospital by a million peoples have correlated with increment of the ratio. Conclusions: As a consequence of tuberculosis control, the ratio was high. Thus this finding suggests that medical utilization and preventive behavior, environment of tuberculosis patient are under handicapped condition. Especially large cities like metropolitan area who have high financial independence, high population density, high percentage of medical aid peoples have high ratio of medical aid over health insurance of age adjusted mortality rate of tuberculosis. There is need for additional and systematic research on the attitude or tendency toward medical services(inc1uding preventive services) utilization of medical aid tuberculosis patients.

• Clinical and Experimental Pediatrics
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• v.53 no.3
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• pp.323-328
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• 2010

Purpose : To verify the effect of hyperglycemia on mortality rates in critically ill children and to identify the blood glucose level that influences prognosis. Methods : From July 2006 to June 2008, a total of 206 patients who were admitted to the pediatric intensive care unit (PICU) at Asan Medical Center and who survived for more than 7 days were retrospectively reviewed. We analyzed the maximum glucose value within 7 days in PICU, PRISM-III score and SOFA score within 24 hours, and mortality. We did not perform an adjustment analysis of drugs affecting glucose level. Results : The maximum glucose level within 7 days in PICU was higher in the nonsurvival group than in the survival group. Using 4 cutoff values (125, 150, 175, and 200 mg/dL), the mortality of patients with hyperglycemia was found to be 13.0 %, 14.4%, 19.8%, and 21.1%, respectively, and the cutoff values of 175 and 200 mg/dL revealed significant differences in mortalities between the hyperglycemic and normoglycemic groups. The PRISM-III score was not significantly different between the hyperglycemic and normoglycemic groups under a glucose cutoff value of 175 mg/dL, but the SOFA score was higher in the hyperglycemic group. Under a glucose cutoff value of 200 mg/dL, the PRISM-III score was higher in the hyperglycemic group, and the SOFA score did not differ between the 2 groups. Conclusion : Hyperglycemia with a maximal glucose value ${\geq}175\;mg/dL$ during the first 7 days after PICU admission was associated with increased mortality in critically ill children.

• Parasites, Hosts and Diseases
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• v.31 no.3
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• pp.239-248
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• 1993

The purpose of this observation was to investigate the natural killer cell activities in mice Infected with pathogenic free-living amoeba, Naegleria fowleri and Acanthomoeba culbertsoni according to the infection doses, and infected with non-pathogenic free-living amoeba, Naegleria fowleri. The natural killer cell activity was examined by means of target binding capacity, active NK cell and maximum recycling capacity of the mice after inoculating free-living amoebae with low and high doses. The mice infected with 1 103, 1 105 A. culbertsoni trophozoites showed mortality rates of 6.9% and 65.5%, respectively. The mice infected with 1 104, 1 105 N.fowleri trophozoites showed mortality rates of 5.9% and 72.2%, respectively. The NK cell activities in all experimental groups increased significantly on day 1 after infection as compared with control group, and then remarkably declined thereafter, there was no difference of the cytotoxic activity of the NK cells In mice among inoculation doses of pathogenic free-living amoebae. The target binding capacities of NK cells and percentages of activated NK cells in mice Infected with pathogenic free-living amoebae were slgrlificantly Increased a day after Infection, as compared Uth control group. There was no difference of the maximal recycling capacities of NK cells in all experimental groups as compared Uth control group. There was significant difference in the cytotoxic activity and single cell cytotoxlcity of NK cells between the experimental groups infected with pathogenic free-living amoebae and that infected with non-pathogenic free-living amoebae.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.21 no.12
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• pp.651-659
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• 2020

The objective of this study is to provide high-quality medical service, by understanding the characteristics and death risk factors of patients at V long-term care hospital, that has established and operated the cooperative treatment system in connection with a public institution, the S veterans hospital. A follow-up survey targeting a total of 850 discharged patients was conducted for the year 2017. Average age of patients was 79.2 years, with 86.4% belonging to the 70 years or over group. The men of national merit were 75.4%, which was more than three times higher than general patients. Hospitalization for 180 days or more was 46.4%, which was higher than general long-term care hospitals (37%). The major death risk factors were age and the number of hospitalized days. Our data indicate that transfer to S veterans hospital results in providing quicker treatment and higher effectiveness of the numerous recovery therapies. We therefore propose that the cooperative treatment system should be expansively operated to increase the quality of happy life, by alleviating the health of patients with chronic diseases in a long-term care hospital.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.14 no.2
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• pp.707-712
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• 2013

In patients with acute myocardial infarction (AMI), the delay from symptom onset to hospital arrival has a critical effect on morbidity and mortality. This study examined to find out the determinants of the prehospital delay in patients with AMI. The study sample consisted of 597 patients hospitalized with AMI between Jan and Dec 2009. Demographic, medical history, and clinical data were abstracted from the hospital medical records of patients with confirmed AMI, the prehospital delay was categorized as less than or greater than 6 hours. Older age, low socioeconomic status(medical aid), and low use of Emergency medical system were associated with delays in seeking emergency care for Acute myocardial infarction. Education programs to improve patient knowledge of acute coronary syndrome symptoms and promote patient responsiveness with regard to seeking medical care should be used to reduce the prehospital delay time, especially in the low socioeconomic group.

• Journal of East-West Nursing Research
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• v.28 no.1
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• pp.10-20
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• 2022

Purpose: We compared the Korean Triage and Acuity Scale (KTAS), Injury Severity Score (ISS), and Revised Trauma Score (RTS) determined the validity of KTAS for classifying trauma patients. Methods: A retrospective chart review of 10,865 trauma patients (aged ≥15 years) who visited a single regional trauma and emergency medical center from January 1, 2016, to December 31, 2020, was conducted. Data were collected from the Korean Trauma Data Bank. Based on KTAS classification, the rates of intensive care unit admission, surgery and intervention, transfusion, emergency room (ER) and hospital mortality, and ER stay time were investigated. Data were analyzed using Chi-square test, Pearson's correlation coefficient, receiver operating characteristic curve, and area under the ROC curve. Results: In the KTAS, severe trauma patients (ISS ≥16) were classified as Level 1 (79.6%), 2 (44.8%), 3 (15.5%), 4 (4.0%) and 5 (7.6%). The following were the predictive powers of KTAS, ISS, and RTS for different parameters: surgery and intervention rate, KTAS (.71), ISS (.70), and RTS (.63); transfusion rate within 4h, KTAS (.82), ISS (.82), and RTS (.74); ER stay time within 90 min, KTAS (.72), ISS (.62), and RTS (.56); and ER mortality, KTAS (.84), ISS (.72), and RTS (.88). These findings were statistically significant (p<.001). The sensitivity and specificity of KTAS for trauma patients were .88 (.87~.90), and .38 (.37~.39), respectively. Conclusion: KTAS is a useful classification system that can predict the clinical outcomes of patients with trauma, and effectively triage acutely ill trauma patients, thus provide appropriate treatment.

• Journal of Korean Clinical Nursing Research
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• v.28 no.1
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• pp.1-12
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• 2022

Purpose: The purpose of this study is to investigate the association between the nurse staffing level and the patient mortality using Korean National Health Insurance data. Methods: The data of 1,068,059 patients from 913 hospitals between 2015 and 2016 were analyzed. The nurse staffing level was categorized based on the bed-to-nurse ratio in general wards, intensive care units (ICUs), and hospitals overall. The x² test and generalized estimating equations (GEE) multilevel multivariate logistic regression analyses were used to explore in-hospital mortality and 30-day mortality after admission. Results: The in-hospital mortality rate was 2.9% and 30-day mortality after admission rate was 3.0%. Odd Ratios (ORs) for in-hospital mortality were statistically lower in general wards with a bed-to-nurse ratio of less than 3.5 compared to that with 6.0 or more (OR=0.72, 95% CI=0.63~0.84) and in ICUs with a bed-to-nurse ratio of less than 0.88 compared to that with 1.25 or more (OR=0.78, 95% CI=0.66~0.92). ORs for 30-day mortality after admission were statistically lower in general wards with a bed-to-nurse ratio of less than 3.5 compared to that with 6.0 or more (OR=0.83, 95% CI=0.73~0.94) and in ICUs with a bed-to-nurse ratio of less than 0.63 compared to that with 1.25 or more (OR=0.85, 95% CI=0.72~1.00). Conclusion: To reduce the patient mortality, it is necessary to ensure a sufficient number of nurses by improving the nursing fee system according to the nurse staffing level.