• Journal of Chest Surgery
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• v.35 no.9
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• pp.680-683
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• 2002

Infective endocarditis that involves the right side of the heart has been estimately 5% of all cases of infective endocarditis. It has been shown that about 70% of right-sided heart infective endocarditis cases have preexisting congenital heart disease or acquired valvular lesion. It would occur in intravenous drug users or end-stage renal disease patients with indwelling venous dialysis catheter. Antibiotic therapy is more effective in the right and, when it fails, the consequence of valve disruption and emboli are less. Patients receiving long-term hemodialysis are a unique population with regard in the risk of bacteremia and subsequent infective endocarditis. We experienced one case of the active infective endocarditis with right atrial vegetation without tricuspid or pulmonary valve involvement in patient with end-stage renal disease receiving long-term hemodialysis, who needed surgical correction after medical treatment failure. Then we reported it with references that right-sided heart infective endocarditis is rare, but difficult to diagnose, life-threatening because of delayed medical treatment.

• Journal of Gastric Cancer
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• v.7 no.1
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• pp.23-30
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• 2007

Purpose: Evaluating the clinicopathologic characteristics of recurred gastric cancer is essential for early detection of the recurrence and for better clinical outcome. The aim of this study was to establish the patterns of the recurrence, the timing of the recurrence, and the clinical result after recurrence according to the clinicopathologic characteristics of gastric cancer. Materials and Methods: From June 1992 to December 2005, of the 1338 gastric cancer patients who underwent a curative gastric resection, 241 patients who recurred during the follow-up period were selected and their cases were analyzed. The clinicopathologic characteristics of the patients, the time to recurrence after operation and survival were determined retrospectively according to the type of recurrence. Results: For the recurrent group, the numbers of total gastrectomies, advanced stages, lymphatic and/or venous infiltrations, whole stomach cancer cases, large tumors, undifferentiated tumors, and Borrmann type 4 tumors were higher than they were for the non-recurrent group, and the differences were statistically significant. When the recurrence types were classified as peritoneal seeding, hematogenous recurrence, and locoregional recurrence, independent risk factors were female gender, stage III, upper third, and whlole stomach cancer, and undifferentiated- type, diffuse-type, and Borrmann type 4 tumors for peritoneal seeding; early gastric cancer, stage I for hematogenous recurrence; and Borrmann type 1, 2, and 3 tumors for locoregional recurrence. Survival duration after detection of the recurrence was shorter for peritoneal seeding than for hematogenous or locoregional recurrence (7.0 months vs. 9.5 months and 12.5 months). Conclusion: For early detection of the recurrence after curative surgery for gastric cancer, it is important to recognize that the high risk factors for recurrence vary with the clinicopathologic data for the patients.

• Advances in pediatric surgery
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• v.16 no.2
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• pp.162-169
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• 2010

The aim of this study is to review our clinical experience with patients with Hirschsprung's disease (HD) Medical records of 39 children who underwent definitive surgery for HD at Inha University Hospital from September 1996 to June 2008 were analyzed by age at presentation, sex, gestational age, birth weight, clinical presentation, diagnostic tools, level of aganglionosis, surgical procedures, postoperative complications, and postoperative bowel function. Twenty-five patients (64.1 %) were males and 14 (35.9 %) were females. Thirty patients (76.9 %) were diagnosed and treated in the neonatal period. The transitional zone was at the rectosigmoid region in 89.7 %. Twenty-seven patients (69 %) were treated by preliminary colostomy or ileostomy. Twenty-four patients had the Duhamel operation, 6 patients anorectal myectomy, and 9 patients had transanal endorectal pull-through (TEP). Five of 9 patients who had the TEP procedure did laparoscopic assistance. Postoperatively, seventeen patients (83 %) passed stool once or more times per day and 3 patients had stool soiling. This study demonstrated that the majority of the patients had good results. To determine which treatment is most effective comparative review by operation method would be required.

• Korean Journal of Social Welfare
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• v.51
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• pp.93-118
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• 2002

The objective of this study was to determine the effect of a psycho-educational group intervention in reducing psychologic distress and enhancing coping in Korean breast cancer patients. The patient selection criteria were age younger than 70 years, having any postoperative adjuvant therapy, and surgery undergone within the previous 12 months as of the start of the study and there were 70 patients eligible for this criteria. They were randomized into three groups; experimental group(24 patients), wait-list control group(24 patients) and wait-list group(36 patients). We conducted a 8-week, structured, psychosocial group intervention, which used psycho-educational strategies combining education and psychological support. Subjects were assessed for psychological distress and coping by administering the Beck Depression Inventory(BDI) and the Ways of Coping Checklist-Revised(WCCL-R) at the baseline and after 8 weeks. Forty eight patients were participated and thirty five patients completed the study. The experimental group had significantly lower scores than the controls for depression on the BDI(p=.012) after 8-week intervention. However, coping did not show a significant difference on WCCL-R after the intervention. Despite of some limitations, the results of this study suggest that a short term psychosocial group intervention produces a significant improvement in the quality of life of patients with primary breast carcinoma in Korea in terms of managing depression.

• Clinical and Experimental Pediatrics
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• v.50 no.6
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• pp.531-535
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• 2007

Purpose : Indomethacin treatment is successful in about 90% of patent ductus arteriosus (PDA) in premature infants, but in some, repeated administration or surgical closure is required. The object of the present study is to determine the factors affecting the efficacy of indomethacin treatment and to predict the treatment result. Method : The 29 preterm neonates, admitted to neonatal intensive care unit of Kyunghee university medical center and Eulji university hospital between September 2002 and April 2006 were diagnosed of PDA and treated with indomethacin. The risk factors that might affect the efficacy of treatment were studied retrospectively. Results : The single-administered group was 19 patients out of 29 (65.5%) and among the repeated-administered group, 5 patients (17.2%) had repeated indomethacin administration and the other 5 patients (17.2%) underwent surgery due to reopening of the duct after repeated medical treatment. In repeated-administered group, the diameter of PDA was significantly larger ($3.66{\pm}0.8mm$ vs $2.55{\pm}0.8mm$, P<0.01), especially when larger than 3.5 mm (sensitivity: 70%, specificity: 89%). Also, the mean postnatal age of the first indomethacin administration was significantly delayed in repeated-administered group (19.7 days vs 12.5 days, P<0.05). There were no significant differences in gestational age (32 wk 5 days vs 30 wk 8 days) and in birth weight (1598.9 g vs 1750.5 g). There were no significant differences in associated morbidities. Conclusion : In patients with larger diameter of PDA (>3.5 mm) and older postnatal age (>7 days), the effect of indomethacin was decreased. Therefore in such cases, repeated dose of indomethacin or surgical ligation should be considered earlier.

• The Journal of the Korean bone and joint tumor society
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• v.10 no.2
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• pp.71-78
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• 2004

Purpose: The purpose of this study is to investigate the characteristic of recurred giant cell tumor after bony curettage and cementation, and to review a way to prevent the recurrence. Materials and Methods : Thirty seven cases were analyzed, which were pathologically diagnosed giant cell tumor after diagnostic biopsy or surgical excision, followed by curative curettage, burring and cementation. Location, character, and time interval to recurrence were reviewed. Results: Thirteen out of thirty seven analyzed cases(35%) showed recurrence after primary curettage and cementation. The mean interval to recurrence was sixteen months(5 months to 43 months). Most of recurrence happened within the first two years except two cases. Among the recurred cases, eleven showed recurrence in the vicinity of window area. Two cases recurred in the depth of bone marrow, where cementation was made. The advantage of curettage and cementation is the immediate stability of the operation site, early rehabilitation, and early detection of recurrence. Furthermore, cementation is beneficial in that the cement-producing heat can eradicate the residual tumor burden. In this study, 85% of cases with insufficient curettage (for example, in cases where too small surgical window was made, or where there were anatomical difficulty in approaching the target tumor burden) showed recurrence. Conclusion: Bony curettage, burring and cementation is widely used as the primary curative modality for giant cell tumor. A few other modalities such as chemical cautery using phenol and $H_2O_2$; cryotherapy; and anhydroalcohol have also been introduced, but the benefit of these are still questionable. For some cases that relatively small surgical window was made due to anatomically complicated structures (such as ligament insertion or origin site) over the target tumor burden, unsatisfactory curettage and burring was made. This study showed high chance of recurrence after unsatisfactory curettage, and 85% of recurrence developed in the vicinity of the small window area. Most of the recurrence occurred within the first two years. It is concluded that sufficient window opening, extensive curettage and eradicative burring are key factors to prevent recurrence. Also, it should be reminded that careful and close observation should be made for at least the first two years after initial treatment for early detection of recurrence.

• Pediatric Infection and Vaccine
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• v.8 no.2
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• pp.181-190
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• 2001

Purpose : Lymphadenitis is the most common complication of BCG vaccination and has various clinical course and prognosis, but there are no accurate guidelines for management of BCG lymphadenitis. We performed this study to reveal the clinical course of BCG lymphadenitis and provide guidelines for its management. Methods : From January, 1997, to May, 2000, 73 patients in the 3~24 months were enrolled. We investigated retrospectively the size, site, and number of lymphadenitis, tuberculin skin test induration, used BCG strains, vaccination age, injection site, treatment and clinical course. The effects of various variables on clinical course were evaluated. Results : 1) There were no statistically significant difference between lymphadenitis size and tuberculin test induration diameter, spontaneous resolution rate, and suppuration rate. 2) Later vaccination(${\geq}1$ mo) and supraclavicular lymphadenitis increased suppuration rate. Using domestic BCG product increased surgical treatment rate. 3) According to treatment(observation vs antituberculous medication), medication did not affect the prevention of suppuration and ironically increased the rate of suppuration and surgical treatment. 4) Suppurative lymphadenitis required more surgical treatment than non-supurative one. Conclusions : Clinical course of BCG lymphadenitis is affected by vaccination age, used BCG strains, site of lymphadenitis, antituberculous medication and suppuration, but not affected by size and number of lymphadenitis. For management of BCG lymphadenitis, systemic antituberculous medicaion is not recommended and regular follow up with observation should be the mainstay. But for suppuration, active surgical en bloc resection should be the treatment of choice.

• Journal of Gastric Cancer
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• v.8 no.3
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• pp.141-147
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• 2008

Purpose: The aim of this study was to compare the short-term operative outcomes of laparoscopy-assisted total gastrectomy (LATG) with those of open total gastrectomy (OTG) for patients suffering with advanced upper gastric cancer. Materials and Methods: Of the 47 patients who underwent LATG with $D1+{\beta}$ or D2 lymphadenectomy from July 2004 to March 2008, 29 patients with pathologically proven advanced gastric cancer were compared with 35 patients who underwent conventional OTG during the same time period. The comparison was based on the clinicopathological characteristics, the surgical outcome, the follow-up survival and tumor recurrence. Results: The patients' age, gender and body mass index were similar between the two groups. However, there were statistically differences in tumor size ($9.2{\pm}3.9$ vs $6.1{\pm}3.6cm$, P=0.002) and the proximal resected margin ($2.1{\pm}2.0$ vs $3.6{\pm}2.1cm$ P=0.004). There was no significant difference in most of the peri- and post-operative courses such as the time to first flatus, the time to starting a solid diet and the length of the hospital stay, except for a longer operating time (289.0 vs. 361.3 minutes, P<0.001) in the LATG group. The complication rate was higher in the LATG group (13.8%) than that in the OTG group (5.7%). The mean overall survival and disease free survival times were 32 and 31 months, and 24 and 28 months, respectively, with an average 18.8 months follow-up duration. The main recurrent sites were peritoneum and lymph node in both groups. Conclusion: The early results of the current study suggest that LATG for AGC is technically feasible and it does not show any inferiorities of the postoperative outcomes as compared to those of conventional open total gastrectomy.

• Journal of Chest Surgery
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• v.39 no.7 s.264
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• pp.520-526
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• 2006

Background: The clinical application of cryosurgery the management of lung cancer is limited because the response of lung at low temperature is not well understood. The purpose of this study is to investigate the response of the pulmonary tissue at extreme low temperature. Material and Method: After general anesthesia the lungs of twelve Mongrel dogs were exposed through the fifth intercostal space. Cryosurgical probe (Galil Medical, Israel) with diameter 2.4 mm were placed into the lung 20 mm deep and four thermosensors (T1-4) were inserted at 5 mm intervals from the cryoprobe. The animals were divided into group A (n=8) and group B (n=4). In group A the temperature of the cryoprobe was decreased to $-120^{\circ}C$ and maintained for 20 minutes. After 5 minutes of thawing this freezing cycle was repeated. In group B same freezing temperature was maintained for 40 minutes continuously without thawing. The lungs were removed for microscopic examination on f day after the cryosurgery. In four dogs of the group A the lung was removed 7 days after the cryosurgery to examine the delayed changes of the cryoinjured tissue, Result: In group A the temperatures of T1 and T2 were decreased to the $4.1{\pm}11^{\circ}C\;and\;31{\pm}5^{\circ}C$ respectively in first freezing cycle. During the second freezing period the temperatures of the thermosensors were decreased lower than the temperature during the first freezing time: $T1\;-56.4{\pm}9.7^{\circ}C,\;T2\;-18.4{\pm}14.2^{\circ}C,\;T3\;18.5{\pm}9.4^{\circ}C\;and\;T4\;35.9{\pm}2.9^{\circ}C$. Comparing the temperature-distance graph of the first cycle to that of the second cycle revealed the changes of temperature-distance relationship from curve to linear. In group B the temperatures of thermosensors were decreased and maintained throughout the 40 minutes of freezing. On light microscopy, hemorrhagic infarctions of diameter $18.6{\pm}6.4mm$ were found in group A. The infarction size was $14{\pm}3mm$ in group B. No viable cell was found within the infarction area. Conclusion: The conductivity of the lung is changed during the thawing period resulting further decrease in temperature of the lung tissue during the second freezing cycle and expanding the area of cell destruction.

• Korean Journal of Optics and Photonics
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• v.19 no.6
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• pp.439-447
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• 2008

There is a need for a finite schematic presbyopic eye that models vision and image quality under various conditions such as cataract or refractive surgery, as well as near vision corrections with an ophthalmic lens or contact lens. Using recently measured biometric data of presbyopic eyes, new model eyes were designed that are optically and anatomically close to real eyes. The parameters changing significantly with age were incorporated into models for four different age groups. The new model eyes have alpha angle, decentered pupil, aspheric GRIN lens and aspheric retinal surface. It is likely that the new finite presbyopic model eyes will be useful for designing visual instruments such as low vision aids, PALs, IOL and contact lenses, and for the clinical prediction of the retinal image quality of a presbyopic patient.