• Title/Summary/Keyword: 환자 선별

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Risk factors of Pneumonectomy in Non-Small Cell Lung Cancer (비소세포폐암에시 전폐절제술의 위험 인자)

  • Hwang Eun-Gu;Baek Heejong;Lee Hae-Won;Park Jong-Ho;Zo Jae-Ill
    • 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.

Clinical significance of the mechanical properties of the abdominal aorta in Kawasaki disease (가와사끼병에서 복부 대동맥의 물리적 특성의 임상적 의의)

  • Kim, Mi Jin;Lee, Sang Yun;Kim, Yong Bum;Kil, Hong Ryang
    • Clinical and Experimental Pediatrics
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    • v.51 no.9
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    • pp.1012-1017
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    • 2008
  • Purpose : This study aimed to assess the mechanical properties of the abdominal aorta in school-aged patients treated for Kawasaki disease and in normal, healthy children. Methods : This study examined 28 children with Kawasaki disease who had been followed up on and 30 healthy subjects of the same age and gender. We recorded systolic (Ps) and diastolic (Pd) blood pressure values and the aortic diameter at both minimum diastolic (Dd) and maximum systolic (Ds) expansion using two-dimensional echocardiography. These measurements were used to determine 1) aortic strain: S=(Ds-Dd)/Dd; 2) pressure strain elastic modulus: Ep=(Ps-Pd)/S; and 3) normalized Ep: $Ep^*=Ep/Pd$. Results : Ep (P=0.008) and $Ep^*$ (P=0.043) of the Kawasaki disease group were relatively high compared to those of the control group. Ep (P=0.002) and $Ep^*$ (P=0.015) of patients with coronary aneurysm were also relatively high compared with those of patients without coronary aneurysm, but lipid profiles did not differ, except for homocysteine (P=0.008). Therefore, in patients with coronary aneurysm, aortic stiffness was higher, compared to not only the control group but also patients without coronary aneurysm. However, in patients without coronary aneurysm, aortic stiffness was not significant, different compared to the control group. Conclusion : Measuring aortic distensibility may be helpful in assessing the risk of early atheroscletic change in the long-term management of Kawasaki disease.

Diagnostic Criteria to Differentiate Medial Meniscal Injury from Degenerative Changes on $^{99m}Tc-MDP$ Knee SPECT in Patients with Chronic Knee Pain (만성 무릎관절 통증환자에서 내측 반월상연골 손상과 관절 퇴행성 변화의 감별을 위한 $^{99m}Tc-MDP$ 무릎관절 SPECT의 진단기준)

  • Paeng, Jin-Chul;Chung, June-Key;Jeong, Hwan-Jeong;Yoo, Jae-Ho;Kang, Won-Jun;So, Young;Lee, Dong-Soo;Lee, Myung-Chul;Seong, Sang-Cheol;Lee, Myung-Chul
    • The Korean Journal of Nuclear Medicine
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    • v.37 no.2
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    • pp.103-109
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    • 2003
  • Purpose: In patients with chronic knee pain, the diagnostic performance of $^{99m}Tc-MDP$ knee SPECT for internal derangement of knee is deteriorated due to degenerative changes. In this study, we tried to establish diagnostic criteria to differentiate medial meniscal injury (MMI) from degenerative change (DC) when the uptake is increased in medial compartment. Materials and Methods: A total of 49 knee SPECT of the patients with chronic (more than 3 months) knee pain, which showed increased $^{99m}Tc-MDP$ uptake in the medial compartment, were included in this study. The diagnosis was confirmed by arthroscopy. On knee SPECT, 3 diagnosic criteria for MMI were investigated. In Criterion I, MMI was diagnosed when crescentic uptake was observed in the medial tibial plateau. In Criterion II, crescentic uptake was further classified into anterior, mid, posterior, and diffuse patterns, according to the location of maximal uptake; and only crescentic mid, posterior, and diffuse patterns were diagnosed as MMI. In Criterion III, MMI was diagnosed when medial tibial plateau showed higher activity then medial femoral condyle. The diagnostic performance of the 3 criteria was compared. Results: The sensitivity and specificity were 93% and 14% in Criterion I, 89% and 38% in Criterion II, and 75% and 67% in Criterion III, respectively. Criterion III had significantly improved diagnostic performance, especially, specificity. Conclusion: In this study, we established a practical diagnostic criterion to differentiate MMI from DC on knee SPECT. The result is helpful to improve the diagnostic value of knee SPECT as a screening test for chronic knee pain.

Assessment of Renal Function in Silicobis with Urinary N-acetyl-$\beta$-D-glucosaminidase Activity (규폐증환자의 신기능 평가를 위한 요중 N-acetyl-$\beta$-D-glucosaminidase활성치 측정의 의의)

  • Lee, Hoo-Rak;Kim, Don-Kyoun;Lee, Su-Il;Cho, Byung-Mann;Kim, Wha-Jo
    • Journal of Preventive Medicine and Public Health
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    • v.26 no.1 s.41
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    • pp.49-64
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    • 1993
  • To provide the basic data for assessment of renal dysfunction related to silicosis, urinary N-acetyl-$\beta$-D-giucobarninidase(NAG) activity known as a sensitive markers for early renal damage were measured in 58 silicosis patients, and control subjects of 40 pulmonary tuberculosis Patients and 51 official workers. The results were summarized as fellows. 1. The values of blood urea nitrogen and serum creatinine in all subjects were within reference limits. But the mean value of urinary NAG activity($7.25{\pm}7.31U/g\;creatinine$) was beyond reference value and more sensitive test than others. 2. The mean value of urinary NAG activity in silicosis group was $11.98{\pm}9.05U/g\;creatinine$ and significantly higher than in tuberculosis and healthy group(p<0.01), but the mean values of NAG activity in tuberculosis and healthy group were not different(p>0.05). 3. The value of NAG activity in tuberculosis had a tendency to be increased according to severity of disease, but that was not significant(p>0.05). The value of NAG activity was increased significantly by use of nephrotoxic antituberculosis drugs(p<0.05). 4. The value of NAG activity in silicosis had a tendecy to be increased according to the size of nodule, use of nephrotoxic antituberculosis drugs and shortness of onset duration, but the increase was not significant(p>0.05). 5. After excluding the users of nephrotoxic antituberculosis drugs, the mean values of NAG activity in healthy control and in tuberculosis control were same as 3.63 U/g creatinine and 3.60 U/g creatinine, respectively. But the mean value of NAG activity in silicosis group was remarkably increased as 10.90 U/g creatinine(p<0.01). As above results, even though there are no abnormal finding in screening renal function test, silicosis can be related with renal dysfunction. And it will be very useful to apply urinary NAG activity in health management of workers exposed to dust.

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Results of Surgical Treatment of Patella Dislocation (슬개골 탈구의 수술적 치료 결과)

  • Kim, Hui Taek;Cho, Yoon Jae
    • Journal of the Korean Orthopaedic Association
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    • v.56 no.2
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    • pp.134-141
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    • 2021
  • Purpose: Patellar dislocations have a range of causes. This study examined the results of treatment aimed at balancing soft tissues around the patella. Materials and Methods: Thirty-two patellar dislocations in 28 patients (21 females and seven males) were examined. The mean patient age at the time of surgery was 11.5 years, and the mean follow-up period was 4.6 years. Dislocations were 19 chronic, six habitual, six congenital, and one acute. Soft tissue balancing surgery included lateral capsular release, medial capsular plication, and inferolateral transfer of the vastus medialis obliquus. Medial transfer of the patellar tendon, partial strip of the rectus femoris and patella tendon, and distal femoral osteotomy were also performed selectively. The preoperative Q angle, femoral anteversion angle, tibial external rotation angle, tibial tubercle-trochlear groove distance (TT-TG distance), mechanical femoral-tibial angle, and femoral trochlear dysplasia according to Dejour were measured, and the pre- and postoperative Lysholm-Tegner scores were used to analyze the clinical results. Results: The mean preoperative Q angle, TT-TG distance, femoral anteversion angle, tibial external rotation angle, mechanical femoraltibia angle, and Lysholm-Tegner score were 9.3°, 15.5 mm, 25.6°, 30.4°, 3.0°, and 75.8, respectively. Eleven patients had systemic ligament laxity with a Beighton score of five or more. Twenty-two patients had femoral trochlear dysplasia: four type A (3 patients), 16 type B (15 patients), one type C (1 patient), and four type D (3 patients). Of the 32 cases, 28 were corrected successfully by the first operation. Of four cases of postoperative subluxation, three were corrected by the second operation, and one of them was corrected after a third operation. The last patient is currently being followed-up. The mean Lysholm-Tegner score improved to 85.6 after the operation. Conclusion: Correcting all the causes of patella dislocation simultaneously is difficult. Nevertheless, satisfactory outcomes were obtained with soft tissue balancing surgery around the patella and a corrective osteotomy for an abnormal mechanical axis of the femur-tibia and torsion.

Development of an Eye Patch-Type Biosignal Measuring Device to Measure Sleep Quality (수면의 질을 측정하기 위한 안대형 생체신호 측정기기 개발)

  • Changsun Ahn;Jaekwan Lim;Bongsu Jung;Youngjoo Kim
    • KIPS Transactions on Computer and Communication Systems
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    • v.12 no.5
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    • pp.171-180
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    • 2023
  • The three major sleep disorders in Korea are snoring, sleep apnea, and insomnia. Lack of sleep is the root of all diseases. Some of the most serious potential problems associated with sleep deprivation are cardiovascular problems, cognitive impairment, obesity, diabetes, colitis, prostate cancer, etc. To solve these problems, the Korean government provided low-cost national health insurance benefits for polysomnography tests in July 2018. However, insomnia patients still have problems getting treated in terms of time, space, and economic perspectives. Therefore, it would be better for insomnia patients to be allowed to test at home. The measuring device can measure six biosignals (eye movement, tossing and turning, body temperature, oxygen saturation, heart rate, and audio). A gyroscope sensor (MPU9250, InvenSense, USA) was used for eye movement, tossing, and turning. The input range of the sensor was in 258°/sec to 460°/sec, and the data range was in the input range. Body temperature, oxygen saturation range, and heart rate were measured by a sensor (MAX30102, Analog Devices, USA). The body temperature was measured in 30 ℃ to 45 ℃, and the oxygen saturation range was 0% for the unused state and 20 % to 90 % for the used state. The heart rate measurement range was in 40 bpm to 180 bpm. The measurement of audio signal was performed by an audio sensor (AMM2742-T-R, PUIaudio, USA). The was -42 dB ±1 dB frequency range was 20 Hz to 20 kHz. The measured data was successfully received in wireless network conditions. The system configuration was consisted of a PC and a mobile app for bio-signal measurement and data collection. The measured data was collected by mobile phones and desktops. The data collected can be used as preliminary data to determine the stage of sleep and perform the screening function for sleep induction and sleep disturbances. In the future, this convenient sleep measurement device could be beneficial for treating insomnia.

A Comparison of Tiotropium 18㎍, Once Daily and Ipratropium 40㎍, 4 Times Daily in a Double-Blind, Double-Dummy, Efficacy and Safety Study in Adults with Chronic Obstructive Pulmonary Disease (만성폐쇄성폐질환 환자에서 Tiotropium 1일 1회, 1회 18㎍ 요법과 Ipratropium 1일 4회, 1회 40㎍ 요법의 치료효과 및 안전성 비교)

  • Kim, Seung Joon;Kim, Myung Sook;Lee, Sang Haak;Kim, Young Kyoon;Moon, Hwa Sik;Park, Sung Hak;Lee, Sang Yeub;In, Kwang Ho;Lee, Chang Youl;Kim, Young Sam;Kim, Hyung Jung;Ahn, Chul Min;Kim, Sung Kyu;Kim, Kyung Rok;Cha, Seung Ick;Jung, Tae Hoon;Kim, Mi Ok;Park, Sung Soo;Choi, Cheon Woong;Yoo, Jee Hong;Kang, Hong Mo;Koh, Won Jung;Ham, Hyoung Suk;Kang, Eun Hae;Kwon, O Jung;Lee, Yang Deok;Lee, Heung Bum;Lee, Yong Chul;Rhee, Yang Keun;Shin, Won Hyuk;Kwon, Sung Yeon;Kim, Woo Jin;Yoo, Chul Gyu;Kim, Young Whan;Shim, Young Soo;Han, Sung Koo;Park, Hye Kyung;Kim, Yun Seong;Lee, Min Ki;Park, Soon Kew;Kim, Mi Hye;Lee, Won Yeon;Yong, Suk Joong;Shin, Kye Chul;Choi, Byoung Whui;Oh, Yeon Mok;Lim, Chae Man;Lee, Sang Do;Kim, Woo Sung;Kim, Dong Soon;Jung, Sung Soo;Kim, Ju Ock;Ko, Young Chun
    • Tuberculosis and Respiratory Diseases
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    • v.58 no.5
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    • pp.498-506
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    • 2005
  • Background : This study compared the bronchodilator efficacy and safety of tiotropium inhalation capsules ($18{\mu}g$ once daily) with a ipratropium metered dose inhaler (2 puffs of $20{\mu}g$ q.i.d.) in patients with chronic obstructive pulmonary disease (COPD). Method : After the initial screening assessment and a two-week run-in period, patients received either tiotropium $18{\mu}g$ once daily or ipratropium $40{\mu}g$ four times daily over a period of 4 weeks in a double blind, double dummy, parallel group study. The outcome measures were the lung function, the daily records of the peak expiratory flow rate (PEFR), the patients' questionnaire, and the use of concomitant salbutamol. The forced expiratory volume in one second ($FEV_1$) and the forced vital capacity (FVC) were measured 5 minutes before inhalation, and 0.5, 1, 2 and 3 hours after inhaling the study drug on days 0, 14 and 28. Result : In 16 centers, 134 patients with a mean (SD) age of 66 (7) years and a predicted $FEV_1$ of 42 (12)% were analyzed. The trough $FEV_1$ response was significantly higher in the tiotropium group than in the ipratropium group after a four-week treatment period. The weekly mean morning PEFR of the tiotropium group was consistently higher than that of the ipratropium group during the 4-week treatment period with differences ranging from 12.52 to 13.88 l/min, which were statistically significant. Tiotropium was well tolerated by the COPD patients during the 4-week treatment period and had a similar safety profile to ipratropium. Conclusion : This study shows that tiotropium administrated once daily has a superior bronchodilator effect with a similar safety profile in treating COPD patients compared with ipratropium, inhaled four times daily.

Diagnostic Efficacy of Anorectal Manometry for the Diagnosis of Hirschsprung's Disease (Hirschsprung병에서 항문직장 내압검사의 진단적 유용성)

  • Chang, Soo-Hee;Min, Uoo-Gyung;Choi, Ok-Ja;Kim, Dae-Yeon;Kim, Seong-Chul;Yu, Chang-Sik;Kim, Jin-Cheon;Kim, In-Koo;Yoon, Jong-Hyun;Kim, Kyung-Mo
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.6 no.1
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    • pp.24-31
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    • 2003
  • Purpose: As diagnostic tools for Hirschsprung's disease (HD), barium enema and rectal biopsy have radiation exposure and invasiveness respectively; however anorectal manometry does not have these disadvantages. We therefore performed this study to evaluate the diagnostic efficacy of anorectal manometry. Methods: We reviewed medical records of infants with one or two symptoms of vomiting, abdominal distension, chronic diarrhea or constipation who had a anorectal manometry followed by barium enema and/or biopsy from July 1995 to May 2002. We evaluated the sensitivity, specificity and predictive value of anorectal manometry and barium enema for diagnosis of HD. We also measured sphincter length, median value of balloon volume at which rectoanal inhibitory reflex (RAIR) occurred. Results: All 61 patients received anorectal manometry, 33 of 61 received barium enema. 18 of 61 were diagnosed as HD according to histology and 43 of 61 were evaluated as a control. The sensitivity, specificity, positive predictive value, negative predictive value of anorectal manometry and barium enema for diagnosis of HD were 1.00, 0.91, 0.82, 1.00 and 0.93, 0.67, 0.70, 0.92 respectively. The mean value of sphincter length in control was $1.68{\pm}0.67$ cm and correlated with age, weight and significantly longitudinal length. The median value of balloon volume at which RAIR occurred was 10 mL and did not correlated with age, weight and longitudinal length. Conclusion: This study suggests that anorectal manometry is an excellent initial screening test for Hirschsprung's disease because of its safety and accuracy.

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Urine Collection from Disposable Diapers in Infants and Young Children (유소아에서 일회용 기저귀를 이용한 소변 채취 방법)

  • Kim Mi Jeong;Kim Ji Hae;Yim Hyung Eun;Kang Hee;Eun Baik Lin;Yoo Kee Hwan;Hong Young Sook;Lee Joo Won;Kwon Junga
    • Childhood Kidney Diseases
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    • v.9 no.2
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    • pp.128-136
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    • 2005
  • Purpose : Urine collection using a sterile adhesive bag for urinalysis has been used commonly in infants and young children. However, this method has had some drawbacks. So, this study was performed to evaluate the usage of disposable diapers as a substitute for the routine urine collection method. Methods : 60 mL of self voided fresh urine was collected from 99 patients. Half of the urine was poured on the disposable diapers which did not contain absorbent gel beads. After 1 hr, we obtained the urine samples(extracted urine) by compressing the wet diapers using a 50 ml syringe. Routine, microscopic and biochemical analyses were performed on the other half of fresh urine and extracted urine. Then we compared each result by correlative analysis. Results : 198 samples from 99 patients were evaluated. The results of routine urinalysis except WBC and biochemical urinalysis showed a significant correlation between the two groups(P<0.05). The relative coefficients of urine SG, pH, glucose, protein, blood and leukocytes between the two groups were 0.964, 0.938, 0.977, 0.956, 0.931 and 0.738, respectively. Those of urinary sodium, potassium, chloride and creatinine were 0.997, 0.998, 0.995 and 0.998, respectively Microscopic examinations showed lower relative coefficients than the other results, 0.740 for RBC and 0.602 for WBC, but these were still significant(P<0.05). Conclusion : The results of the urine analysis with extracted urine from diapers correlates well with that of fresh urine. This new method is very helpful and can be used as an alternative of urine collection, especially for infants and young children. (J Korean Soc Pediatr Nephrol 2005;9:128-136)

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Analysis of source localization of P300 in college students with schizotypal traits (조현형 인격 성향을 가진 대학생의 P300 국소화 분석)

  • Jang, Kyoung-Mi;Kim, Bo-Mi;Na, Eun-Chan;An, Eun-Ji;Kim, Myung-Sun
    • Korean Journal of Cognitive Science
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    • v.28 no.1
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    • pp.1-26
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    • 2017
  • This study investigated the cortical generators of P300 in college students with schizotypal traits by using an auditory oddball paradigm, event-related potentials (ERPs) and standardized low resolution brain electromagnetic tomography (sLORETA) model. We also investigated the relationship between the current density of P300 and the clinical symptoms of schizophrenia. Based on the scores of Schizotypal Personality Questionnaire(SPQ), schizotypal trait (n=37) and control (n=42) groups were selected. For the measurement of P300, an auditory oddball paradigm, in which frequent standard tones (1000Hz) and rare target tones (1500Hz) were presented randomly, was used. Participants were required to count the number of the target tones during the task and report this at the end of the experiment. The two groups did not differ significantly in the accuracy of the oddball task. The schizotypal trait group showed significantly smaller P300 amplitudes than control group. In terms of source localization, both groups showed the P300 current density over bilateral frontal, parietal, temporal and occipital lobes. However, the schizotypal trait group showed significantly reduced activations in the left superior temporal gyrus and the right middle temporal gyrus, but increased activations in both left inferior frontal gyrus and right superior frontal gyrus compared to the control group. Furthermore, a negative correlation between the current density of the right superior frontal gyrus and SPQ disorganization score was found in the schizotypal trait group. These findings indicate that the individuals with schizotypal traits have dysfunctions of frontal and temporal areas, which are known to be the source of P300, as observed in patients with schizophrenia. In addition, the present results indicate that the disorganization score, rather than total score, of the SPQ is useful in predicting the risk of future schizophrenia.