• Journal of Hospice and Palliative Care
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• v.13 no.1
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• pp.24-31
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• 2010

Purpose: A central venous catheterization (CVC) is frequently used for delivering anti-cancer chemotherapeutic agents, blood products, parenteral nutrition, and other intravenous therapy in patients with cancer. Major complications of CVC use are thrombosis, infection, and mechanical complications. The aim of this study was to evaluate the frequency of CVC complications and related factors. Methods: The records of cancer patients who received a CVC at our university hospital from March 2001 to October 2006 were retrospectively investigated. Chi square test was used to determine whether there was a related factor for thrombosis or infection, and Kaplan-Meier analysis for univariate analysis, or Cox-regression analysis for multivariate analysis was used for catheter life span. Results: Three hundred and ten CVCs (235 nontunneled, 75 tunneled) were inserted in 310 patients (157 males, 153 females). Among them, 104 had hematologic cancers and 206 had solid cancers. The mean age of the patients was 52 years (range, 19~82 years). CVC complications occurred in 60 cases (19%). CVC-related thrombosis occurred frequently in patients with infection (P=0.003), whereas diagnosis, catheter type, transfusion, and TPN history did not affect infection or thrombosis. The mean duration of the catheter was 102 days (range, 2~1,330 days), and the duration was prolonged in patients with tunneled catheters (P=0.000), or without transfusion through CVC (P=0.030). Conclusion: The major complications for long-term use of a CVC were infectionand thrombosis. Tunneled catheter was effective tool for long term use, especially in cases without transfusion through CVC. The studies on the prevention or treatment ofthrombosis and infection are, therefore, warranted by using CVC for an extended period of time.

• Radiation Oncology Journal
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• v.10 no.2
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• pp.171-180
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• 1992

The precise role of radiotherapy for low grade gliomas including the optimal radiation dose and timing of treatment remains unclear. The information given by a retrosepctive analysis may be useful in the design of prospective randomized studies looking at radiation dose and time of surgical and radiotherapeutic treatment. The records of 56 patients (M:F = 29:27) with histologically verified cerebral low grade gliomas (47 cases of grade 1 or 2 astrocytomas and 9 oligodendrogliomas) diagnosed between 1979 and 1989 were retrospectively reviewed. The extent of surgical tumor removal was gross total or radical subtotal in 38 patients ($68\%$) and partial or biopsy only in the remaining 18 patients ($32\%$). Postooperative radiation therapy was given to 36 patients ($64\%$) of the total 56 patients with minimum dose of 5000 cGy (range=1250 to 7220 cGy). The 5-and 10-year survival rates for the total 56 patients were $44\%$ and $32\%$ respectively with a median survival of 4.1 years. According to the histologic grade the 5- and 10-year survivals were $52\%$ and $35\%$ for the 24 patients respectively with grade I astrocytomas compared to $20\%$ and $10\%$ for the 23 patients with grade II astrocytomas. Survival of oligodendroglioma patients was greater than those with astrocytoma ($65\%$ vs $36\%$ at 5 years), and the difference was also remarkable in the long term period of follow up ($54\%$ vs $23\%$ at 10 years). Those who received high-dose radiation therapy ($\geq$5400 cGy) had significant better survival than those who received low-dose radiation (< 5400cGy) or surgery alone (p<0.05). The 5- and 10-year survival rates were, respectively $59\%$ and $46\%$ for the 23 patients receiving high-dose radiation, $36\%$ and $24\%$ for the 13 patients receiving low-dose radiation, and $35\%$ and $26\%$ for the 20 patients with surgery alone. Survival rates by the extent of surgical resection were similar at 5 years ($46\%$ vs $41\%$), but long term survival was quite different (p<0.01) between total/subtotal resection and partial resection/biopsy ($41\%$ and $12\%$, resepctively). Previously published studies have identified important prognostic factors in these tumor: age, extent of surgery, grade, performance status, and duration of symptoms. But in our cases statistical analysis revealed that grade I histology (p<0.025) and young age (p<0.001) were the most significant good prognostic variables.

• Journal of Veterinary Clinics
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• v.31 no.2
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• pp.90-94
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• 2014

This study was performed to investigate on the frequent chief complaints and the causes of dogs and cats visiting to an emergency department, and to suggest the minimum requirements for veterinary emergency clinics in South Korea. The medical records were reviewed for 2,368 dogs and 347 cats visiting the emergency department of Haemaru Referral Animal Hospital from March 2012 to August 2013. Among them, 255 dogs and 35 cats visited more than one time and each visit was considered as an individual case. Therefore, 2,784 cases of dogs and 396 cases of cats were reviewed. The medical records were analyzed according to the criteria such as signalment, chief complaints, diagnoses, hospital admission, and outcome. In dogs, vomiting, diarrhea, or both were the most common chief complaints, followed by dyspnea, trauma, seizure, and lethargy. The most common causes of emergency visits were gastrointestinal disorders, followed by neurologic, cardiovascular, respiratory, urologic, and hematologic disorders. In cats, dyspnea was the most common chief complaint, followed by vomiting, diarrhea, or both, trauma, dysuria, and lethargy. The most common causes of emergency visits were urologic disorders followed by gastrointestinal, respiratory, infectious, and cardiovascular disorders. According to the results, vomiting, diarrhea, dyspnea, and trauma were the most frequently encountered chief complaints, which accounted for approximately 48.6% of all cases in both dogs and cats. However common causes were differed between the dogs and the cats. In order to provide proper emergency service, it is required to prepare the clinicians and facilities to diagnose and stabilize these emergency patients.

• Journal of Gastric Cancer
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• v.9 no.4
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• pp.262-268
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• 2009

Purpose: We wanted to analyze the clinicopathologic characteristics of patients with gastric carcinoid tumor, which is a rare gastric tumor (less than 2% of all gastric tumors). Materials and Methods: We reviewed all the carcinoid patients who were treated from 1996 to 2006. The clinicopathologic characteristics, the treatment modalities and the survival rates were retrospectively analysed. Results: There were 8 type I patients and 10 type III patients, but there were no type II patients. The mean age of onset for type I was 47.75 years and that for type III was 57.90 years. More type III patients were female, but the gender ratio of type I patients was equal at a ratio of 1：1. There were 4 cases of solitary tumor, which were all T1 except for one case, and there was neither distant metastasis nor lymph node involvement for the type T1 cases. In the 13 patients who had no metastasis, 5 underwent endoscopic mucosal resection and 8 underwent surgery, and their combined 5 year survival rate was 92.3%. For the 5 cases who had metastastses, their mean survival was 22 months and especially, 3 of them underwent palliative surgery and their median survival were 24 months (95%, ${\pm}6.52$). Conclusion: Higher incidence of type III gastric carcinoid tumor and less multiplicity in type I gastric tumor were identified in our study compared with previous reports. For the type III cases, there were some noteable differences compared with the Western country's survival rate for the patients who underwent palliative surgery, so physicians must pay close attention to the definite clinicopathologic characteristics of gastric carcinoid patients.

• Journal of Chest Surgery
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• v.43 no.1
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• pp.39-46
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• 2010

Background: Preoperative chemotherapy has been adopted in our hospital as a standard treatment for non-small cell lung cancer patients with N2 disease. However, there have been cases of pathologic N2 disease that have been detected after curative-intent surgical resection. We retrospectively studied the outcomes of initial surgical treatment without neoadjuvant therapy in patients with unexpected N2 non-small cell lung cancer. Material and Method: Between January 1995 and June 2007, 225 patients were diagnosed with pathologic N2 disease after they underwent initial pulmonary resection without neoadjuvant therapy. Among them, 170 patients were preoperatively diagnosed with lymph node stage N0 or N1. We retrospectively reviewed their medical record and analyzed the outcomes. Result: The overall 5-year survival rate was 35.4%. The prognostic factors that were significantly associated with survival were no adjuvant therapy, histologic cell types other than adenocarcinoma or squamous cell carcinoma, a pathologic T stage more than T1, old age (${\geq}$70 years) and no mediastinoscopic biopsy. During the follow-up, 79 patients (46.5%) experienced tumor recurrence, including loco-regional recurrence in 20 patients (25.3%) and distant metastasis in 56 (70.9%). The 5-year recurrence-free survival rate was 33.7%. Conclusion: Based on our findings, the survival was good for patients with unexpected N2 non-small cell lung cancer and who underwent initial pulmonary resection without neoadjuvant therapy. A prospective comparative analysis is needed to obtain more conclusive and persuasive results.

• Pediatric Infection and Vaccine
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• v.24 no.3
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• pp.160-167
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• 2017

Purpose: Because children with asplenia have an increased risk of fulminant infection associated with a high fatality, chemoprophylaxis, and vaccinations against encapsulated bacteria are recommended. However, there have been few reports of the burden of severe bacterial infection and the current status of chemoprophylaxis and immunization among children with asplenia in Korea. Methods: We conducted a retrospective study including children with asplenia who were treated at our institute between January 1997 and December 2016. Results: From a total of 213 children with asplenia, 114 (53.5%) had congenital asplenia and 58 (27.2%) had functional asplenia. The remaining 41 (19.3%) had acquired asplenia with the median age at splenectomy being 12.2 years (range, 5.0 to 16.9 years); the most common cause of splenectomy was hereditary spherocytosis (39.0%). The chemoprophylaxis rate was 16.4%. The immunization rates were 44.1% for pneumococcus, 53.0% for Haemophilus influenzae type B, and 10.7% for meningococcus. The incidence of invasive bacterial infection among children with asplenia was 0.28/100 person-year; a total of six episodes (2.8%) were observed in five patients with congenital asplenia and one patient with functional asplenia. The median age for these infections was 15 months (range, 4 to 68 months). Five of the six episodes were bacteremia, and the other was meningitis. The most common pathogen was Streptococcus pneumoniae (n=3), followed by H. influenzae (n=1). Three of the six patients (50.0%) died, all of whom had pneumococcal bacteremia. None of the six had chemoprophylaxis or proper vaccinations. Conclusions: Although there is an increased risk of a severe infection proper vaccinations and chemoprophylaxis are still lacking. Physicians should be encouraged to implement appropriate chemoprophylaxis and immunizations for patients with asplenia.

• Tuberculosis and Respiratory Diseases
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• v.46 no.6
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• pp.767-774
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• 1999

Background : Tuberculous mediastinal lymphadenitis (TML) is a relatively commonly encountered in Korea. However, there were no datas available on TML without other combined tuberculous infections in Korea. We retrospectively analyzed clinical manifestations, radiologic findings, Chest CT scan findings, the duration of treatment, and follow up Chest CT scan findings of 23 cases who had only TML. Method : 23 cases from 1991 to 1997 with TML confirmed by biopsy and had no other combined tuberculous infections were studied retrospectively. Results : Of the 23 cases, 7 cases were male and 16 female. The male to female ratio was 1 : 2.4. Mean age was 31 years and the most prevalent age group was the 3rd decade(43%). The most common presenting symptoms were fever(39%) followed by no symptom, cough, swallowing difficulty, and chest discomfort. On simple chest X-ray, mediastinal enlargement were noted in 20 cases(90%). The most frequently involved site was the paratracheal node in 11 cases with the right to left side involvement ratio being 4.6 : 1. On chest CT scan, the most commonly enlarged node was the paratracheal node(33%) followed by the subcarinal(20%), hilar(13%), tracheobronchial (8%), subaortic(8%), supraclavicular(8%) and anterior. mediastinal nodes. 6 cases were dropt out due to incomplete follow up. Thirteen cases were treated with HERZ regimen and the mean duration of treatment was 14 months. Three cases were treated with second line drug regimens(Tarivid, Pyrazinamide, Streptomycin plus Ethambutol or Para-aminosalicylic acid) for 18 months. In HERZ groups, one case was recurred after 10 months later and retreatment was done by same HERZ regimen during 12 months. Follow up chest CT scan after completion of treatment were done in 13 cases and that revealed more than a 50% decrease in size in 77% of the cases and no interval change in 23% of the cases. Conclusion : In cases of TML without other combined tuberculous infection, the minimal duration of treatment was required 12 months by HERZ regimen and 18 months by a 2nd line regimen or more. Further studies will be needed to confirm the treatment duration for TML without other combined tuberculous infections.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.5 no.2
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• pp.158-165
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• 2002

Purpose: We designed this retrospective study to establish the incidence of diagnosic delay in children diagnosed with acute appendicitis and to identify associated factors with delayed diagnosis and its impact on the clinical course. Methods: All cases of children under 15 years of age who underwent appendectomy from 1996 to 2001 at Gangneung Asan Hospital were reviewed. We reviewed signs and symptoms, type of health professional first contacted, the advice given by the health professional and a history of appendicitis in first degree relatives. Diagnostic period is the time elapsed between first complaints and definitive diagnosis. Delay was defined as diagnostic period exceeded the 48 hours. Postoperative course and complications were also reviewed. Results: Incidence of diagnostic delay differed by whether diarrhea and fecalith on X-ray were present. Also children whose parents were advised to observe them at home were more likely to have a diagnostic delay. In almost half of the cases in delayed group, initial diagnosis was not acute appendicitis but gastroenteritis. The perforation rate in non-delayed group was 22%, whereas 87% in delayed group. The delayed group showed a higher number of postoperative complication and a longer hospitalization period. Conclusions: Diarrhea with abdominal pain and fever in children should not be dismissed as gastroenteritis, respiratory infections or other common disorders. Our study suggests that physicians have a responsibility to prevent diagnostic delay and resultant perforation of acute appendicitis in children by having a high index of suspicion about acute appendicitis.

• The Journal of Korean Academy of Prosthodontics
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• v.57 no.1
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• pp.8-17
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• 2019

Purpose: The study analyzed the prevalence of peri-implantitis and factors which may have affected the disease. Materials and methods: This study based on medical records and radiographs of 422 patients (853 implant cases) who visited Ewha Womans University Mokdong Hospital Dental Center from January 1, 2012 to December 31, 2016. Generalized estimation equations (GEE) was utilized to determine the statistical relationship between peri-implantitis and each element, and the cumulative prevalence of peri-implantitis during the observation period was obtained by using the Kaplan Meier Method. Results: The prevalence rate of peri-implantitis at the patient level resulted in 7.3% (31 patients out of a total of 422 patients), and at the implant level 5.5% (47 implants out of a total of 853 implants). Sex, GBR, guided bone regeneration (GBR) and functional loading periods had statistical significance with the occurrence of peri-implantitis. Upon analysis of the cumulative prevalence of peri-implantitis in terms of implant follow-up period, the first case of peri-implantitis occurred at 9 months after the placement of an implant, and the prevalence of peri-implantitis showed a non-linear rise over time without a hint of a critical point. Conclusion: The prevalence of peri-implantitis at the patient level and the implant were 7.3% and 5.5%, respectively. Male, implant installed with GBR and longer Functional Loading Periods were related with the risk of peri-implantitis.

• 한국체육학회지인문사회과학편
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• v.57 no.3
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• pp.345-356
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• 2018

Objective: The purpose of this study was to investigate the local stability of the lower extremity joints and muscle activation patterns of the lower extremity during walking between falling and non-falling group in the elderly women. Method: Forty women, heel strikers, were recruited for this study. Twenty subjects (age:72.55±5.42yrs; height:154.40±4.26cm; mass:57.40±6.21kg; preference walking speed:0.52±0.17m/s; fall frequency=1.70±1.26 times) had a history falls(fall group) within two years and Twenty subjects (71.90±2..90yrs; height:155.28±4.73cm; mass:56.70±5.241kg; preference walking speed: 0.56±0.13m/s) had no history falls(non-fall group). While they were walking on a instrumented treadmill at their preference speed for a long while, kinematic and EMG signals were obtained using 3-D motion capture and wireless EMG electrodes, respectively. Local stability of the ankle and knee joint were calculated using Lyapunov Exponent (LyE) and muscles activation and their co-contraction index were also quantified. Hypotheses were tested using one-way ANOVA and Mann-Whitey. Spearman rank was also used to determine the correlation coefficients between variables. Level of significance was set at p<.05. Results: Local stability in the knee joint adduction-abduction was significantly greater in fall group than non-fall group(p<.05). Activation of anterior tibials that acts on the foot segment dorsal flexion was greater in non-fall group than fall group(p<.05). CI between gastrocnemius and anterior tibials was found to be significantly different between two groups(p<.05). In addition, there was significant correlation between CI of the leg and LyE of the ankle joint flexion-extention in the fall group(p<.05). Conclusion: In conclusion, muscles that act on the knee joint abduction-adduction as well as gastrocnemius and anterior tibials that act on the ankle joint flexion-extention need to be strengthened to prevent from potential fall during walking.