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Prophylactic cranial irradiation in limited small-cell lung cancer : incidence of brain metastasis and survival and clinical aspects (예방적 두강내 방사선 조사후 소세포 폐암 환자의 뇌전이 빈도와 생존율에 대한 연구)

  • Suh, Jae-Chul;Kim, Myung-Hoon;Park, Hee-Sun;Kang, Dong-Won;Lee, Kyu-Seung;Ko, Dong-Seok;Kim, Geun-Hwa;Jeong, Seong-Su;Cho, Moon-June;Kim, Ju-Ock;Kim, Sun-Young
    • Tuberculosis and Respiratory Diseases
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    • v.49 no.3
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    • pp.323-331
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    • 2000
  • Purpose: Brain metastases are present in approximately 10-16% of small cell lung cancer patients at diagnosis. Brain metastasis is an important clinical problem associated with increasing the survival rate, with a cumulative incidence of up to 80% in patients surviving 2 years. Prophylactic cranial irradiation(PCI) reduces the incidence of brain matastasis and may prolong survival in patients with limited small-cell lung cancer who achieved complete remission. This study was performed to analyze the incidence of brain metastasis, survival and clinical aspects after PCI in patients with limited small-cell lung cancer who achieved complete remission. Methods : Between 1989 and 1999, forty-two patients with limited small-cell lung cancer who achived achieved complete remission after therapy were enrolled into this study retrospectively. All patients received etoposide and cisplatin(VPP) alternating with cytoxan, adriamycin, and vincristine(CAV) every 3 weeks for at least 6 cycles initially. All patients received thoracic radiotherapy: concurrent(38.1%) and sequential(61.9%). All patients received late PCI. Results : Most patients(88.1%) were men, and the median age was 58 years. The median follow-up duration was 18.1 months. During the follow-up period, 57.1% of the patients developed relapse. The most frequent site of relapse was chest(35.7%), followed by brain(14.3%), liver(11.9%), adrenal gland(44%), and bone(2.2%). With the Kaplan-Meier method, the average disease-free interval was 1,090 days(median 305 days). The average time to development of brain relapse after PCI and other sites relapse(except brain) were 2,548 days and 1,395 days(median 460 days), respectively. The average overall survival was 1,233 days(median 634 days, 21.1 months), and 2-year survival rates was 41.7%. The average overall survival in the relapse group was 642 days(median 489 days) and in the no relapse group was 2,622 days(p<0.001). The average overall survival in the brain relapse group was 928 days(median 822 days) and in the no brain relapse group was 1,308 days(median 634 days)(p=0.772). In most patients(85.7%), relapse(except brain) or systemic disease was the usual cause of death. Brain matastasis was the cause of death in 14.3% of the cases. Conclusions : We may conclude that PCI reduces and delays brain metastasis in patients with limited small cell lung cancer who achieved complete remission. We found decreased survival in relapse group but, no significant survival difference was noted according to brain matastasis. And relapse(except brain) or systemic disease was the usual cause of death. In order to increase survival, new treatment strategies for control methods for relapse and systemic disease are required.

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Clinical Characteristics and Adherence of Patients Who Were Prescribed Home Oxygen Therapy Due to Chronic Respiratory Failure in One University Hospital: Survey after National Health Insurance Coverage (한 대학병원에서 조사된 재택산소요법을 받고 있는 환자의 특성과 재택산소요법 처방에 대한 순응도: 건강보험급여전환 후 조사)

  • Koo, Ho-Seok;Song, Young Jin;Lee, Seung Heon;Lee, Young Min;Kim, Hyun Gook;Park, I-Nae;Jung, Hoon;Choi, Sang Bong;Lee, Sung-Soon;Hur, Jin-Won;Lee, Hyuk Pyo;Yum, Ho-Kee;Choi, Soo Jeon;Lee, Hyun-Kyung
    • Tuberculosis and Respiratory Diseases
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    • v.66 no.3
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    • pp.192-197
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    • 2009
  • Background: Despite the benefits of home oxygen therapy in patients suffering chronic respiratory failure, previous reports in Korea revealed lower compliance to oxygen therapy and a shorter time for oxygen use than expected. However, these papers were published before oxygen therapy was covered by the national insurance system. Therefore, this study examined whether there were some changes in compliance, using time and other clinical features of home oxygen therapy after insurance coverage. Methods: This study reviewed the medical records of patients prescribed home oxygen therapy in our hospital from November 1, 2006 to September 31, 2008. The patients were interviewed either in person or by telephone to obtain information related to oxygen therapy. Results: During study period, a total 105 patients started home oxygen therapy. The mean age was 69 and 60 (57%) were male. The mean oxygen partial pressure in the arterial blood was 54.5 mmHg and oxygen saturation was 86.3%. Primary diseases that caused hypoxemia were COPD (n=64), lung cancer (n=14), Tb destroyed lung (n=12) and others. After oxygen therapy, more than 50% of patients experienced relief of their subjective dyspnea. The mean daily use of oxygen was 9.8${\pm}$7.3 hours and oxygen was not used during activity outside of their home (mean time, 5.4${\pm}$3.7 hours). Twenty four patients (36%) stopped using oxygen voluntarily 7${\pm}$4.7 months after being prescribed oxygen and showed a less severe pulmonary and right heart function. The causes of stopping were subjective symptom relief (n=11), inconvenience (n=6) and others (7). Conclusion: The prescription of home oxygen has increased since national insurance started to cover home oxygen therapy. However, the mean time for using oxygen is still shorter than expected. During activity of outside their home, patients could not use oxygen due to the absence of portable oxygen. Overall, continuous education to change the misunderstandings about oxygen therapy, more economic support from national insurance and coverage for portable oxygen are needed to extend the oxygen use time and maintain oxygen usage.

The Structural Lineage of Palsangjeon in Pubjoo Temple Analyzed through Gilt-bronze Pagoda in the Koryo Period (고려(高麗) 금동탑(金銅塔)을 통해 본 법주사(法主寺) 팔상전(捌相殿)의 구조형식계통(構造形式系統))

  • Kim, Kyeong-Pyo
    • Journal of architectural history
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    • v.14 no.1 s.41
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    • pp.89-105
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    • 2005
  • The central aim of this thesis is to see if the structure of Palsangjeon(捌相殿) in Pubjoo Temple(法住寺), a five sto wooden pagoda in Chosen(朝鮮) Dynasty, was handed down from the ancient and middle ages. This study was performed through an analysis of Gilt-Bronze Pagoda built in Koryo(高麗) period. In other words, it is aimed at analyzing which lineage the structure of Palsangjeonbelongs to as a wooden pagoda. In analyzing the structure of Palsangjeon, I attempted to find out its source from the remains of Koryo period prior to the Chosen Dynasty. Examples are the Gilt-Bronze Pagoda, built during the Koryo period. I have also examined its relationship with other existing wooden pagodas and remains. The analysis of Palsangjeon, a five story wooden pagoda in Chosen Dynasty, focuses on the following: First, I explored the possibilities of whether the structure of Palsangjeon was newly invented in Chosen Dynasty, or if it had been derived from the wooden pagodas in the Koryo period. Secondly, I tried to find out if the stable vertical planes, with a great successive diminution ratio, were derived from the middle age, i.e. Koryo period. The results of the study of Palsangjeon through Gilt-Bronze Pagoda analysis are as follows: 1. The structure of Gilt-Bronze Pagoda, a wooden pagoda from the Koryo period, is roughly classified into the accumulation type, using pipe pillars, and the one story type using whole pillars. In the accumulation type, stories are connected in either a flat format or an intervening format. The Gilt-Bronze Pagoda is mainly composed of pipe pillars, with some whole pillars. However, the central pillar was omitted in the building structure. Generally, the upper and lower stories are connected by pipe pillars in a crutch format. All the pillars, whether they are pipe pillars or whole pillars, used Naiten(內轉) technology. The Eave supporter has the Haang type(下昻) and the Muhaang type(無下昻). In most cases, high balustrades are furnished, but few tables of high balustrades have been found. The slanting roof formats have been handed down from Paekche(百濟), Silla(新羅), or Koryo(高麗). However, the structure of the octagon is assumed to be derived from Koguryo(高句麗). The structure of the Gilt-Bronze Pagoda from the Koryo period is mainly composed of accumulated flat squares, with some spire types. intervening format, the structure of Palsangjeon used whole pillars in a half story format in which upper level side pillars are installed on the lower level tie beam. From the Bronze Pagoda from the Koryo period, we can assume that the half story format of wooden pagodas that has stable vertical planes with a great successive diminution ratio was created during the mid-Koryo period at the latest and had been idly developed by the time of the Chosen Dynasty. 3. The whole pillars in Palsangjeon are also found in Gilt-Bronze Pagodas from the Koryo period. Hence, all of the pillars in Palsangjeon seem to have been handed down from the ancient construction technology. They were also used in the construction of wooden pagodas from the Koryo period. Therefore, it is assumed that Palsangjeon was constructed using the construction technology of the Chosen Dynasty that had been developed from the wooden pagoda construction technology of the Koryo period. The stable vertical planes with a great successive diminution ratio in Palsangjeon are derived from ancient Korean wooden pagodas, which have developed into indigenous Korean wooden pagodas with fairly stable vertical planes and a great design, in the half story format of Koryo and Chosen Dynasty. Therefore, it is assumed that the structure of Palsangjeon has a systematic relationship with traditional Korean wooden pagodas and is one of the indigenous Korean wooden pagoda structures. 4. In China, the intervening format has been mainly used between stories in multi-story architecture since the ancient days. At the same time, the flat format as also used in ancient and middle ages. However, the flat format was replaced by whole pillars during the Ming(明) and Manchu(淸) Dynasties, in favor of simple and compact construction. The half-story format, in which upper level side pillars are installed on tie beams, has been found in some cases, but it doesn't seem to have been the primary construction technology. Few traces of the half-story format have been found in multi-story architecture in Japan, and it has not been used as a general construction format. By contrast, the half-story format, which seems to have been derived from the Koryo period, was used as a general construction format in multi-story architecture of the Chosen Dynasty. The construction technology of multi-story architecture is related to that of multi-story wooden pagodas, but they have different production technologies. It seems that the structure of Palsangjeon did not just adopt the construction technology of multi-story architecture in the Chosen Dynasty, but it was developed from wooden pagodas in the Koryo period, including the Gilt-Bronze Pagoda. 5. Since the ancient days, most Chinese and Japanese wooden pagodas have adopted an accumulation type of structure using pipe pillars, with accumulated pointed towers. On the other hand, though most Korean wooden pagodas have also adopted an accumulation type of structure from the ancientdays, one story type using whole pillars was created in the Koryo and Chosen Dynasties. The wooden pagoda structure of Palsangjeon, with stable vertical planes in a half story format, is a unique Korean construction technology, different from the construction technologies of Chinese and Japanese wooden pagodas. This thesis clearly determined the structural characteristics of Palsangjeon. However, various remains have yet to be analyzed in depth, to establish an accurate construction technology system. In the beginning of this thesis, I had difficulty in precisely interpreting the internal structure of the Gilt-Bronze Pagoda from its appearance. However, in the process of study, the more serious problem was that there are few remains or ruins of multi-story architecture in ancient and the middle ages of Korea. Therefore, it is urgent to discover various remains in the future. This thesis succeeded in determining the structural characteristics of Palsangjeon. However, it fell short of clarifying the structural lineage of the stable vertical planes, although they show indigenous Korean architectural taste, representing the unique national emotion, and the construction format of multi-story wooden pagodas in Korea. I hope this is clarified in the future research.

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Structural Adjustment of Domestic Firms in the Era of Market Liberalization (시장개방(市場開放)과 국내기업(國內企業)의 구조조정(構造調整))

  • Seong, So-mi
    • KDI Journal of Economic Policy
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    • v.13 no.4
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    • pp.91-116
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    • 1991
  • Market liberalization progressing simultaneously with high and rapidly rising domestic wages has created an adverse business environment for domestic firms. Korean firms are losing their international competitiveness in comparison to firms from LDC(Less Developed Countries) in low-tech industries. In high-tech industries, domestic firms without government protection (which is impossible due to the liberalization policy and the current international status of the Korean economy) are in a disadvantaged position relative to firms from advanced countries. This paper examines the division of roles between the private sector and the government in order to achieve a successful structural adjustment, which has become the impending industrial policy issue caused by high domestic wages, on the one hand, and the opening of domestic markets, on the other. The micro foundation of the economy-wide structural adjustment is actually the restructuring of business portfolios at the firm level. The firm-level business restructuring means that firms in low-value-added businesses or with declining market niches establish new major businesses in higher value-added segments or growing market niches. The adjustment of the business structure at the firm level can only be accomplished by accumulating firm-specific managerial assets necessary to establish a new business structure. This can be done through learning-by-doing in the whole system of management, including research and development, manufacturing, and marketing. Therefore, the voluntary cooperation among the people in the company is essential for making the cost of the learning process lower than that at the competing companies. Hence, firms that attempt to restructure their major businesses need to induce corporate-wide participation through innovations in organization and management, encourage innovative corporate culture, and maintain cooperative labor unions. Policy discussions on structural adjustments usually regard firms as a black box behind a few macro variables. But in reality, firm activities are not flows of materials but relationships among human resources. The growth potential of companies are embodied in the human resources of the firm; the balance of interest among stockholders, managers, and workers of the company' brings the accumulation of the company's core competencies. Therefore, policymakers and economists shoud change their old concept of the firm as a technological black box which produces a marketable commodities. Firms should be regarded as coalitions of interest groups such as stockholders, managers, and workers. Consequently the discussion on the structural adjustment both at the macroeconomic level and the firm level should be based on this new paradigm of understanding firms. The government's role in reducing the cost of structural adjustment and supporting should the creation of new industries emphasize the following: First, government must promote the competition in domestic markets by revising laws related to antitrust policy, bankruptcy, and the promotion of small and medium-sized companies. General consensus on the limitations of government intervention and the merit of deregulation should be sought among policymakers and people in the business world. In the age of internationalization, nation-specific competitive advantages cannot be exclusively in favor of domestic firms. The international competitiveness of a domestic firm derives from the firm-specific core competencies which can be accumulated by internal investment and organization of the firm. Second, government must build up a solid infrastructure of production factors including capital, technology, manpower, and information. Structural adjustment often entails bankruptcies and partial waste of resources. However, it is desirable for the government not to try to sustain marginal businesses, but to support the diversification or restructuring of businesses by assisting in factor creation. Institutional support for venture businesses needs to be improved, especially in the financing system since many investment projects in venture businesses are highly risky, even though they are very promising. The proportion of low-value added production processes and declining industries should be reduced by promoting foreign direct investment and factory automation. Moreover, one cannot over-emphasize the importance of future-oriented labor policies to be based on the new paradigm of understanding firm activities. The old laws and instititutions related to labor unions need to be reformed. Third, government must improve the regimes related to money, banking, and the tax system to change business practices dependent on government protection or undesirable in view of the evolution of the Korean economy as a whole. To prevent rational business decisions from contradicting to the interest of the economy as a whole, government should influence the business environment, not the business itself.

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A Study of Upper Airway Resistance Syndrome : Clinical and Polysomnographic Characteristics (상기도저항 증후군에 대한 연구 : 임상 및 수면다원검사 특징)

  • Yang, Chang-Kook;Clerk, Alex
    • Sleep Medicine and Psychophysiology
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    • v.3 no.2
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    • pp.32-42
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    • 1996
  • Objectives : Upper airway resistance syndrome(UARS) is a sleep-related breathing disorder characterized by abnormal negative intrathoracic pressure during sleep. Abnormally increased negative intrathoracic pressure results in microarousal and sleep fragmentation which underlay UARS-associated complaints of daytime fatigue and sleepiness. Although daytime dysfunction in patients with UARS is comparable to that of sleep apnea syndrome, UARS has been relatively unnoticed in clinical setting. That is why UARS is apt to be excluded in diagnosing of sleep-related breathing disorders since its respiratory disturbance index and arterial oxygen saturation are within normal limits. The current study presents a summary of clinical and polysomnographic characteristics found in patients with UARS. The present study aims (1) to explore characteristics of patients diagnosed with UARS, (2) to characterize the polysomnographic findings of UARS patients, and (3) to enhance the understanding of UARS through those clinical and laboratory characteristics. Methods : This was a retrospective study of 20 UARS patients (male 15, female 5) and 30 obstructive sleep apnea (OSA) patients (male 21, female 9) at the Stanford Sleep Disorders Clinic. We diagnosed patients as having UARS when they met critenia, RDI < 5 characteristic findings of an elevated esophageal pressure($<-10\;cmH_2O$), frequent arousals secondary to an elevated esophageal pressure, and symptoms of daytime fatigue and sleepiness. We used polysomnographic value, which is standardized by Williams et al(1974), as normal control. Statiotical test were done with student t-tests. Results : (1) Mean age of UARS was $41.0\;{\pm}\;14.8$ years and OSA was $50.9\;{\pm}\;12.0$ years. UARS subject was significantly younger than OSA subject (p<0.05). (2) The total score of Epworth Sleepiness Scale (ESS) was UARS $9.7\;{\pm}\;6.3$ and OSAS $11.2\;{\pm}\;6.3$. There was no significant difference between two groups. (3) The mean body mass index was UARS $28.1\;{\pm}\;5.7\;kg/m^2$ and OSAS $32.9\;{\pm}\;7.0\;kg/m^2$. UARS had significantly lower meen body man index than OSAS subjects (p<0.05). (4) The polysomnographic parameters of UARS were not significantly different from those of OSA except RDI(p<0.001), $SaO_2$ (p<0.001) and slow wave sleep latency (p<0.05). (5) Compared with normal control, Total sleep time in UARS subjects was significantly shorter (p<0.001), sleep efficiency index was significantly lower (p<0.001), total awakening percentage was significantly higher (p<0.001), and sleep stage 1 (p<0.001) were significantly higher. (6) OSA patients showed poor sleep quality and distinct abnormal sleep architectures compared with normal control. Conclusions : Conclusions from the above results are as follows : (1) UARS patients were younger and had lower body mass index when umpared with OSA patients. (2) The quality of sleep and sleep architectures of the UARS and OSA patients are significantly different from those of normal control. (3) ESS scores and awakening frequencies of UARS are similar with those of OSA, suggesting that daytime dysfunction of UARS patients may be comparable to those of OSA patients. (4) The RDI and the $SaO_2$ which are important indicators in diagnosing sleep-related breathing disorders, of UARS subjects are close to normal value. (5) According to the the above results, we unclude that despite the absence of $SaO_2$ drops and the absence of an elevated number of apnea and hypopnea, subjects developed clinical complaints which were associated with laborious breathing, elevated Pes nadir, and frequently snoring. (6) Accordingly, we suggest including LIARS in the differential diagnosis list when sleep related breathing disorder is suspected clinically and overnight polysomnographic findings except snoring and frequent microarousal are within normal limits.

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Multicenter Analysis of Gestational Trophoblastic Neoplasia in Turkey

  • Ozalp, Sabit Sinan;Telli, Elcin;Oge, Tufan;Tulunay, Gokhan;Boran, Nurettin;Turan, Taner;Yenen, Mufit;Kurdoglu, Zehra;Ozler, Ali;Yuce, Kunter;Ulker, Volkan;Arvas, Macit;Demirkiran, Fuat;Bese, Tugan;Tokgozoglu, Nedim;Onan, Anil;Sanci, Muzaffer;Gokcu, Mehmet;Tosun, Gokhan;Dikmen, Yilmaz;Ozsaran, Aydin;Terek, Mustafa Cosan;Akman, Levent;Yetimalar, Hakan;Kilic, Derya Sakarya;Gungor, Tayfun;Ozgu, Emre;Yildiz, Yunus;Kokcu, Arif;Kefeli, Mehmet;Kuruoglu, Serkan;Yuksel, Hasan;Guvenal, Tevfik;Hasdemir, Pinar Solmaz;Ozcelik, Bulent;Serin, Serdar;Dolanbay, Mehmet;Arioz, Dagistan Tolga;Tuncer, Nadire;Bozkaya, Hasan;Guven, Suleyman;Kulaksiz, Deniz;Varol, Fusun;Ali, Yanik;Ogurlu, Gonca;Simsek, Tayyup;Toptas, Tayfun;Dogan, Selen;Camuzoglu, Hakan;Api, Murat;Guzin, Kadir;Eray, Caliskan;Doger, Emek
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.8
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    • pp.3625-3628
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    • 2014
  • Background: To evaluate the incidence, diagnosis and management of GTN among 28 centers in Turkey. Materials and Methods: A retrospective study was designed to include GTN patients attending 28 centers in the 10-year period between January 2003 and May 2013. Demographical characteristics of the patients, histopathological diagnosis, the International Federation of Gynecology and Obstetrics (FIGO) anatomical and prognostic scores, use of single-agent and multi-agent chemotherapy, surgical interventions and prognosis were evaluated. Results: From 2003-2013, there were 1,173,235 deliveries and 456 GTN cases at the 28 centers. The incidence was calculated to be 0.38 per 1,000 deliveries. According to the evaluated data of 364 patients, the median age at diagnosis was 31 years (range, 15-59 years). A histopathological diagnosis was present for 45.1% of the patients, and invasive mole, choriocarcinoma and PSTTs were diagnosed in 22.3% (n=81), 18.1% (n=66) and 4.7% (n=17) of the patients, respectively. Regarding final prognosis, 352 (96.7%) of the patients had remission, and 7 (1.9%) had persistence, whereas the disease was mortal for 5 (1.4%) of the patients. Conclusions: Because of the differences between countries, it is important to provide national registration systems and special clinics for the accurate diagnosis and treatment of GTN.

Study on Medical Records In ${\ulcorner}$the Historical Records of the Three Kingdoms${\lrcorner}$ ("삼국사기(三國史記)"에 기록된 의약내용(醫藥內容) 분석)

  • Shin, Soon-Shik;Choi, Hwan-Soo
    • Journal of The Association for Neo Medicine
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    • v.2 no.1
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    • pp.35-54
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    • 1997
  • We tried to observe the features of ancient medical practice by analysing the records related to medicine in the book, ${\ulcorner}$the Historical Records of the Three Kingdom${\lrcorner}$ of which content includes the features of medicine in mythology, plague, delivery of twins, drugs, medical system, shamanism, constitutional medicine, psychiatry, forensic medicine, deformity, a spa, medical phrase, health and welfare work, religion, death. physiological anatomy, Taoist medicine, acupuncture, the occult af of transformation and etc. Our initial concern was about where to draw line as of medical field and we defined medicine in more broad meaning. The book ${\ulcorner}$the Historical Records of the Three Kingdoms${\lrcorner}$ describes the world of mythology by way of medicine which is not clearly a conventional one. There appears records of birth of multiple offsprings 7 times in which cases are of triplets or more. Delivering multiple offsprings were rare phenomenon though such fertility was highly admired. This shows one aspect of ancient country having more population meant more power of the nation. Of those medical records conveyed in that book includes stories of childbirth such as giving birth to a son after praying, giving birth to Kim Yoo-shin after 20 months after mother's dream of conception, and a song longing for getting a laudable child. Plagues were prevalent throughout winter to spring season and one can observe various symptoms of plagues in the record. Of these epidemic diseases, cold type might have been more common than the heat one. Appearance of epidemic diseases frequently coincided with that of natural disasters that this suggests a linkage between plague and underlying doctrine on five elements' motion and six kinds of natural factors. There exists only a few names of diseases such as epidemic disease, wind disease, and syndrome characterized by dyspnea. Otherwise there appeared only afflictions that were not specified therefore it remains cluless to keep track of certain diseases of prevalence. Since this ${\ulcorner}$Historical Records of the Three Kingdoms'${\lrcorner}$ wasn't any sort of medical book, words and terms used were not technical kind and most were the ones used generally among lay people. Therefore any mechanisms of the diseases were hardly mentioned. Some of medicinal substances such as Calculus Bovis, Radix Ginseng, Gaboderma Luciderm, magnetitum were also in use in those days. 53 kinds of dietary supplies appears in the records and some of these might have been used as medicinal purpose. Records concerning dicipline of one's body includes activities such as hunting, archery, horseback riding etc. In Shilla dynasty there were positions such as professor of medicine, Naekongbong(內供奉), Kongbong's doctor(供奉醫師), Kongbong's diviner(供奉卜師). As an educational facility, medical school was built at the first year of King Hyoso's reign and it's curricula included various subjects as ${\ulcorner}$Shin Nong's Herbal classic${\lrcorner}$, ${\ulcorner}$Kabeul classic of acupuncture and moxbustion${\lrcorner}$, ${\ulcorner}$The Plain Questions of the Yellow Emperor's Classic of Internal Medicine${\lrcorner}$, ${\ulcorner}$Classic of Acupuncturer${\lrcorner}$, ${\ulcorner}$The Pulse Classic${\lrcorner}$, ${\ulcorner}$Classic of Channels and Acupuncture Points${\lrcorner}$ and ${\ulcorner}$Difficult Classic${\lrcorner}$. There were 2 medical professors who were in charge of education. To establish pharmacopoeia, 2 Shaji(舍知), 6 Sha(史), 2 Jongshaji(從舍知) were appointed. In Baekje dynasty, Department of Herb was maintained. Doing praying for the sake of health, doing phrenology also can be extended to medical arena. Those who survived over 100 years of age appear 3 times in the record, while 98 appears once. The earliest psychiatrist Nokjin differentiated symptoms to apply either therapies using acupuncture and drug or psychotherapy. There appears a case of rape, a case of burying alive with the dead, 8 cases of suicide that can characterize a prototype of forensic medicine. Deformity-related records include phrases as follow: 'there seems protrudent bone behind the head', 'a body which has two heads, two trunks, four arms.', 'a body equipped with two heads' In those times spa can be said to be used as a place for he리ing, convalescence, and relaxation seeing the records describing a person pretended illness and went to spa to enjoy with his friends. Priest doctors and millitary surgeons were in charge of the medical sevice in the period of the Three Kingdoms by the record written by Mookhoja(墨胡子) and Hoonkyeom(訓謙). Poor diet and regimen makes people more vulnerable to diseases. So there existed charity services for those poor people who couldn't live with one's own capacity such as single parents, orphans, the aged people no one to take care and those who are ill. The cause of affliction was frequently coined with human relation. There appeared the phenomenon of releasing prisoners and allowing people to become priests at the time of king's suffering. Besides, as a healing procedure, sutra-chanting was peformed. There appears 10 cases of death related records which varies from death by drowning, or by freezing, death from animals, death from war, death from wightloss and killing oneself at the moment of spouse's death and etc. There also exist certain records which suggest the knowledge of physiology and anatomy in those times. Since the taoist books such as ${\ulcorner}$Book of the Way and Its Power(老子道德經)${\lrcorner}$ were introduced in the period of Three Kingdoms, it can be considered that medicine was also influenced by taoism. Records of higher level of acupuncture, records which links the medicine and occult art of transformation existed. Although limited, we could figure out the medical state of ancient society.

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The Outcome of Anterior Cruciate Ligament Reconstruction in Patients with Meniscal Injury (반월판 연골 손상이 동반된 환자에서 전방 십자 인대 재건술의 임상적 결과)

  • Lee Kwang Won;Park Jae Guk;Jung Yu Hun;Kim Byung Sung;Kim Ha Yong;Choy Won Sik
    • Journal of the Korean Arthroscopy Society
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    • v.7 no.2
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    • pp.160-168
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    • 2003
  • Purpose : To analyze the anterior stability and functional results after the arthroscopic ACL reconstruction and meniscectomy based on meniscus status at the time of surgery. Materials and Methods : From October 1997 to October 2002, 78 patients (male 64 female 14) were treated by arthroscopic ACL reconstruction and meniscectomy and followed more than 12 months (range, $12\~72$ months, average: 32 months). Average age was 32 years old (range, $18\~57$ years old). We divided the patients into 4 groups; Both menisci was intact (BMI, control group), lateral meniscus removed (LMR), medial meniscus removed (MMR) and both menisci removed (BMR). Anterior passive displacement (objective stability) was estimated using KT-2000 arthrometer under the loading of 15lb,20lb and 30lb and evaluated anterior drawer test, Lachman test, range of motion, thigh circumference. Functional evaluation system of IKDC, OAK and Lysholm knee score was used. Results : Average anterior displacement under the loading of 30lb were 2.47 mm, 2.96 mm, 2.96 mm and 3.57 mm in each group(BMI, LMR, MMR, BMR) and it was statistically significant difference (p<0.05). There is no statistically significant difference in average anterior displacement under the loading of 15lb and 20lb in each group but it has showed decreasing tendency in meniscal removed groups. The mean anterior displacement was within 3 mm in 21 cases, 15 cases, 24 cases and 12 cases (total 72 cases, $94\%$) under the loading of 15lb and 20 cases, 15 cases, 24 cases and 11 cases (total 70 cases, $91\%$) under the loading 20lb of in each group and postoperative knee joint stability has showed increasing tendency (p>0.05). The mean score was 94.5, 93.2, 92.2 and 90.4 points in each group and 71 cases $(91\%)$ were more than excellent or good with a OAK score and fair results were noted 4 cases in both meniscal removed group. There were 65 cases $(83\%)$ with a Lysholm knee score more than excellent or good, and IKDC grading were more than normal or nearly normal in 74 cases $(95\%)$ except 4 cases (2 cases in MMR group and 2 cases in BMR group). Conclusion : Long-term anterior stability and functional results of a successful ACL reconstruction affected by tile status of the menisci at the time of surgery and KT-2000 arthrometer was good for estimation of objective follow up.

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Graves' Disease in Prepubertal Children Compared with Pubertal Children (소아 Graves병의 임상적 고찰 : 사춘기 이전군과 사춘기군의 비교)

  • Kim, Hyun Mi;Yoon, Ju Yun;Jung, Min Ho;Suh, Byung Kyu;Lee, Byung Churl
    • Clinical and Experimental Pediatrics
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    • v.46 no.1
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    • pp.76-82
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    • 2003
  • Purpose : The aim of this study was to determine whether differences exist in the presentation, clinical course, and outcome of Graves' disease between prepubertal children and adolescents. Methods : A retrospective chart review of 14 prepubertal(PREPUB, $7.2{\pm}0.9yr) and 38 pubertal (PUB, $12.4{\pm}1.5yr$) children with Graves' disease between January 1989 and November 1995 at St. Mary's Hospital and Kangnam St. Mary's Hospital was undertaken. Results : There were no significant differences in $T_3$, $T_4$, TSH between two the groups at diagnosis. The PUB group had significantly higher titers of antimicrosomal antibody(positive dilution factor $11,727.3{\pm}22,888.4$) than did the PREPUB group($2,111.5{\pm}2,285.0$, P<0.001). The PREPUB group had significantly higher titers of TSH-binding inhibitory immunoglobulin(TBII, $62.5{\pm}39.6$) than did the PUB group($44.9{\pm}10.4$, P<0.05) before treatment started. The duration(months) of medical therapy before thyroid function tests were normalized was longer in the PREPUB group than in the PUB group($T_3:6.8{\pm}5.0$ vs. $5.4{\pm}13.2$, $T_4:2.3{\pm}1.9$ vs. $2.1{\pm}2.2$, $TBII:26.7{\pm}24.0$ vs. $20.8{\pm}12.1$), especially that of TSH was significantly longer in the PREPUB group($14.6{\pm}11.0$ vs. $6.8{\pm}7.8$, P< 0.05). Total length of medical therapy was significantly longer in the PREPUB group than the PUB group($52.3{\pm}19.3$ vs. $37.9{\pm}16.3months$, P<0.01). During three years of antithyroid drug therapy, in the PREPUB group, the remission rate was lower and the relapse rate was higher than in the PUB group. Total length of treatment correlated negatively with chronological age(P=0.03). Conclusion : Prepubertal children require longer medical therapy to achieve a remission than do pubertal children. But there is an obvious need for more studies because of the small number of patients and the short duration of the follow-up.

A study on dietary habits, nutrient intakes and dietary quality in adults of a health screening and promotion center according to non-alcoholic fatty liver disease (건강증진센터 고객의 비알콜성 지방간 유무에 따른 식습관 및 영양섭취, 식사의 질에 관한 연구)

  • Chang, Ji Ho;Lee, Hye Seung;Kang, Eun Hee
    • Journal of Nutrition and Health
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    • v.47 no.5
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    • pp.330-341
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    • 2014
  • Purpose: The purpose of this study was to evaluate dietary habits, food intakes, nutrient intakes, and diet quality of non-alcoholic fatty liver disease in a health screening and promotion center. Methods: The total number of study subjects was 10,111 adults, where 3087 subjects (30.5%) were diagnosed as NAFLD. The dietary intakes were obtained using a food frequency questionnaire. They were then compared with the dietary reference intakes could be used in the future for development of diet and nutrition guidelines s (KDRIs). Results: Mean age of subjects in the normal group was $52.9{\pm}10.3yrs$ and body mass index (BMI) was $22.4{\pm}2.6kg/m^2$, and those of the NAFLD group were $55.1{\pm}9.2yrs$ and $25.4{\pm}2.9kg/m^2$. BMI, blood pressure of the NAFLD group were significantly higher than those of the normal group. The rates of skipping breakfast, overeating, and eating out were significantly could be used in the future for development of diet and nutrition guidelines er in the NAFLD group (p < 0.05, p < 0.000, p < 0.000 respectively). The speed of eating was fast in the NAFLD group (p < 0.000). The NAFLD group consumed significantly higher amounts of grains, meats, fish, seaweeds, kimchies, sugars, sweets, coffee, teas, and oils compared to the normal group (p < 0.05). Meanwhile, intakes of starch products, fruits, milk, and milk products were significantly lower in the NAFLD group compared with those of the normal group (p < 0.05). Riboflavin, calcium, and dietary fiber nutrient adequacy ratio (NAR) of the NAFLD group were significantly lower than those of the normal group. The Korean's dietary diversity score (KDDS) of the NAFLD group was lower than that of the normal group. Conclusion: In conclusion, we suggest that diet guidelines, such as increasing the intake of calcium and dietary fiber, reducing the intake of energy, fat, and simple carbohydrates, are necessary to improvement of NAFLD. The results could be used in the future for development of diet and nutrition guidelines for NAFLD.