• Korean journal of health promotion
• /
• v.19 no.2
• /
• pp.91-95
• /
• 2019

Background: Obesity and deterioration of pulmonary function are known to increase all-cause mortality and morbidity associated with chronic diseases. Obesity is a known risk factor for decreasing pulmonary function; however, studies on the effect of changes in body weight or body mass index (BMI) on pulmonary function are rare. This study aimed to investigate the relationship between the change in body weight or BMI and the pulmonary function test (PFT) in Koreans who underwent consecutive screening at a health promotion center. Methods: We enrolled 5,032 patients who underwent consecutive screening health check-ups at a health promotion center in 2015 and 2017. The BMI was calculated as the body weight (kg) divided by the square of the height (m²) in 2015 and 2017. We analyzed the association between the change in body weight or BMI and PFT. Results: In males, PFT and changes in body weight were associated with forced expiratory volume in 1 second (FEV₁) but not with changes in BMI. In females, FEV₁/forced vital capacity and forced expiratory flow between 25-75% of vital capacity (FEF_25-75%) were significantly associated with the changes in body weight and BMI. A correlation analysis between body weight and BMI showed a negative correlation with FEF_25-75% in males. In females, FEV₁/FVC and FEF_25-75% were negatively correlated. Conclusions: We observed that the increase in body weight and BMI was significantly associated with pulmonary function. This finding suggests that careful monitoring of body weight and BMI may aid in maintaining proper pulmonary function, thereby, reducing mortality and morbidity.

• Journal of Chest Surgery
• /
• v.30 no.9
• /
• pp.862-868
• /
• 1997

Shone's syndrome is a congenital cardiac malformation that consists of multiple levels of left heart obstruction including supravalvular mitral ring, congenital mitral stenosis(parachute mitral valve), subaortic stenosis, and coarctation of aorta. This syndrome is a very rare congenital anomaly and its prognosis is poor. We experienced 9 patients with Shone's syndrome between 1985 and 1994. There were 8 male and 1 female patients, and mean age was 33.0$\pm$31.0 months ranged from 2 months to 1 1 years. The congenital mitral, stenosis and coarctation of aorta existed in all patients and the supravalvular mitral ring and subaortic stenosis in 4 patients. Two patients had all four anatomic lesions. 3 patients underwent one stage total correction and the other 6 patients underwent two staged operation that was initial coarctoplasty with thoracotomy and later correction of intracardiac anomalies with median sternotomy. A third operation was performed in 2 patients. These procedures included reoperation for coarctation and replacement of mitral valve for persistent mitral stenosis. There was no operative death at the first operation but two operative deaths at the second operation. The cause of death in two cases was severe heart failure secondary to left ventricular hypoplasia. There was no operative death at the third operation. The seven survivors have beeli followed from 11 months to 12 years(mean follow-up 6.7 $\pm$ 3.6 years). There was no late death and the New York HeArt Association activity level was class I for all patients. We conclude that a food lone-term outcome can be expected by proper surgical treatment tailred to each individual's anatomy and pathophysiology although the operative mortality and morbidity of Shone's syndrome are high.

• Journal of Chest Surgery
• /
• v.42 no.2
• /
• pp.226-232
• /
• 2009

Background: Blunt chest trauma accounts for 90% of all chest traumas in Europe and the United States and this causes 20% of all trauma-related deaths. The major cause of morbidity and mortality after blunt chest trauma is undetected injuries. For this reason, chest computerized tomography has gained popularity for the evaluation of trauma, but it is expensive and it exposes patients to radiation. This study identified the clinical features associated with the diagnosic information obtained on a CT chest scan, as compared with a standard chest X-ray, for patients who sustained blunt trauma to the chest. This study also evaluated the role of a routine computed tomographic (CT) scan for these patients. The patients who had chest computed tomography done after the initial chest x-ray were analyzed separately for the presence of occult injuries. Material and Method: We studied 100 consecutive patients from November 2006 to July 2007: 74 patients after motor vehicle crashes and 26 patients after a fall from a height >2m. Simultaneous with the initial clinical evaluation, an anteroposterior chest radiograph and a helical chest CT scan were obtained for all the patients. The data extracted from the medical record included the vital signs, the interventions and the type and severity of injury (RTS). Result: Among the 100 cases, 79 patients showed at least more than one pathologic sign on their chest radiograph, and 21 patients had a normal chest radiograph. For 17 of the patients who had a normal chest X ray, the CT scan showed multiple injuries, which were pneumothorax, hemothorax, lung contusion, sternal fracture etc. This represents that a CT scan is statistically superior to a chest radiograph to diagnose the pathologic signs. But on the other hand, as for treatment, only 31 patients were diagnosed by CT scan and they were treated with chest tube insertion ect. 42 patients needed ony conservative management without invasive thoracosurgical treatment such as chest tube insertion or open thoracotomy. 27 patients were treated based on the diagnosis made by the chest radiograph and physical examination. Conclusion: Chest computerized tomography was significantly more effective than routine chest X-ray for detecting lung contusion, pneumothorax and mediastinal hematoma, as well as fractured ribs, scapula and, sternum. Although the occult findings increased, the number of patients who needed treatment was small. Therefore, we suggest making selective use of a CT scan to avoid its overuse in ERs.

• Journal of Yeungnam Medical Science
• /
• v.16 no.2
• /
• pp.283-295
• /
• 1999

Background: Patients with acute non-traumatic chest pain are among the most challenging patients for care by emergency physicians, so the correct diagnosis and triage of patients with chest pain in the emergency department(ED) becomes important. To avoid discharging patients with acute myocardial infarction(AMI) without medical care, most emergency physicians attempt to admit almost all patients with acute chest pain and order many laboratory tests for the patients. But in practice, many patients with non-cardiac pain can be discharged with simple tests and treatment. These patients occupy expensive intensive care beds, substantially increasing financial cost and time of stay at ED for the diagnosis and treatment of myocardial ischemia and AMI. Despite vigorous efforts to identify patients with ischemic heart disease, approximately 2% to 5% of patients presented to the ED with AMI and chest pain are inadvertently discharged. If the cause for the chest pain is known, rapid and accurate diagnosis can be implemented, preventing wastes in time and money and inadvertent discharge. Methods and Results: The medical records of 488 patients from Jan. 1 to Dec. 31, 1997 were reviewed. There were 320(angina pectoris 140, AMI 128) cases of cardiac diseases, and 168(atypical chest pain 56, pneumothorax 47) cases of non-cardiac diseases. The number of associated symptoms were $1.1{\pm}0.9$ in non-cardiac diseases, $1.4{\pm}1.1$ in cardiac diseases and $1.7{\pm}1.1$ in AMI(p<0.05). In laboratory finding the sensitivity of electrocardiography(EKG) was 96.1%, while the sensitivity of myoglobin test ranked 45.1%. Admission rate was 71.6% in for cardiac diseases and 50.6% for non-cardiac diseases(p<0.01). Mortality rate was 8.8% in all cases, 13.8% in cardiac diseases, 0.6% in non-cardiac diseases, and 28.1% especially in AMI. Conclusion: In conclusion, all emergency physicians should have thorough knowledge of the clinical characteristics of the diseases which cause non-traumatic chest pain, because a patient with any of these life-threatening diseases would require immediate treatment. Detailed history on the patient should be taken and physical examination performed. Then, the most simple diagnostic approach should be used to make an early diagnosis and to provide treatment.

• Pediatric Infection and Vaccine
• /
• v.18 no.1
• /
• pp.40-47
• /
• 2011

Purpose : Norovirus infection, a common cause of community-acquired gastroenteritis, can also lead to severe illness in immunocompromised patients. We investigated clinical manifestations of norovirus infection in pediatric cancer patients. Methods : Stool specimens were collected from pediatric patients with gastrointestinal symptoms between November 2008 and September 2009 at Samsung Medical Center, Seoul, Korea. Norovirus infection was identified by reverse-transcription polymerase chain reaction (RT-PCR). A retrospective chart review was performed in pediatric cancer patients who were diagnosed with norovirus infection. Results : Ten patients were diagnosed with norovirus infection by RT-PCR in stool samples. The median age was 0.83 years (range 0.25-5.5 years) and the male to female ratio was 1.5:1 (6 males and 4 females). Underlying diseases were hematologic malignancies (4/10, 40%), neuroblastoma (4/10, 40%), and brain tumors (2/10, 20%). Three patients were infected before hematopoietic cell transplantation (HCT) and four patients after HCT. All patients had diarrhea (10/10, 100%), with a median frequency of diarrhea of 8.5 times/day (range 4-22 times/day). Median virus shedding duration was 72.5 days (range 19-299 days). Four patients with pneumatosis intestinalis were conservatively treated with bowel rest and total parenteral nutrition. One patient with severe diarrhea and bloody stool had concomitant chronic gut graft-versus-host disease (GVHD). Norovirus infection-related mortality was not observed. Conclusion : Norovirus infection can cause significant clinical manifestations with prolonged viral shedding in immunocompromised patients. Norovirus should be considered in pediatric cancer patients with severe gastrointestinal symptoms.

• Pediatric Infection and Vaccine
• /
• v.12 no.2
• /
• pp.140-148
• /
• 2005

Purpose : To characterize the epidemiology and clinical features of invasive pneumococcal infections in Korean children. Methods : One hundred ninety four cases of invasive pneumococcal infections diagnosed at the Seoul National University Children's Hospital from October 1985 to December 2003 were analysed retrospectively. All isolates were screened for resistance to penicillin by oxacillin disc diffusion test. Serotypes were determined for 125 isolates. Results : The types of infection were bacteremia without focus 84/194(43%), meningitis 36/194(19%), pneumonia with bacteremia 36/194(19%), peritonitis 24/194(12%), other focal infections 3/194(2%). Fifty seven percent(110/194) of the episodes developed in the immunocompromised and 20%(37/194) were nosocomially acquired. The patients younger than 2 years of age was 60% in the immunocompetent patients and 25% in the immunocompromised patients. The overall case fatality rate was 7%. All the isolates by 1988 were susceptible to penicillin screened by oxacillin disk. Penicillin resistance was first detected in 1989(20%), and then increased rapidly; 89% in 1995, 69% in 1996, and 80~100% thereafter. The seven most frequently isolated serotypes were 23F, 19F, 14, 6B, 6A, 9V and 19A, which accounted for 70% of total isolates. Conclusion : S. pneumoniaeis an important cause of morbidity and mortality in children. Invasive infections caused by S. pneumoniae most often occurred in infants and young children, while they are frequent in older immunocompromised children as well. This is the largest case series on invasive pneumococcal infections in Korean children.

• Clinical and Experimental Pediatrics
• /
• v.48 no.11
• /
• pp.1193-1200
• /
• 2005

Purpose : Invasive bacterial infection is a major cause of morbidity and mortality in children. Previously, we reported etiology of invasive infections in healthy children in 1985-1995. This study was performed to update etiology of invasive bacterial infections in the previously healthy children. Methods : We reviewed medical records of 98 episodes of invasive bacterial infections in immunocompetent children at the Seoul National University Children's Hospital in 1996-2004. Results : The frequent pathogens identified over all age groups were Streptococcus pneumoniae (33%) and Staphylococcus aureus(33%). The proportion of Salmonella species and Haemophilus influenzae has been declined to 4% each from 23% and 14%, respectively, compared to previous study. S. agalactiae was the most common isolate in the infants ${\leq}3$ months. Among the infants and children aged 3 months to 2 years and children of 2-5 years, S. pneumoniae(57%, 52%, respectively, in each group) was the most common isolates followed by S. aureus(17% and 24%, respectively). S. aureus was the most common isolates(73%) in children >5 years. Primary bacteremia was the most common clinical diagnosis(27%). S. pneumoniae was responsible for 42% of primary bacteremia, 50% of meningitis, and 69% of bacteremic pneumonia and empyema. S. aureus accounted for 80% of bone and joint infections. The case fatality rate was 8.1% for all invasive infections. Conclusion : We reviewed frequency of bacterial agents of invasive infections in children. The data may be useful for pediatricians to select adequate empirical antibiotics in the management of invasive bacterial infections.

• Journal of Chest Surgery
• /
• v.32 no.2
• /
• pp.144-150
• /
• 1999

Background: Surgery has been considered the most effective and standard treatment modality in non-small cell lung cancer(NSCLC). However in stage IIIA lung cancer, the role of surgery is still controversial. To evaluate the role of surgery for stage IIIA NSCLC, we investigated the survival after surgery and the prognostic factors. Material and Method: We evaluated 158 consecutive cases of stage IIIA NSCLC patients operated on between 1990 and 1996. There were 130 male patients and 28 female patients, and the mean age was 58.5 years. All patients except one underwent lung resection beyond lobectomy and extended mediastinal dissection. Postoperative adjuvant therapy were undertaken in 145(94.8%) patients. All patients(153) were followed and the mean follow-up period was 21.4months. Result: Twenty nine cases of the postoperative complications developed in 25 patients (15.8%). There were 5 operative mortality cases(3.2%) and the main cause of death was acute respiratory distress syndrome (ARDS). Local or distant recurrences developed in 84 patients(54.9%). The 5-year survival of 153 patients was 29.6% and the median survival time was 18.0 months. The 5-year survival of non N2 disease group(36.8%) was better than that of N2 disease group(26.6%)(p=0.35) and the 5-year survival of squamous cell carcinoma (38.1%) was better than that of adenocarcinoma(25.7%)(p=0.39) however there were no significant differences. Regarding the postoperative adjuvant therapy, in combined therapy group(84 patients), radiotherapy group(37 patients) and chemotherapy group(24 patients), the 5-year survival were 31.3%, 32.4%, and 14.6% respectively. There was no difference of survival between radiotherapy and combined therapy group(p=0.31), however the survival of the combined therapy group was better than the chemotherapy group(p=0.005). The survival of the complete resection group(31.9%) was better than the incomplete resection group(16.6%) however there was no significant difference(p=0.19). Conclusion: These observations indicate that the good 5-year survival(29.6%) in patients with stage IIIA NSCLC result from the agressive surgical treatment including extensive mediastinal nodes dissection.

• Clinical and Experimental Pediatrics
• /
• v.49 no.8
• /
• pp.882-888
• /
• 2006

Purpose : Bacteremia is one of the major concerns in the treatment of pediatric cancer patients. This study was to determine the etiologic agents and the pattern of antibiotic susceptibilities in a single tertiary medical center. Methods : We retrospectively reviewed the medical records of the cases of bacteremia in pediatric cancer patients from 1998 to 2005 in Keimyung University Dongsan Medical Center. Results : There were 62 cases of bacteremia from 44 patients. Gram-positive organisms(48.3%) were more common than gram-negative organisms(38.7%) or fungi(13%). Among gram-positive organisms, Staphylococcus epidermidis was the most common etiologic agent(63.3%), followed by Staphylococcus aureus(16.7%), ${\alpha}$-hemolytic Streptococcus(16.7%), and Streptococcus mitis(3.3%). Among gram-negative organisms, Alcaligenes xylosoxidans was the most common agent(41.7%) and the other organisms were Klebsiella pneumoniae(20.8%), Stenotrophomonas maltophilia(12.5%), Acinetobacter baumanii(8.2%), etc. In febrile neutropenic patients, however, K. pneumoniae was the most common cause of gram-negative bacteremia. All of the isolated K. pneumoniae in our center produced extended-spectrum beta-lactamase and were related with high mortality. S. aureus, S. epidermidis, and Streptococcus species were all susceptible to vancomycin and teicoplanin. Most staphylococci were resistant to penicillin and oxacillin. Most of the gram-negative organisms were susceptible to imipenem. Conclusion : Gram-positive organisms were more commonly isolated than gram-negative organisms in pediatric cancer patients like other studies. We could obtained valuable information on the choice of proper antibiotics in our institution. Further studies will be needed to explain the prevalence of A. xylosoxidans in our center.

• Journal of fish pathology
• /
• v.3 no.1
• /
• pp.21-25
• /
• 1990

In inland aquaculture, a lot of fishes often died cause of touch of L. carteri which is attached on the net cage. In this works, the experiment were carried out on classification of species, toxin test, and extermination with some chemicals. A bryozoa from net cage in lake Okjeong is classified into the Phylactolaemata, Lophopodella carteri Hyatt. A bryozoa broke out firstly on the 30th of June with water temperature up to $31^{\circ}C$ and it reattached on the net with water temperature below $30^{\circ}C$. Size of bryozoa colony is about $0.8{\times}0.6{\sim}1.7{\times}1.5cm$. Water column of attachment was 0~5m and the peak is 2~3m. In toxin test on the israeli carp, goldfish and catfish touched with bryozoa for 1 minute at $25^{\circ}C$ of water temperature, a dead fish appeared at 20 minutes after touched. Mortality was 90% for israeli carp and 100% for goldfish at 100 minuties after touched, but catfish was not died at all. It was supposed that the toxin is from nematocyst being around tentacles and this toxin act a deadly poison on a israeli carp and goldfish. In extermination test, the bryozoa treated with 300ppm of formalin, 5% of sodium chloride, 5ppm of malachite green, 200ppm of potassium permanganate, 1000ppm of potassium iodide, 10ppm of DDVP for minute respectively, all of them were not effected.