• Journal of Chest Surgery
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• v.32 no.3
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• pp.237-248
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• 1999

Background: The late results of repair of tetralogy of Fallot(TOF) are favorable in most patients. Some portion of the patients with tetralogy, however, require reoperation for residual lesions or result in late death. The outcome of patients after tetralogy repair performed during the past 13 years was studied, with an emphasis on postrepair survival and problems including reoperations. Material and Method: A retrospective review of clinical, echocardiographic and catheterization data was performed in 569 of 775 patients with TOF who underwent corrective repair between 1983 and 1995 at Sejong General Hospital, Buchon, Korea. Result: Of 28(4.9%) early deaths(defined as 30 days postrepair), 12 deaths(42.9%) were <1 year of age, with an operative mortality of 15.4%. The surviving 541 patients(age 2.8 months to 43.4 years, median 23 months) have been followed up from 1 month to 12.6 years(median 35 months) postoperatively. Most patients were in good functional class and had normal right ventricular(RV) function. Postrepair results were compared between the transatrial-transpulmonary approach and the conventional right ventriculotomy. The former technique provided a lesser incidence of significant pulmonary regurgitation(P<0.001) and alesser degree of RV dysfunction(P<0.05) compared with those in the latter. There were 10(1.8%) late deaths during the follow-up period and 6 of the deaths were directly related to reoperation or ventricular dysfunction. The 10-year actuarial survival rate was 96.7%. There were 44 reoperations(8.1%) in 39 patients(7.2%), with an operative mortality of 10.3%. The main indications or reoperation included residual ventricular septal defect(VSD) (n=6), pulmonary stenosis(PS) (n=11), VSD with PS(n=17), pulmonary regurgitation(n=7), and tricuspid regurgitation(n=2). The 5- and 10-year freedom from reoperation were 89.4% and 76.1%, respectively. Conclusion: Although the majority of patients with repaired TOF are clinically well, with a high rate of survival, approximately 7% of patients have residual lesions that require surgical therapy. Therefore, the timely and meticulous corrective repair is mandatory to avoid reoperation, and continued close surveillance is also needed for the early detection of residual problems.

• Journal of Chest Surgery
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• v.34 no.12
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• pp.909-916
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• 2001

Background : Varicose vein is a very common vascular disease and has recently become a matter of concern for thoracic and cardiovascular surgens. Material and Method : We analyzed 209 cases or 269 feet with varicose vein retrospectively, which had been treated in our hospital from April 1999 to December 2000. Result : Male : Female ratio was 1:3(Male : 52 cases, Female : 157 cases), mean age was 42.2$\pm$9.7 years old, mean duration of varicosities was 12.2$\pm$9.7 years, and mean follow up was 14.8$\pm$6.1 months from July 2001. Most common symptom was leg pain(122 cases, 58.4%). Long standing job(44 cases), pregnancy(37 cases), and family history related to varicose vein came to 79.9% as the major predisposing or precipitating factors. Anatomic classifications of main lesion were GSV (greater saphenous vein,126 cases), LSV(lesser saphenous vein,18 cases), and reticular veins and telangiectasias(65 cases). Main treatments were stripping of GSV, stab avulsion, ligation of saphenofemoral junction, sclerotherapy, and conservative treatment. Comparing A group (stripping of GSV) with B group(sclerotherapy of GSV), A group had more complications than B group; however, A group had less recurrences than B group(p 0.05). Comparing C group(stab avulsion of LSV) with D group(sclerotherapy of LSV), there were 2 cases of recurrence in D group; however, there were no statistical differences between the two groups in complication and recurrence(p>0.05). Comparing B group(sclerotherapy of GSV) with E group(sclerotherapy of reticular vein and telangiectasia), there were no differences in complication; however, B group had more recurrences than E group. Post-stripping complications were ankle numbness and tingling(2 cases), ankle pain(2 cases),ankle swelling(2 cases), and wound pain(1 case). Postsclerotherapy complications were thrombophlebitis(1 case) and skin ulcer(1 case). Conclusion: Sclerotherapy for varicose vein involving GSV had more recurrences than stripping for lesions involving GSV. Sclerotherapy for reticular vein and telangiectasia had less recurrences than sclerotherapy for lesion involving GSV. Sclerotherapy is a very convenient method without operation and admission, thus further research is demanded in case of varicose vein involving GSV.

• The Korean Journal of Nuclear Medicine
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• v.36 no.6
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• pp.344-356
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• 2002

Purpose: RBC blood pool SPECT has been used to diagnose focal liver lesion such as hemangioma owing to its high specificity. However, low spatial resolution is a major limitation of this modality. Recently, ordered subset expectation maximization (OSEM) has been introduced to obtain tomographic images for clinical application. We compared this new modified iterative reconstruction method, OSEM with conventional filtered back projection (FBP) in imaging of liver hemangioma. Materials and Methods: Sixty four projection data were acquired using dual head gamma camera in 28 lesions of 24 patients with cavernous hemangioma of liver and these raw data were transferred to LINUX based personal computer. After the replacement of header file as interfile, OSEM was performed under various conditions of subsets (1,2,4,8,16, and 32) and iteration numbers (1,2,4,8, and 16) to obtain the best setting for liver imaging. The best condition for imaging in our investigation was considered to be 4 iterations and 16 subsets. After then, all the images were processed by both FBP and OSEM. Three experts reviewed these images without any information. Results: According to blind review of 28 lesions, OSEM images revealed at least same or better image quality than those of FBP in nearly all cases. Although there showed no significant difference in detection of large lesions more than 3 cm, 5 lesions with 1.5 to 3 cm in diameter were detected by OSEM only. However, both techniques failed to depict 4 cases of small lesions less than 1.5 cm. Conclusion: OSEM revealed better contrast and define in depiction of liver hemangioma as well as higher sensitivity in detection of small lesions. Furthermore this reconstruction method dose not require high performance computer system or long reconstruction time, therefore OSEM is supposed to be good method that can be applied to RBC blood pool SPECT for the diagnosis of liver hemangioma.

• Journal of Korean Society of Spine Surgery
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• v.25 no.4
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• pp.147-153
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• 2018

Study Design: Retrospective case series. Objectives: We retrospectively evaluated the clinical efficacy of postganglionic nerve block in symptomatic Schmorl nodules (SNs). Summary of Literature Review: SNs are common lesions that are often asymptomatic. In certain cases, SNs have been reported to cause severe axial back pain, thereby considerably impacting patients' quality of life. No consensus currently exists on the treatment of symptomatic SNs. Materials and Methods: From October 2015 to October 2017, a total of 21 patients with symptomatic SNs diagnosed by magnetic resonance imaging (MRI) that did not respond to conservative treatment after 4 weeks were included in the study. All patients received postganglionic nerve block. We evaluated effective pain relief (improvement of back pain of more than 50% compared with before the intervention) and functional improvements, assessed by visual analogue scale (VAS) and Oswestry Disability Index scores obtained at 4 hours, 4 weeks, 8 weeks, 3 months, and 6 months after the procedure. Results: Symptomatic SNs were more common at the L2-3 level, and the lower end plate was more commonly involved than the upper end plate. Eighteen of the 21 patients (85.7%) showed effective pain relief, and no deterioration was observed within the followup period. Throughout the follow-up period, the VAS remained significantly improved compared to before the procedure (p<0.05). Complications were not reported in any cases. Conclusions: Postganglionic nerve block for symptomatic SNs that do not respond to conservative treatment is a non-invasive modality for pain relief.

• Korean Journal of Psychosomatic Medicine
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• v.26 no.2
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• pp.94-101
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• 2018

Objectives : The purpose of this study is to investigate the change pattern and the leading factors of delirium in the palliative ward from 2 weeks before to the end of life. Methods : From October 2015 to August 2017, a retrospective chart review was conducted on the final 180 patients of 207 patients with terminal cancer patients at the Inha University Hospital. Clinical records were collected during palliative care hospitalization. Patients were diagnosed with three subtypes of delirium through the Richmond Agitation Sedation Scale and the Nursing Delirium Screening Scale, which were evaluated daily. Results : The prevalence of delirium 13 days before death was 46%, of which 18.3% were hyperactive subtypes, 13.8% were hypoactive subtypes, and mixed subtypes were 13.8%. And hyperactive delirium gradually decreased with the approach to the end of the day, and the mixed subtype gradually increased until 4 days before the end of life. Of the patients, the day before death, 86.9% were diagnosed with delirium. In multivariate analysis, hematologic malignancy was associated with a lower rate of delirium at the end of life than gastrointestinal cancer. Overweight was associated with hyperactive, mixed, and hypoactive delirium. Conclusions : Most palliative care patients experienced delirium at the end of life. Overweight was considered as a protective factor that reduced the all subtypes of delirium at the end of life. Further prospective studies are needed to reveal the prevalence of terminal delirium, and their risk factors.

• Korean Journal of Psychosomatic Medicine
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• v.27 no.1
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• pp.42-49
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• 2019

Objectives : Living donor liver transplantation (LDLT) is a life-saving therapy for patients with terminal liver disease. Many studies have focused on recipients rather than donors. The aim of this study was to assess the emotional status and personality characteristics of LDLT donors. Methods : We evaluated 218 subjects (126 male, 92 female) who visited Daegu Catholic University Medical Center from August 2012 to July 2018. A retrospective review of their preoperative psychological evaluation was done. We investigated epidemiological data and the Minnesota Multiphasic Personality Inventory-2 questionnaire. Subanalysis was done depending on whether subjects actually underwent surgery, relationship with the recipient, and their gender. Results : Mean age of subjects was $32.19{\pm}10.91years$. 187 subjects received LDLT surgery (actual donors) while 31 subjects didn't (potential donors). Donor-recipient relationship included husband-wife, parent-children, brother-sister etc. Subjects had statistical significance on validity scale L, F, K and all clinical scales compared to the control group. Potential donors had significant difference in F(b), F(p), K, S, Pa, AGGR, PSYC, DISC and NEGE scales compared to actual donors. F, D and NEGE scales were found to be predictive for actual donation. Subanalysis on donor-recipient relationship and gender also showed significant difference in certain scales. Conclusions : Under-reporting of psychological problems should be considered when evaluating living-liver donors. Information about the donor's overall psychosocial background, mental status and donation process should also be acquired.

• Korean Journal of Psychosomatic Medicine
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• v.29 no.1
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• pp.34-41
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• 2021

Objectives : The purpose of this study is to investigate the characteristics of depressive patients who admitted to general hospital. We examined the clinical characteristics of patients who were referred to the Department of Psychiatry as depressive symptoms, according to the type of consultation request, and comparing 'with re-consultation' and 'without re-consultation' groups. Methods : We performed a retrospective chart review of 4,966 inpatients who were referred to the Department of Psychiatry from August 2005 to December 2011. Results : For about 6 years, among the inpatients referred for psychiatric consultation, a total of 647 patients were referred for depressive symptoms, accounting for 13.82% of the total consultations. The average age of depressive patients was 58.6 years, which was higher than the average of 56.4 years of overall patients. Among the depressive patients, 275 patients were included in 'with re-consultation' group and there was no statistically significant difference when comparing 'with re-consultation' group and 'without re-consultation' group. However, there was a difference in the tendency of the two groups in the type of consultation request. 'With re-consultation' group was in the order of frequency of consultation type 3-2-1, whereas the 'without re-consultation' group was in the order of frequency of consultation type 2-3-1. Conclusions : The group of inpatients who were referred for depressive symptoms in general hospital showed the largest proportion of the group of patients referred to the Department of Psychiatry. 'With re-consultation' group had a higher rate of re-consultation due to the occurrence of new symptoms after hospitalization compared to 'without re-consultation' group. Therefore, doctors in each department and psychiatrists should pay attention to the depressive symptoms of inpatients and actively discuss treatment plans to improve the quality of medical services, identify risk factors, and make efforts to intervene early if necessary.

• The Journal of Korean Society for Radiation Therapy
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• v.32
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• pp.85-92
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• 2020

Purpose: To find out the advantages of thermoplastic bolus compared to conventional bolus, which is mainly used in clinical practice, We evaluated Two cases in terms of dose and location reproducibility to assess Usability of thermoplastic Bolus for skin VMAT radiotherapy. Materials and Methods: Two patient's treated with left breast skin lesion were simulated using thermoplastic Bolus and planned with 2arc VMAT. the prescription dose was irradiated to 95% or more of the target volume. We evaluated The reproducibility of the bolus position by measuring the length of the air gap in the CBCT (Cone Beam CT) image. to evaluate dose reproducibility, we compared The dose distribution in the plan and CBCT and measured in vivo for patient 2. Results: The difference between the air gap in patient 1's simulation CT and the mean air gap (M1) during 10 treatments in the CBCT image was -0.42±1.24mm. In patient 2, the difference between the average air gap between the skin and the bolus (M2) during 14 treatments was -1.08±1.3mm, and the air gap between the bolus (M3) was 0.49±1.16. The difference in the dose distribution between Plan CT and CBCT was -1.38% for PTV1 D95 and 0.39% for SKIN (max) in patient 1. In patient 2, PTV1 D95 showed a difference of 0.63% and SKIN (max) -0.53%. The in vivo measurement showed a difference of -1.47% from the planned dose. Conclusion: thermoplastic Bolus is simpler and takes less time to manufacture compared to those produced by 3D printer. Also compared to conventional bolus, it has high reproducibility in the set-up side and stable results in terms of dose delivery.

• Journal of the Korean Burn Society
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• v.24 no.2
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• pp.21-29
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• 2021

Purpose: Frostbite is a hazard to people exposed to cold environments. With the progression of modern industrial development and change of leisure behavior encountering cold environments, frequent accidental exposure to frostbite injury during work and human behavior is increasing, and the predisposing factors of frostbite were greatly changed than before. The purpose of this study was to make epidemiological analysis, and to review the treatment outcomes of frostbite. Methods: From March 2010 to February 2021, this study has included 27 patients with second- to third-degree frostbite injuries in Advanced Burn Reconstruction Center, Bundang Jesaeng Hosptial. A retrospective study was made about the distribution of age, gender, predisposing factors, prevalent area, type of managements, and the length of treatment period. Results: In our institution, acute management of frostbite patients has included rewarming, anticoagulation therapy (acetylsalicylic acid), and agents to improve vascular perfusion (lipo-prostaglandin E1 [Eglandin^®]). The 25 frostbite patients with second-degree frostbite (92.6%) were successfully managed by the conservative treatment alone with a mean of 20.3 days healing time. Two patients with third-degree frostbite (7.4%) also showed good outcomes after surgical reconstruction with a mean of 59 days healing time. In our clinical experiences of third-degree frostbite, definitive surgical reconstruction should be recommended to wait for more than 4~6 weeks for identification of clear demarcation of necrotic tissue caused by frostbite. In this study, 43 frostbite injuries site in 27 frostbite patients occurred. Among them, 15 patients (55.6%) had multiple-site frostbite injury. The most common predisposing cause of frostbite was refrigerant gas accidents (44.4%), followed by outdoor activity in cold environments (40.8%), misapplying ice pack for treatment purposes (7.4%), barefoot walking on the cold ground (3.7%), and loss of consciousness in cold grounds (3.7%). The most prevalent sites of frostbite injuries revealed as the hand (58.1%), followed by the foot (32.6%), face (7.0%), and abdomen (2.3%). And in the winter season from the November to March, the incidence rate of frostbite injuries was high at 74.1%. Conclusion: This study included 27 frostbite patients with 43 frostbite sites since last decade in a single institution at the community hospital. The frostbite patients with second-degree frostbite (92.6%) were successfully healed by the conservative treatment alone with a mean of 20.3 days healing time. The most common predisposing cause of frostbite was refrigerant gas accidents (44.4%), followed by outdoor activity in cold environments, etc. The most prevalent site of frostbite injuries was the hand (58.1%). And the most prevalent seasonal incidence of frostbite was from November to March (74.1%).

• Pediatric Infection and Vaccine
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• v.28 no.3
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• pp.133-143
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• 2021

Purpose: This study aimed to determine the incidence of central line-associated bloodstream infection (CLABSI) in the neonatal intensive care unit (NICU), evaluate the patients' clinical characteristics, and identify the etiologic agents for guidance in prevention and treatment. Methods: A retrospective chart review study of infants classified as having CLABSI was conducted at the NICU of Seoul National University Bundang Hospital from January 2016 to December 2020. Results: Of the 45 infants, 53 had CLABSIs within a follow-up period of 18,622 catheter days. The incidence of CLABSIs was 2.85 per 1,000 catheter days. The most common catheter type was a peripherally inserted central catheter (n=47, 81%). A total of 57 pathogens were isolated, of which 57.9% (n=33) were Gram-positive bacteria, 36.8% (n=21) were Gram-negative bacteria, and 5.3% (n=3) were Candida spp. The most common pathogens were Staphylococcus aureus (n=12, 21%) and coagulase-negative staphylococci (n=12, 21%), followed by Klebsiella aerogenes (n=8, 14%). The median duration of bacteremia was 2 days, and 19 episodes showed bacteremia for 3 days or more. The mortality rate of infants within 14 days of CLABSI was 13.3% (n=6). Conclusions: This study analyzed the incidence of CLABSI and the distribution of pathogens in the NICU. Continuous monitoring of CLABSI based on active surveillance serves as guidance for empiric antibiotic use and also serves as a tool to assess the necessity for implementation of prevention strategies and their impact.