• Journal of Chest Surgery
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• v.50 no.2
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• pp.78-85
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• 2017

Background: Closure of a secundum atrial septal defect (ASD) is possible through surgical intervention or device placement. During surgical intervention, concomitant pathologies are corrected. The present study was conducted to investigate the outcomes of surgical ASD closure, to determine the risk factors of mortality, and establish the effects of concomitant disease correction. Methods: Between October 1989 and October 2009, 693 adults underwent surgery for secundum ASD. Their mean age was $40.9{\pm}13.1years$, and 199 (28.7%) were male. Preoperatively, atrial fibrillation was noted in 39 patients (5.6%) and significant tricuspid regurgitation (TR) in 137 patients (19.8%). The mean follow-up duration was $12.4{\pm}4.7years$. Results: There was no 30-day mortality. The 1-, 5-, 10-, and 20-year survival rates were 99.4%, 96.8%, 94.5%, and 81.6%, respectively. In multivariate analysis, significant preoperative TR (hazard ratio [HR], 1.95; 95% confidence interval [CI], 1.09 to 3.16; p=0.023) and preoperative age (HR, 1.04; 95% CI, 1.01 to 1.06; p=0.001) were independent risk factors for late mortality. The TR grade significantly decreased after ASD closure with tricuspid repair. However, in patients with more than mild TR, repair was not associated with improved long-term survival (p=0.518). Conclusion: Surgical ASD closure is safe. Significant preoperative TR and age showed a strong negative correlation with survival. Our data showed that tricuspid valve repair improved the TR grade effectively. However, no effect on long-term survival was found. Therefore, early surgery before the development of significant TR mat be beneficial for improving postoperative survival.

• Korean Journal of Social Welfare
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• v.64 no.4
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• pp.359-381
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• 2012

This Study aims to investigate the patterns and causes of the time to return-to-work(RTW) of the injured workers. This study collected data with structured questionnaires and finally included 791 injured workers. The Kaplan-Meier method is used for describing the patterns of the time to RTW after the injury and after claim closure. And the Cox regression is used to identify significant factors on the time to RTW after the injury and after claim closure. The results show that amom the all respondents, the 2.65% returned to work within 1 month, 28.82% within 6 months, 50.95% within 1 year, 71.69% within 2 years after the injury, and the 29.46% of the all repondent returned to work before claim closure or directly after the claim closure, the 36.41% returned to work within 1 month, 56.64% within 6 months, 67.54% within 1 year after the claim closure. And the Cox regression results of the time to RTW after the injury show that the time to RTW affected by gender, age, income, the retirement during the treatment, the RTW to the company at injured time, injury type, surgery, the claim duration, disability ratings, vocational training. Also, the Cox regression results of the time to RTW after the claim show that the time to RTW affected by gender, age, income, the return to the company at injured time, disability ratings, vocational training. As a result, some implication and policies are suggested for reducing the time to RTW of the injured workers.

• The Journal of the Korean dental association
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• v.54 no.8
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• pp.613-629
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• 2016

This study assayed regional distribution of dental hospital & dental clinics, the number of population & households per one dental hospital & clinic, operation condition & duration. This study used public data that display from 1946 years(the first dental clinic open in republic of korea) to 2016 years. We collected present condition of 21,686 dental hospital and clinics available in public data portal site on 28. Feb.2016. Data were classified by scale, location, permission year, operation duration of dental hospital & clinics and were analyzed using SPSS 20.0 program. Surveyed on Feb. 2016. Best top 10 regions of permission dental clinics are (1) Gangnam-gu, Seoul(1,337), (2) Seongnamsi, Gyeonggi-do(555), (3) Songpa-gu, Seoul(491), (4) Yeongdeungpo-gu, Seoul(472), (5) Suwon-si, Gyeonggi-do(443), (6) Seocho-gu, Seoul(428), (7) Nowon-gu, Seoul(417), (8) Goyang-si, Gyeonggi-do(413), (9) Jung-gu, Seoul(380), (10) Yongin-si, Gyeonggi-do(353). Whereas best top 10 regions of operating dental clinics are (1) Gangnam-gu, Seoul(581), (2) Seongnamsi, Gyeonggi-do(415), (3) Suwon-si, Gyeonggi-do(382), (4) Seocho-gu, Seoul(320), (5) Changwon-si, Gyeongsangnam-do(303), (6) Songpa-gu, Seoul(295) (7) Goyang-si, Gyeonggi-do(290), (8) Bucheon-si and Yongin-si, Gyeonggi-do(262), (9) Jeonju-si, Jeollabuk-do(224). Average population per one dental hospital & clinic by regional local government are 3,120 people. Best five region of population per one dental hospital & clinic are (1) Sejong-si(5,272), (2) Gangwon-do(4,653), (3) Chungcheongbuk-do(4,513), (4) Gyeongsangbuk-do(4,490), (5) Chungcheongnam-do(4,402). Average households per one dental hospital & clinic by regional local government are 1,316 households. Best three region of households per one dental hospital & clinic are (1) Sejong-si(2,126), (2) Gangwon-do(2,057), (3) Gyeongsangbuk-do(1,946). From 1946 to 1986, permission and operating dental hospital and clinics was steadily increasing. On 1986-1990, 1991-1995, permission, operation and closure of dental hospital and clinics increase rapidly. From the 2011-2015 to 2016(present), permission, operation and closure of dental hospital and clinics is decreasing. Average operating duration of closured dental hospital and clinics are 14.054 years. We need to map of dental hospital and clinics for open and operation of one, base on analyzed results. In an era of 30,000 dentist, we should to be concerned about operation of dental clinics in the light of past operating condition.

• Journal of Chest Surgery
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• v.19 no.1
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• pp.25-34
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• 1986

Recently, radionuclide angiocardiogram is one of the most common procedure for assessment of ventricular performance due to its distinctive advantages such as safety, accuracy, and ease of repeated studies. Also, measurement and comparison between pre and postoperative left ventricular ejection fraction [LVEF] are meaningful for assessing the severity of myocardial damage which occurred during open heart surgery and the status of myocardial recovery. We obtained pre and post operative LVEF using radionuclide angiocardiogram on 30 patients composed of atrial septal defect, ventricular septal defect, cyanotic congenital heart disease, and valvular heart disease who undergone the open heart surgery from March to august 1984. The study revealed that ventricular septal defect and mitral valvular heart disease showed 8.1% and 6.2% decreases of postoperative LVEF, respectively. But, there are little increases of postoperative LVEF in the atrial septal defect and cyanotic congenital heart disease. In ventricular septal defect, each group of Qp/Qs over 2.0 and systolic pulmonary artery pressure over 50mmHg showed significant 17% and 14.7% decreases of postoperative LVEF, respectively. Considering the duration of the aortic cross clamping times and closing methods of VSD, each group of duration over 30 min. and of patch closure showed 13.9% and 14.2% decreases of LVEF between pre and postoperative status respectively which was significant finding statistically.

• The Korean Journal of Emergency Medical Services
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• v.25 no.1
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• pp.243-249
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• 2021

A decrease in coronary blood flow leads to an imbalance between the supply of oxygen to the myocardium and its demand, and reversible or irreversible damage to the myocardium could occur depending on the severity of the resultant ischemia and the duration of the imbalance. This imbalance results in a cascade of ischemic reactions in the following order: metabolic abnormalities, diastolic dysfunction, systolic dysfunction, and electrocardiogram changes. Variant angina is caused by the closure of the coronary artery due to reversible coronary artery spasm, resulting in myocardial ischemia and subsequent chest pain as a clinical symptom. Variant angina may be observed as ST segment elevation in electrocardiogram measured when present in chest pain. However, 12-lead electrocardiogram performed after the patient's chest pain resolves does not help in the diagnosis. Since the duration of chest pain appears to be <15 minutes, it is important to perform the 12-lead electrocardiogram when clinical symptoms are present. If nitroglycerin is administered without performing 12-lead electrocardiogram by 119 pre-hospital paramedics, the chest pain would be resolved, making it impossible to identify changes in the ST segment. Before administration of nitroglycerin, changes in the ST segment must be recorded by performing 12-lead electrocardiogram.

• Journal of Chest Surgery
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• v.35 no.7
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• pp.517-522
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• 2002

Background: Congenital heart surgery may lead to myocardial swelling and hemodynamic instability. Delayed sternal closure may be beneficial in this setting. The purpose of this study was to assess mortality and mediastinal infection rate associated with delayed sternal closure after congenital heart surgery and to evaluate the risk factors which affect mortality and mediastinal infection rate. Material and Method: We retrospectively reviewed 40 patients who underwent delayed sternal closure after repair of congenital heart disease at Yonsei Cardiovascular Hospital, from January 1994 to May 2001. In these patients, we assessed the mortality and mediastinal infection rate, and evaluated their risk factors including operation time, bypass time, aortic cross clamp time, duration to sternal closure and postoperative artificial ventilation time. Mediastinal infection was defined to have positive culture in mediastinum. Result: Hemodynamic instability was the most common indication for delayed sternal closure(n=36) and other indications included postoperative bleeding(n=2) and conduit compression(n=2). The median age at operation was $14.4{\pm}33.4$months old(range, 2days-12years). The patients with postoperative bleeding and conduit compression were much older than the others. The sternum was left open for $4.5{\pm}3.4$ days(range, 1-20days). Overall mortality was 25%(10/40) and mediastinal infection occured in 24.3%(9/37) (3 patients were excluded in mediastinal infection for early death). In risk factor analyses, only aortic cross clamp time had statistical significance for mortality in univariate analyses. However, multivariate analyses revealed that there were no significant predictors for risk of mortality and mediastinal infection. Conclusion: Delayed sternal closure after repair of congenital cardiac disease had relatively high mortality and mediastinal infection rate. But, in patients with hemodynamic instability, postoperative bleeding and conduit compression after repair of congenital cardiac disease, delayed sternal closure may be an effective life saving method.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.49 no.2
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• pp.68-74
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• 2023

Objectives: Drug holidays are suggested to reduce the formation of osteonecrosis in patients under intravenous (IV) bisphosphonates (BPs) therapy. The objectives of this study are to evaluate the incidence of medication-related osteonecrosis of the jaw (MRONJ) following tooth extraction in cancer patients using IV BP, and to assess the effect of drug holiday on the development of MRONJ. Patients and Methods: A manuel search of the patient folders of Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hacettepe University was undertaken to identify cancer patients who used IV BPs and had at least one tooth extraction between 2012 and 2022. Patents' age, sex, systemic condition, the type of BP used, duration of BP used, number of tooth extraction, duration of drug holiday, localization of tooth extraction and incidence of MRONJ were recorded. Results: One hundred nine teeth were removed from 57 jaws in 51 patients. All tooth extractions were performed under perioperative antibiotic prophylaxis and with primary wound closure. The incidence of MRONJ was 5.3%. Stage 1 MRONJ developed in 3 patients (only one had a drug holiday). The median duration of drug holiday was 2 months. No significant difference between the patients with and without a drug holiday and MRONJ development was found (P=0.315). The mean age of patients developed MRONJ was 40.33±8.08 years. A statistically significant difference was found between age and MRONJ development (P=0.002). Conclusion: The effect of a short-term drug holiday on the development of MRONJ may be limited because BPs remain in bone tissue for a long time. Drug holidays should be applied with the approval of an oncologist with other preventive measurements.

• Proceedings of the Acoustical Society of Korea Conference
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• 1998.06e
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• pp.93-96
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• 1998

이 논문은 모음 사이에 오는 예사소리와 된소리의 음향적 특징을 비교하여 예사소리와 된소리 사이에 뚜렷한 차이가 나는 음향적 특징 가운데 몇 개를 골라 그것을 변수로 삼았을 때 청취에 미치는 영향을 알아보는 것을 목적으로 삼았다. 모음 사이에 오는 예사소리와 된소리의 음향적 특징은 첫째, 자음의 폐쇄지속 시간이 된소리가 예사소리보다 길다. 둘째, 예사소리 앞에 오는 모음의 길이가 된소리 앞에 오는 모음의 길이보다 길다. 셋째, VOT는 예사소리와 된소리 사이에 차이가 거의 없다. 이 같은 음향적 특징 가운데에서 자음의 폐쇄지속시간과 앞에 오는 모음의 길이가 예사소리와 된소리의 구별에 영향을 미치는 반면 앞에 오는 모음의 길이는 예사소리와 된소리의 구별에 영향을 미치지 않았다.

• Journal of Veterinary Clinics
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• v.16 no.2
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• pp.478-481
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• 1999

A 8 years old male Pomeranian weighing 4 kg was referred because of coughing of 4 months' duration. Heart sounds and cardiac apex beat were showed more intense on the right side. On radiographic views, loss of normal line of the diaphragm, gas-containing intestines and stomach in thoracic cavity, and right displacement of heart were observed. Ultrasonography revealed that liver located adjacent to the heart. Although the dog died due to severe respiratory disorder in surgical procedure, in thoracic and abdominal surgery, a large defect was found in the left and right ventral muscular portion and left central tendon of the diaphragm, extending from the esophageal hiatus to rib. Left and right cranial lobe of liver, small intestines, stomach and spleen were herniated in the thoracic cavity. Because of the size and chronicity of the defect in the diaphragm, closure was impossible with an abdominal muscle graft.

• Journal of Chest Surgery
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• v.28 no.4
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• pp.360-364
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• 1995

Between January 1984 and January 1994, 13 patients developed mediastinitis after cardiac operations. There were 7 women and 6 men with a mean age of 24.2 years[range 0.7 - 61 . Initial operation included 7 valve replacements and 6 congenital cardiac repairs. The duration between initial operation and diagnosis was 13.5 days[range 4-57 . Organisms cultured from debridement material included S.aurus[n=9 , S.epidermidis[n=3 and Enterobacter[n=1 . Fever was the most frequent complaint and purulent drainage was noticed in 9 patients[69% . Seven patients were treated with radical debridement followed by closed irrigation. In other 6 patients, the wounds were managed by debridement, open granulation and delayed wound closure. Two hospital deaths [15.4% following open granulation method, resulted from sepsis. The 11 survivors were followed-up for 1-120 months, averaging 42 months and had healed wounds. One late death occurred due to massive hemorrhage.