• Clinical and Experimental Pediatrics
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• v.52 no.4
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• pp.488-493
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• 2009

Purpose : The aim of this study was to assess the efficacy and safety of recent-generation patent ductus arteriosus (PDA) closure devices applied by a new selection strategy according to the characteristics of each PDA. Methods : From February 2003 to January 2006, 138 patients underwent transcatheter closure of PDA (study group). According to the size and morphology of each ductus, a COOK Detachable Coil or 'flex' PFM Nit-Occlud was used for a small ductus (group 1, n=43); 'medium' PFM Nit-Occlud (group 2, n=49) for a moderate ductus; and an Amplatzer Duct Occluder (group 3, n=46) for a large ductus. The 83 patients who underwent transcatheter closure of PDA from February 2000 to January 2003 were defined as the comparison group. The Qp/Qs ratio, pulmonary/aorta pressure ratio, and MD of the ductus were compared. Immediate and follow-up results including residual shunts and complications were also evaluated and compared among groups. Results : In all 138 patients, complete occlusions were confirmed without major complications, while procedure failure (n=2, 2.2%), device embolization (n=1, 1.1%), and persistent residual shunt (n=4, 4.5%) were documented in the comparison group. Total complication rates were lower in the study group than in the comparison group (study group, 1.4%; comparison group, 9.0%; P<0.05). Conclusion : A novel strategy adopting the merits of various recent-generation devices for transcatheter closure of PDA provides excellent clinical results with minimal risk.

• Clinical and Experimental Pediatrics
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• v.50 no.1
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• pp.65-73
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• 2007

Purpose : Short stature is an important complication that impairs the quality of life in survivors of childhood brain tumors. We studied their final adult height (FAH) to evaluate risk factors for short stature. Methods : We reviewed the medical data of 95 survivors of childhood brain tumors (64 males and 31 females) who had been followed up from 1982 to 2006, reached FAH, and had a more than five year-disease-free survival. Results : Final adult height standard deviation score (FAHTSDS: $mean{\pm}SD$) of the patients was lower than those of general population ($-1.15{\pm}1.72$), HTSDS at diagnosis ($-0.13{\pm}1.57$), and target HTSDS ($-0.49{\pm}0.69$). FAHTSDS of craniopharyngioma patients did not decrease ($0.57{\pm}1.17$), but those of germ cell tumor and medulloblastoma patients were significantly reduced ($-1.20{\pm}1.45$, $-2.70{\pm}1.46$; P<0.05). The patients treated with craniospinal radiation or chemotherapy had lower FAHTSDS ($-1.93{\pm}1.58$, $-2.27{\pm}1.44$; P<0.01). In the spinal irradiation group, the younger the age at diagnosis was, the more the loss of FAH (r=0.442, P<0.01). Growth hormone replacement (GHR) didn't improve FAHTSDS, but starting GHR under 12 years was an independent factor for improving FAH once treatment methods were taken into account (P=0.01). Conclusion : The younger age at diagnosis, spinal radiation and chemotherapy were all important risk factors of height loss, and height gain was expected in patients who received GHR under the age of 12 years. Therefore, regular check-ups of growth and early intervention with growth hormones are needed for high risk groups to improve FAH.

• Clinical and Experimental Pediatrics
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• v.50 no.1
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• pp.40-46
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• 2007

Purpose : This study assessed the long term survival rate and long term complications of patients who had a modified Fontan operation for functionally univentricular cardiac anomaly. Methods : Between June 1986 and December 2000, 302 patients with a functional single ventricle underwent surgical interventions and were followed up until February 2006. The mean follow-up period was $8.3{\pm}5.3years$ (range 3.5-18 years). Their median age was 2.4 years at the Fontan operation. The survival rate, the incidence and the risk factor of late complications were evaluated retrospectively. Results : The verall survival rate was 91 percent at 5 years and 87 percent at 10 years. In multivariate analysis, early calendar year of operation and significant regurgitation were risk factors of death. The surviving patients showed NYHA functional class I in 82 percent, class II in 15 percent, and class III in 3 percent. Redo Fontan operations were necessary in 8.8 percent of patients at average $12.8{\pm}3.6years$ after initial Fontan operation. The most common cause of Fontan conversion was atrial arrhythmia. The incidence of thromboembolic events was 9.3% and these complications were associated with the occurrence of atrial tachyarrhythmia. Supraventricular tachycardia including atrial flutter or fibrillation were reported on the follow-up examination by 11.2 percent of survivors after $8.4{\pm}5.6years$. Atriopulmonary connection showed higher rates of late tachycardia than lateral tunnel operation. Conclusions : This study revealed that the recent survival rate of Fontan type operation was satisfactory, but the occurrence of late complications after a Fontan type operation increased with the longer survival. There is a need for strict follow up and early treatment of late complications in patients who had a Fontan operation.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.34 no.3
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• pp.341-349
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• 2008

Purpose: The purpose of this study was to evaluate the $Osstem^{(R)}$ implants (US II/SS II implants) through the retrospective study for the clinical success rate during the installation of the $Osstem^{(R)}$ implants (US II/SS II implants) by using of the procedures of maxillary sinus floor elevation. Materials and methods: The current study was researched in the 6 medical institutions: Chonnam National University, Chosun University, Pusan DaeDong Hospital, Bundang Seoul National University Hospital, Ap-Seon Clinic, and All Clinic. Based on the total number of 116 patients whose treatment was the installation of the US II/SS II implants with the procedures of the maxillary sinus floor elevation, they were conferred on the dental records of the patients under the joint consultation of the 6 medical institutions. On the dental recording charts, there were included in as the following; the name of the institutions, gender, age, with or without smoking or drinking, with or without the generalized diseases, the height of the alveolar bone on the operational sites, elapsed edentulous state period, the state of the opposed or adjacent teeth, the methods of the maxillary sinus floor elevation, secondary time period for surgery, the lengths, types, and diameters of implants, with or without bone transplantation or the types of bone, postoperative current bone height, current adjacent soft tissue state of the implants, with or without the success of the installations of the implants. We have done our survey with the clinical and radiolographical examinations and dental questionaries. The success and survival rate of the implants was evaluated. Results 1. Total number of the patients with the installation of the US II implants were 62. The 252 numbers of US II implants were installed on the 89 maxillary sinuses. The patient's mean age was 54.1 years old and there were 36 men and 27 women. 2. Total number of patients with the installation of SS II implant were 57. The 165 numbers of SS II implants were planted on the 80 maxillary sinuses. Their mean age was 48.7 years old and there were 37 men and 20 women. 3. The follow-up period was 30.7 months(21-49 mon) on average. The vertical bone loss of installed implants after the procedures of the maxillary sinus elevation was 1.1 mm on average in SS II and 1.3 mm on average in US II. There existed no statistical significance on each group. The mean enlarged bone height after the maxillary sinus floor elevation was 8.2 mm. 4. For the procedures of the maxillary sinus elevation, the Lateral approach technique occupied 87.1%, which was the most used one. In addition, the most frequently used transplanted bone was autogenous bone only which was 72.7% during the maxillary sinus floor elevation. 5. The complication of maxillary sinus floor elevation were perforation of sinus membrane, disesthesia on doner site, exposure of cover screw and exposure of maxillar bone. 6. The survival rate of US II and SS II after maxillary sinus floor elevation was 99.2% and 95.8%, respectively. And the success rate of US II and SS II after maxillary sinus floor elevation was 97.6% and 89.7%, respectively. Conclusion : On the evaluation of the analysis of our study, both US II and SS II implants showed the excellent clinical results by use of the procedures of maxillary sinus floor elevation.

• Journal of Chest Surgery
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• v.36 no.6
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• pp.404-410
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• 2003

Different treatment options are available according to the stage and duration of the empyema. Stage I empyema (exudate stage) is treated concurrently by the administration of appropriate antibiotics and chest tube drainage. Stage III empyema (organized stage) is considered for decortication through an open thoracotomy. However, the treatment of fibrinopurulent, stage II empyema remains controversial. Recently, debridement with the use of Video-Assisted Thoracoscopic Surgery (VATS) has been proposed for the treatment of stage II empyema. We analyzed and report our initial experience of 5 cases of stage II empyema, treated with the use of VATS. Material and Method: Between June 2001 and February 2002, 5 patients with fibrinopurulent empyema that did not respond to antibiotics, chest tube drainage or Percutaneous Catheter drainage (PCD), and instillation of fibrinolytic agent were treated by debridement and irrigation with the use of VATS. A CT scan was performed in all patients before the operation to confirm the diagnosis of loculated empyema and to detect additional lung parenchymal diseases. Result: All 5 patients underwent successful debridement and irrigation with the use of VATS and the chest tube was inserted properly. And no patients needed conversion to open thoracotomy. The ratio of sex was 4 : 1 (male : female), the mean age was 53 years old (range, 26~73 years), the mean operative time was 73.4 minutes (range, 52~95 minutes), the mean duration of postoperative chest tube placement was 12.4 days (range, 6~19 days), and the mean duration of postoperative hospital stay was 20.8 days (range, 10~36 days). In all patients, clinical symptoms such as pain and fever subsided and simple chest PA view revealed satisfactory lung expansion. No major postoperative complication was observed during the hospital course and no patient suffered from the recurrence of empyema in the follow-up period. Conclusion: We think that early operation with the use of VATS is safe and efficient for stage II empyema which did not respond to medical treatment(antibiotics and chest tube drainage), therefore, it can prevent stage II empyema from advancing to stage III, organized empyema.

• Journal of Korean Academic Society of Home Health Care Nursing
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• v.1
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• pp.57-70
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• 1993

This study was carried out to investigate agreement, content and demand for home nursing care of hospital inpatients in brain, spain and musculoskeletal diseases .The data was collected by interviewing with 242 patients who were hospitalized in university hospital on Taegu, from September 6,60 October 9, 1993. Of 242 patients, 66.1% agreed to home nusing care system and rate of agreement was highest between 30 years to 49 years of age as 75.5%, in middle urban area residents as 75.9% and was lowest in medicaid as 40.0% in general chareacteristics. The rate of agreement according to type of diagnosis was highest inpatients with spinal diseases as 75.6% according to functional status was the highest in patients who had daily living activity freely as 69.4% according to prognosis in patients at terminal stage as 80.0% and the rate of agreement to home nursing care of patients who wanted early discharege was 73.9%. The first-ranking reasom of agreement to home nursing care was asking for continuous relationship with doctor as 37.3% and there was statistically significant difference in reasons of agreement to home nursing care according to functional status of patients. The first-ranking reason of eary discharge among patients who wanted early discharge(74.8%) was because of long time stay in hospital. Among 23 items of nursing activity that patient wanted, the first-ranking item was recovery promotion, prevention of complication, education and counseling for health as 76.4%, drug management was 2nd-ranking item as 62.1% and the third was regular checking of vital signs as 55.9%. The lowest item of demand for home unring care was hospice care(3.9%) and airway keep(9.1%).

• Journal of Hospice and Palliative Care
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• v.1 no.1
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• pp.14-22
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• 1998

Purpose : Cancer is a common cause for admission to emergency room(ER). Cancer patient present to ER with undiagnosed cancer, acute vague problem of cancer, or treatment related complication. But there is little information on the magnitute of the problems in the Korea. The purposes of our study were to evaluate the appropriateness of care for oncologic emergencies in Korea. Materials and Methods : This study was undertaken of all cancer patients above 15 years old presenting to the Seoul National University Hospital ER, who visited during the period from Oct. 16 to Nov. 15, 1997. ER record was reviewed and ER doctors evaluated patients' reason for visiting ER, appropriateness in patients' utilization of ER, oncology emergency Results : 266 cancer patients(17.4% of total patients) visited ER during this period and 166 cancer patients(62.4%) utilized inappropriately ER. Their average stay is 32.0 hours and 65.8% of them stayed for 6 hours. There were complaints of patients such as pain(44.8%), abdomen distension(9.4%), and dyspnea(7.5%). The most common oncologic emergency in ER during this study were gastrointestinal(34.0%), neurologic(21%), hematologic(8.0%), infectious(7.0%), respiratory(6.0%), and genitourinary(5.0%). Conclusion : For the care of symptoms like pain, most of cancer patients utilize ER inappropriately due to lack of attention from primary health delivery system. For the better care, the palliative medicine should be established in Korea.

• Journal of Chest Surgery
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• v.29 no.9
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• pp.983-988
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• 1996

Aneurysm of the sinus of Valsalva is fairly rare. Between 1987 and 1994, we operated on a total of 12 cases of aneurysm of the sinus of Valsalva at the Inje University Seoul Paik Hospital. This represents 0.7% of all cardiac operation under cardiopulmonary bypass. There were eight male and four female patients aged from 8 to 38 years(mean, 19.2 years). 8 of 12 patients had ruptured aneurysms. The origin of aneurysm of the sinus of Valsalva was the right coronary sinus in 10(83. 3%), and the noncoronary sinus in 2(16.6%). In ruptured aneurysm, the origin was the right oronary sinus in 6, and the noncoronary sinus in 2. The aneurysms originating from the right coronary sinus ruptured into the right ventricle in 5, and into both the right atrium and right ventricle in 1. The aneurysms originating from the noncoronary sinus ruptured into the right ventricle in 1, and into the right atrium in 1. Associated congenital cardiac defects included ventricular septal defect in 10(83.3%) patients 39 cases of these were associated with the aneurysms of the right coronary sinus), aortic regurgi- tation in 3 (all of these had an additional ventricular septal defect), mitral regurgitation in 1, and double chambered right ventricle in 1. No hospital deaths occurred, although one late death occurred as a result of endocarditis 15 months after the first operation. The mean follow-up period was 29 months, range from 4 to 60 months. Eleven patients except one late death were in New York Heart Association class 1. Due to the low mortality risk o( an operation for aneur sm of the sinus of Valsalva, a ruptured aneurysm of the sinus of Valsalva should be corrected surgically when the diagnosis is mane, and unruptured aneurysm of the sinus of Valsava with complication should also be operated. In most cases the aorta was opened to examine the morphology of the aneurysm and the aortic cusps, and an associated aortic valve defect should be corrected simultaneously.

• Tuberculosis and Respiratory Diseases
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• v.44 no.1
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• pp.59-68
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• 1997

Background : Tuberculous chest wall abscess is a rare complication of tuberculosis. However, there have been few reports about the variable extents and shapes of tuberculous chest wall abscesses. We analyzed the extent and shape of tuberculous chest wall abscess-es and grouped them according to combined pleuroparenchymal lesions by CT scans. Materials and Methods : CT findings were evaluated in 20 patients of tuberculous chest wall abscesses. We classified 29 abscesses in 20 patients into three types according to pleuroparnechymal lesions. Type 1 was defined when there was no active pleuroparenchymal lesion, Type 2, when intrathoracic tuberculosis was contacted with chest wall abscess, Type 3, when ipsilateral subpleural nodules were not contacted with chest wall abscess. Results : The type 1 included 6 abcesses in 6 patients. They showed rib and/or costal cartilage destruction in their center. They were relatively large and round. The type 2 included 13 abscesses in 10 patients. The abscesses in contact with pleural lesion or mediastinal lesion were mainly located in the outer muscle layer, and they were relatively large in size. However, the abscesses in contact with parenchymal lesion were mainly located in extrapleural space. They were relatively small and they were longest along the long axis of ribs. The type 3 included 10 abscesses in 6 patients. They were located mainly in the extrapleural space. Conclusion : Tuberculous chest wall abscess-es showed variable extents and shapes according 10 pleuroparenchymal lesions. CT is a good diagnostic modality to visualize the extent of tuberculous chest wall abscess and combined pleuroparenchymal lesion.

• Tuberculosis and Respiratory Diseases
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• v.57 no.4
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• pp.345-350
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• 2004

Background : To evaluate the frequency and clinical significance of lymph node micrometastasis in patients of non-small-cell lung cancer pathologically staged to be T1-2,N0. Method : From consecutive 29 patients of non-small-cell lung cancer who received curative operation and routine systemic nodal dissection, we immunohistochemically examined 806 lymph nodes from mediastinal, hilar and peribronchial lesion. All slides were stained with hematoxylin and eosin staining for one section and with cytokeratin AE1/AE3 antibody for another consecutive section of same lymph node to find out micrometastasis. Results : In 806 lymph nodes examined, no tumor cell was seen on hematoxylin and eosin staining and micrometastic foci were shown to be on 0.37%(3) of 806 lymph nodes, in which were upper paratracheal, interlobar and peribronchial lymph node. These three positive stains constitute 10.3%(3) of the 29 patients with non-small-cell lung cancer. Nine patients died from disease progression(4), postoperative complication(3) and concomitant diseases(2). The four patients with disease progression did not show evidence of micrometastasis on their lymph node examination. Conclusion : The frequency of lymph node micrometastasis was in 0.37% of 806 lymph nodes examined. The study results might suggested that routine analysis of micrometastasis on the lymph node didn't give any clinical implication on patients with non-small-cell lung cancer.