• Radiation Oncology Journal
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• v.20 no.1
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• pp.53-61
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• 2002

Purpose : To determine the optimal scheme of postoperative chemoradiotherapy in rectal cancer by comparing survival, Patterns of failure, toxicities in early and late radiotherapy groups using a Phase III randomized prospective clinical trial. Materials and Methods : From January 1996 to March 1999, 307 patients with curatively resected AJCC stage II and III rectal cancer were assigned randomly to an 'early (151 patients, arm 1)' or a 'late (156 patients, arm II)' and were administered combined chemotherapy (5-FU $375\;mg/m^2/day$, leucovorin $20\;mg/m^2$, IV bolus daily, for 3 days with RT, 5 days without RT, 8 cycles with 4 weeks interval) and radiation therapy (whole pelvis with 45 Gy/25 fractions/5 weeks). Patients of arm I received radiation therapy from day 1 of the first cycle of chemotherapy and those of arm II from day 57 with a third cycle of chemotherapy. The median follow-up period of living patients was 40 months. Results : Of the 307 patients enrolled, fifty patients did not receive scheduled radiation therapy or chemotherapy. The overall survival rate and disease free survival rate at 5 years were $78.3\%\;and\;68.7\%$ in arm I, and $78.4\%\;and\;67.5\%$ in arm II. The local recurrence rate was $6.6\%\;and\;6.4\%$ (p=0.46) in arms I and II, respectively, no significant difference was observed between the distant metastasis rates of the two arms ($23.8\%\;and\;29.5\%$, p=0.16). During radiation therapy, grade 3 diarrhea or more, by the NCI common toxicity criteria, was observed in $63.0\%\;and\;58.2\%$ of the respective arms (p=N.S.), but most were controlled with supportive care. Hematologic toxicity (leukopenia) greater than RTOG grade 2 was found in only $1.3\%\;and\;2.6\%$ of patients in each respective arm. Conclusion : There was no significant difference in survival, patterns of failure or toxicities between the early and late radiation therapy arms. Postoperative adjuvant chemoradiation was found to be a relatively safe treatment but higher compliance is needed.

• Journal of Chest Surgery
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• v.30 no.2
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• pp.164-171
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• 1997

Heart transplantation is now accepted as a definitive therapeutic modality in patients with terminal hear failure. The first successful heart transplantation in humans was done in 1967 and the first case in Korea was performed in november, 1992. Since the first case in 1992, more than 50 cases have been performed in Korea. A total of 20 patients underwent orthotopic heart transplantation since November, 1992 in Asan Medicla Center. The purpose of this study is to evaluate the early results and the follow-up course of 20 cases of heart transplantation done in Asan Medical Center. The average age of 20 patients was 39.9$\pm$11.8 years old(20~58). The mean follow-up duration was 14.4$\pm$11.2 months(1~41). All patients are alive till now. The blood type was identical in 14 and compatible in 6 patients. ihe original heart disease was dilated cardiomyopathy in 16, valvular heart disease in 2, ischemic cardiomyopathy in 1, and giant cell myocarditis in 1 patient. HLA cross matching for recipient and donor was done in 18 cases and the results were negative for T-cell and B-cell in 16 patients, pos tive for warm B-cell in 2 patients. Among 6 loci of A, B, and DR, one locus was matched in 8 cases, 2 loci in 5 cases, and 3 loci matched in 1 case. The number of acute allograft rejection averaged 2.8$\pm$0.5 (0~6) per case and the number of acute allograft rejection requiring treatment averaged 1.0$\pm$0.9 (1~3) per case. The time interval from operation to the first acute rejection requiring treatment was 35.5$\pm$20.4 days (5~60). Acute humoral rejection was suspected strongly in 1 case and was successfully treated. The left ventricular ejection fraction measured by echocardiography and/or MUGA scan was dramatically increased from 17.5$\pm$6.8 (9~32)% to 58.9$\pm$2.0 (55~62)% after heart transplantation. Temporary pacing was needed in 5 patients over 24 hours but normal sinus rhythm appeared within 7 days in all cases. One patient has been taken permanent pacemaker implantation due to complete AV block appearing 140 days after heart transplantaion. One patient had cyclosporine-associated n urotoxicity during the immediate postoperative period and was recovered after 27 hours. The heart transplantation of Asan Medical Center is on a developing stage but the early result is comparable to that of well established centers in other countries, even though the long-term follow-up result must be reevaluated. We can conclude that the heart transplantion is a promising therapeutic option in patients with terminal heart failure.

• Tuberculosis and Respiratory Diseases
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• v.60 no.5
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• pp.540-547
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• 2006

Background : Vital stability and right side heart failure are major prognostic factors of acute pulmonary thromboembolism. While it is important to recognize right side heart failure, it is often difficult in real practice. Recently, several studies have described early diagnostic tools for detecting right side heart failure including echocardiography and biochemical markers. This study, we evaluated the prognostic role of the B-type natriuretic peptide (BNP) in an acute pulmonary thromboembolism. Methods : Thirty-four patients with a diagnosis of acute pulmonary thromboembolism were enrolled in the study. The BNP levels were measured and echocardiography was performed at the Emergency Department. Data on the prognostic factors including ventilatory support, vital stability, pulmonary artery pressure, degree of tricuspid valve regurgitation, complications and death was collected from the patients' medical records. The patients with an acute pulmonary thromboembolism were divided into two groups based on the vital stability and the BNP level and the cutoff values and prognostic factors of the two groups were compared. Results : The predictors of the vital stability that influence the prognosis of patients with acute pulmonary thromboembolism were the BNP level, ventilatory support and death. The plasma BNP levels showed a strong correlation with the vital stability, ventilatory support, thrombolytic therapy and death. When the BNP cutoff level was set to 377.5 pg/dl in a ROC curve, the sensitivity and the specificity for differentiating between the groups with stable or unstable vital signs was 100% and 90%, respectively. Conclusion : This study indicates that a measurement of the plasma BNP levels may be a useful prognostic marker in patients with an acute pulmonary thrombo-embolism.

• Journal of Chest Surgery
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• v.30 no.10
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• pp.966-972
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• 1997

Between June 1994 to August 1996, 13 patients underwent emergency coronary artery bypass operations. There were 3 males and 10 females and ages ranged from 56 to 80 years with the mean of 65.5 years. The indications for emergency operations were cardiogenic shock in 12 cases and intractable polymorphic VT(ve'ntricular tachycardia) in 1 case. The causes of cardiogenic shock were acute evolving infarction in 6 cases, PTCA failure in 4 cases, acute myocardial infarction in 1 case, and post-AMI VSR(ventricular septal rupture) in 1 case. Pive out of 13 patients could go to operating room within 2 hours. However, the operations were delayed from 3 to 10 hours in 8 patients due to non-medical causes. In 12 patients, 37 distal anastomoses were constructed with only 3 LITA's(left internal thoracic arteries) and 34 saphenous veins. In a patient with post-AMI VSR, VSR repair was added. In a patient with intractable VT and critical sten sis limited to left main coronary artery, left main coronary angioplasty was performed. Pive patients died after operation with the operative mortality of 38.5%. Three patients died in the operating room due to LV pump failure, one patient died due to intractable ventricular tachycardia on postoperative second day, and one patient died on postoperative 7th day due to multi-organ failure with complications of mediastinal bleeding, low cardiac output syndrome, ARF, and lower extremity ischemia due to IABP. In 8 survived patients, 3 major complications (mediastinitis, PMI, UGI bleeding) developed but eventually recovered. We think that the aggressive approach to critically ill patients will salvage some of such patients and the most important factor for patient salvage is early surgical intervention before irreversible damage occurs.

• Childhood Kidney Diseases
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• v.2 no.2
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• pp.125-132
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• 1998

Purpose : To study whether a low protein diet increase the efficacy of antihypertensive therapy on the progression of renal failure, we conducted an experimental study using 5/6 nephrectomized rats(n=63). Methods : At 7 days after surgery, rats were randomly assigned to three groups according to receiving antihypertensive drug: no antihypertensive drug (U), enalapril (E), and nicardipine (N), respectively and fed a low protein diet (6$\%$ protein). Proteinuria, mesangial matrix expansion score and glomerular volume were assessed at 4, 12 and 16 weeks after renal ablation. Results : Group U rats on a low protein diet developed progressive hypertension ($140{\pm}8,\;162{\pm}5,\;171{\pm}5\;and\;184{\pm}11\;mmHg$ at 4, 8, 12 and 16 weeks) which were controlled by E and N. Group U rats on a low protein diet developed proteinuria ($74{\pm}15\;mg/day$ at 16 weeks) which were decreased by E ($42{\pm}12 mg/day$) or N ($48{\pm}8 mg/day$) (p<0.05). Mesangial matrix expansion score and glomerular volume were not different between groups U, E and N on a low protein diet regardless of the antihypertensive drugs administered. Conclusion : A low protein diet did not affect blood pressure. Enalapril and nicardipine-treated rats on a low protein diet did not have different mesangial matrix expansion and glomerular volumes from rats on a low protein diet at 12 weeks and 16 weeks, in spite of the better controlling of systemic hypertension and lessening of proteinuria. Thus, combined treatment with a low protein diet and antihypertensive drugs didn't appear to show any addition,11 effects to attenuate glomerular injury.

• Asia-Pacific Journal of Business Venturing and Entrepreneurship
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• v.10 no.5
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• pp.1-13
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• 2015

The purpose of this research is to do exploratory analysis on the relationships between demographic characteristics of entrepreneurial candidates and their developmental level of entrepreneurial traits as well as the choice of business field. We analyzed gender, age, and educational level of the entrepreneurial candidates and their developmental level of entrepreneurial traits such as achievement tendencies, degree of awareness, planning skills, sincerity, interpersonal relationship, and problem-solving skills. Industry fields were classified into 4 types: restaurants, retail, services, internet business. Descriptive statistical analyses, logistic regressions, and variance analyses were performed about the sample data gathered from 1,441 persons since the year 2002 to 2014. Males and highly educated above university preferred service industry than restaurant, retail, and internet business. Females preferred internet business, retail, and restaurants than service industry field. The young persons under 20 showed higher probability to choose internet business. The college level and high school graduates preferred retail and restaurants than service industry. The developmental level of entrepreneurial traits were higher in male and highly educated. By this study, we could find the divide between groups with high and low probabilities of failure: restaurants and retail field showed higher failure probability than service industry in the business fields of self-employed. Furthermore, we could identify that entrepreneurial traits also had been developed differently depending on the groups. It is necessary to refrain from entering into the fields with high failure probabilities as well as to provide supporting policies to build the systems and environment to reduce the cases to begin new business without special knowledges and know-hows. The competency development training should be provided in the early stage of start-ups considering their entrepreneurial traits and aptitudes. Not only the assessment of the entrepreneurial traits but also professional counseling from initial stage are necessary.

• Radiation Oncology Journal
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• v.15 no.2
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• pp.129-136
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• 1997

Purpose : We analyzed the survival and failure patterns of cervix cancer patients treated with irradiation alone to evaluate our treatment method and to compare with the others Methods and Materials : Two hundred and twenty cervical cancer patients, Stage IB, II A, and II B who completed the planned treatment between Mar 1987 and December 1991 were analyzed retrospectively. The Stage IB patients were restaged to the Stage IB1 and IB2 by the recently revised FIGO classification, Patients were treated with a combination of external irradiation and the intracavitary brachytherapy Determination of the tumor control was done at the time of 6 months Postirradiation. The follow-up time was ranged from 3 to 115 months and the mean was 62 months and the follow-up rate was $93.6\%$(206/220) Results : The overall 5-year survival rate of Stage IB1 (N=50), IB2(N: 15). II A(N=58), and II B(N=97) was $94\%,\;87\%,\;69\%,\;and\;56\%$. respectively. In the univariate analysis of prognostic factors, stage(0.00), initial Hg level (P=0.00), initial TA-4(tumor-associated) antigen level(p= 0.02), initial CEA level(p=0.02), barrel-shaped tumor(p=0.02), whole cervical involvement (0.00), pelvic tyrnphadenopathy(LAP) in CT(p=0.04), and Post-irradiation adiuvant chemotherapy(P=0.00) were statistically significant in survival analysis. In a while multivariate analysis showed that the stage was the most powerful Prognostic indicator and the Post-irradiation chemotherapy factor also showed the statistical significance. The overall local control rate was $81\%$ and by the stage, $100\%$ in Stage IBI, $86.7\%$ in Stage IBS, $84.5\%$ in Stage IIA, and $68.1\%$ in Stage IIB, respectively The overall tumor recurrence rate was $15.5\%$(27/174) and by the stage, $8\%$(4/50) in Stage IB1, $0\%$(0/l3) in Stage IB2, $22.4\%$(l1/49) in Stage II A, and $19.4\%$(12/62) in Stage II B, respectively. Conclusions : We obtained the similar treatment results to the other's ones in early stage cervical cancer patients. But in Stage II B, the local control rate was lower than that of the other institutes and also the survival was poorer. So it seems to be necessary to reevaluate the treatment method in advanced cervical cancer patients.

• Childhood Kidney Diseases
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• v.4 no.2
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• pp.136-143
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• 2000

Purpose : The hemolytic uremic syndrome (HUS) is characterized by microangiopathic hemolytic anemia thrombocytopenia, and acute renal failure. It is ole of tile most common cause of acute renal failure in children but few reports are available in Korea. Thus we investigated the 23 patients diagnosed as HUS during last 14 years. Method : We retrospectively investigated the etiologic factor, clinical manifestations laboratory findings, treatment modalities, and final outcomes of the patients. Then patients were divided into two groups according to outcome, md comparison was performed. Group A(8) comprised patients who progressed to end-stage renal disease or expired. Group B(15) comprised patients who completely recovered after dialysis treatment. Result The number of patients aged less than 4 years were 17; between 5 and 10 were 4 and more than 10 were 2. The gende ratio was M:F=2 : 1. The etiologic factors were as follows: acute gastroenteritis in 14 patients including 4 bloody diarrhea, upper respiratory tract infection in 7 patients, and 1 patient with herbal mediation. The overall mortality rate was 22$\%$: 2 patients died of US complications, 2 patients died of sepsis, and 1 patient died of pulmonary hemorrhage. Group A (Hb 4.8${\pm}$1.2 g/dL) showed lower value in hemoglobin than group B (Hb 6.3${\pm}$1.7 g/dL) during hospital stay (P< 0.05), And the time interval between tile disease onset and dialysis treatment was significantly longer in group A ($11.9{\pm}9.1\;days\;vs\;2.8{\pm}2.1\;days$) (P< 0.05). Conclusion : Overall mortality rate was 22$\%$. Low hemoglobin value and the prolonged time interval between the disease onset and dialysis treatment were related with poor prognosis. So early diagnosis and appropriate intensive care including dialysis treatment is essential to achieve better outcome in children.

• Journal of Chest Surgery
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• v.30 no.4
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• pp.383-389
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• 1997

From March, 1992 to March, 1996, a total of 279 patients underwent coronary bypass surgery at the Sejong General Hospital, Puchon. We selected 22 patients with severe left ventricular(LV) dysfunction from them. The criteria were the presence of global or segmental abnormalities of left ventricular contraction and LV ejection fraction(EF) less than 35% based on biplane LV angiography by planimetry method. The mean age of 17 male and 5 female patients was 60$\pm$5.6years(range:47~73 years). All had the anginas, which were Canadian class II in 6, class 111 in 12 and class IV in 4. All patients except one had the history of previous myocardial infarction more than once. Seven of them had the symptoms and signs of congestive heart failure, such as dyspnea on excertion and increased pulmonary vascular markings. Their mean LVEF was 29.4$\pm$4 5%(range : 18~35%) and mean LV end-diastolic pressure was 18.7 $\pm$8. 2mmHg(range:10~42mmHg). 21 patients had 3 vessel-disease and 1 had 2 vessel-disease. Complete revascularization was tried with the use of 16 internal mammary arteries and 60 sapheuous veins and 3 radial arteries grafts. The mean number of distal anastomosis was 3.5$\pm$ 1.1. Concomitantly, one mitral valvuloplasty and annuloplasty was performed in the patient with moderate mitral regurtigation. The hospital mortality was 4.5%. During the follow-up, there were 3 late deaths. Of 18 survivors, 2 patients were lost in follow-up 24 and 27 month respectively after operation and the remaining 16 patients have bcen followed up with an average of 30.4 $\pm$ 13.4 months.15 patients had improvement with respect to angina but 8 patients still have the continuing or progressing heart failure. The 1-year, 2-year and 3-year actuarial survival rate was 85.2, 69.1, 46.1%, respectively. This study indicates that coronary artery bypass sur ery can be performed in the patients with severe LV dysfunction at acceptable risk but does not greatly contribute to the improvement of congestive heart failure.

• Clinical and Experimental Reproductive Medicine
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• v.37 no.3
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• pp.231-237
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• 2010

Objective: To evaluate whether T helper 1 (Th1) immune response is predominant in women with reproductive failures (recurrent spontaneous abortion and recurrent implantation failure) and the activation of T cell is related to Th1 propensity. Methods: Women with a history of recurrent implantation failure or recurrent spontaneous abortion comprise the study group (n=37). Controls are normal fertile women without a history of infertility or pregnancy losses (n=11). Th1/Th2 ratios of interferon (INF)-$\gamma$/interleukin (IL)-10 and tumor necrosis factor (TNF)-$\alpha$/IL-10 expression on $CD3^+/4^+$ cells, CD154, and CD69 expression on T cells are measured by flow cytometric analysis. Results: The ratios of TNF-$\alpha$ to IL-10 expressing on $CD3^+/4^+$ cells (Th1/Th2 cell ratios) are significantly higher in study group ($42.1{\pm}2.3$) as compared with that of controls ($28.7{\pm}2.7$) (p=0.002). The overall trend of CD154 and CD69 expression on T cells are elevated in study group than those of controls. The proportion (%) of $CD3^+/4^+/154^+$ cells ($1.7{\pm}0.5$ vs. $0.3{\pm}0.2$, p=0.038) and the % of $CD3^+/8^+/154^+$ cells ($0.6{\pm}0.2$ vs. $0.1{\pm}0.0$, p=0.024) are significantly higher in study group. The % of $CD3^+/69^+$ cells ($5.6{\pm}1.9$ vs. $1.3{\pm}5.4$, p=0.046) and % of $CD3^+/8^+/69^+$ cells ($4.8{\pm}1.3$ vs. $1.8{\pm}0.2$, p=0.035) among $CD3^+/8^+$ cells are significantly increased in study group. Conclusion: Women with reproductive failures have Th1 propensity with increased T cell activation. These finding means that activated T cell has a harmful effect on early pregnancy and implantation by induction of Th1 immunity.