• Journal of Chest Surgery
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• v.30 no.9
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• pp.862-868
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• 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
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• v.30 no.3
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• pp.282-286
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• 1997

In the era of coronary artery bypass grafting, the intraaortic balloon pump (IABP) is more widely used and its indication has been ex anded. We perf'orbed retrospective clinical analysis on the patients who have received IABP pre andfor postoperatively during the course of CABG. From January 1981 to June 1995, total 322 patients have received CABG at the Seoul National University Hospital and among them 50 patients (15.5%) were supported by IABP during the course of the operation. The mean age at the time. of the operation was 57.2 years (39∼ 75 years) and the male to female ratio was 33 : 17. The preoperative diagnosis was unstable angina in 33 (66%), stable angina in 7 (14%) and postinfarct angina in 8 patients(16%). As for the indications of the IABP, there were 13 cases(26%) with left main disease, 13 (26%) with class IV angina, 12 (24%) with difficulty in CPB weaning, 6 (12%) with postinfarct angina and 3 (6%) with severe LV dysfunction. In the remaining 3 cases, one patient was operated on after PTCA failure in emergency basis, another was a patient with AMI, and the other was one who had postoperative low c rdiac output syndrome. All IABPS were introduced via femoral artery and among them 45 cases (90%) percutaneously. The mean postoperative assist time was 22.3 hours (0.5 ∼ 168 hours) and IABP could be removed within 48 hours in most of them (44150). The operative mortality was 6.1% (3 cases) and postoperative morbidity was only one with lower extremity ischemia. The more general application of the IABP during the course of the CABG ,especially in patients with high preoperative risk factors or difficulty in CPB weaning is a good measure of protecting and recovering myocardial function with minimal risk.

• Clinical and Experimental Pediatrics
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• v.48 no.6
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• pp.619-623
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• 2005

Purpose : Bacteremia in immunocompromised pediatric cancer patients can lead to high morbidity and mortality, if not treated early and properly. The incidence and antibiotic sensitivities to common pathogens of bacteremia in pediatric cancer patients are liable to change, according to region and time. We investigated the causative organisms and antibiotic sensitivities of bacteremia in pediatric cancer patients to assess the adequacy of empiric antimicrobial therapy. Methods : From September 1995 to August 2003, we retrospectively evaluated 58 episodes in 39 pediatric cancer patients with bacteremia treated at the Pediatric Department of Yeungnam University Hospital. We investigated and analyzed the causative organisms and the antibiotic sensitivity test results by reviewing the records of the microbiologically proven positive blood culture results. Results : The incidence of bacteremia in pediatric cancer patients in this study was 5.7 percent (58 episodes out of 1,022 occasions of blood cultures). Gram-positive organisms were isolated more often than gram-negative organisms (63.8 percent vs 36.2 percent) in the following order : Staphylococcus epidermidis (37.9 percent), Staphylococcus aureus (17.3 percent), Escherichia coli (12 percent), Streptococcus (8.6 percent), Enterobacter (6.9 percent), Klesiella (6.9 percent), Serratia (3.5 percent), Acinetobacter (3.5 percent), Proteus (1.7 percent) and Morganella morganii (1.7 percent). In antibiotic sensitivity tests, only six of 37 isolates (16 percent) of gram positive bacteria were sensitive to penicillin and 15 of 37 isolates (40 percent) were sensitive to oxacillin. All except one Staphylococcus aureus were sensitive to vancomycin and all except one Staphylococcus epidermidis were sensitive to teicoplanin among 37 isolates of gram positive bacteria. In the case of gram negative bacteria, two of 21 isolates (10 percent) and four of 21 isolates (19 percent) were sensitive to cefotaxime and ceftazidime, respectively. Only six of 21 isolates (29 percent) were sensitive to aminoglycoside, but all 21 isolates (100 percent) were sensitive to imipenem. All seven isolates tested after the year 2000 were sensitive to meropenem. Conclusion : In conclusion, we should choose the proper antimicrobials in treating pediatric cancer patients with suspected bacteremia, reflecting the increasing episodes of gram positive bacteremia and polymicrobial resistance of gram positive and negative organisms.

• Clinical and Experimental Pediatrics
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• v.48 no.9
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• pp.953-959
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• 2005

Purpose : The administration of total parenteral nutrition(TPN) has become a standard procedure in the management of nutritionally deprived and critically low birth weight neonates. Sepsis remains the most frequent serious complication during TPN, resulting in increased morbidity, mortality and health care costs. This study was performed to evaluate the clinical efficacy and complications of percutaneous central venous catheterization(PCVC) in very low birth weight infants. Methods : A total of 56 very low birth weight infants below 1,500 g during the period from January 1998 to December 2003 were enrolled and their medical records reviewed. Study group(n=32) included the babies who had undergone PCVC and a control group(n=24) included babies who had not undergone PCVC. We compared the study group with the control group for factors such as subject characteristics and catheter-related complications. Results : There was no difference in subject characteristics, such as birth weight, gestational week, respiratory distress syndrome, duration of ventilator therapy, duration from tube to complete oral feeding, days at TPN and its total duration, body weight at discontinuation of TPN and the days taken to reach to 2,000 g. However, the morbidity rate due to patent ductus arterious, chronic lung disease, necrotizing enterocolitis, osteopenia, cholestasis, and sepsis showed no difference. The study group with infants below 1,000 g showed a higher incidence of sepsis compared to the control group of the same weight group. The study group with infants between 1,000 to 1,500 g showed significantly higher incidences of intraventricular hemorrhage and took longer reach the a body weight of 2,000 g. Conclusion : Considering the high incidence of sepsis in the PCVC group, every attempt should be made to minimize the length of TPN therapy and encourage early enteral feeding. We also recommend the use of PCVC carefully in patients requiring prolonged nutritional support.

• The Korean Journal of Pesticide Science
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• v.4 no.4
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• pp.40-47
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• 2000

The comparative toxicity of ten acaricides, seven insecticides and five fungicides to the two-spotted spider mite, Tetranychus urticae and its predators, Amblyseius womersleyi and A. eharai was evaluated by a leaf spray bioassay. Five of the acaricides tested, bifenazate, etoxazole, acequinocyl, flufenoxuron and chlorfenapyr were much less toxic to adult females of A. womersleyi and A. eharai than to T. urticae adult females. A. womersleyi adult females treated with five acaricides produced $52{\sim}93%$ as many eggs as untreated adult females. And A. eharai adult females treated with five acaricides laid $54{\sim}73%$ as many eggs as untreated adult females. The remaining acaricides showed high toxicity to adult females of A. womersleyi and A. eharai. All the insecticides tested were less toxic to T. urticae adult females than to adult females of A. womersleyi and A. eharai. However, tebufenozide and diflubenzuron did not significantly affect the survival and reproduction of adult females of A. womersleyi and A. eharai. All the fungicides tested showed low mortality (${\leq}24%$) to adult females of predatory mites. However, benomyl had significant effect on the reproduction of adult females of A. womersleyi and A. eharai. Four acaricides (bifenazate, acequinocyl, flufelloxuron and chlorfenapyr) were much less toxic to eggs of A. womersleyi and A. eharai than to T. urticae eggs. However, etoxazole caused relatively low hatchability ($58{\sim}62%$) of eggs of A. womersleyi and A. eharai. All the insecticides and fungicides tested did not significantly affect the hatch of eggs of predatory mites. It may be suggested from these results that four acaricides, two insecticides and four fungicides described could be Incorporated into the integrated mite management system with A. womersleyi and A. eharai in pear orchard.

• The Korean Journal of Pesticide Science
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• v.13 no.1
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• pp.39-44
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• 2009

This study was conducted to evaluate the actual risk of fipronil on worker honey bees (Apis mellifera L.) through acute contact toxicity test, acute oral toxicity test, toxicity of residues on foliage test, and small scale field test. The $48h-LD_{50s}$ of fipronil SC on honeybee were $0.005{\mu}g$ a.i./bee in acute contact toxicity test and $0.004{\mu}g$ a.i./bee in acute oral toxicity test, respectively. In toxicity of residues on foliage test, fipronil showed over 90% of mortality during 28days after treatment at recommended application rate. The $DT_{50}$ of dislodgeable foliar residue was 9 days. Finally, In small scale field test, fipronil showed similar toxicity in the residues on foliage test. It was concluded that fipronil has very high acute toxicity and long residual toxicity to honeybee. Therefore, fipronil is highly toxic to bees exposed to direct treatment or residues on blooming crops or weeds. Do not apply this product or allow it to drift to blooming crops or weeds if bees are visiting the treatment area. To protect honeybee and wild pollinators from outdoor use of fipronil, ultimately it should need to limit for only indoor use to prevent pollinators from unintentionally exposure of fipronil.

• Clinical and Experimental Pediatrics
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• v.46 no.12
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• pp.1224-1229
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• 2003

Purpose : Bacterial meningitis is a serious disease, especially in the neonatal period, and it carries a significant degree of mortality and morbidity. Group B streptococcus(GBS) is a common cause of neonatal bacterial meningitis. The purpose of this study was to evaluate the clinical manifestations, treatment results and complications of GBS meningitis. Methods : We analyzed 29 cases retrospectively who had been admitted to the pediatric ward or NICU in Asan Medical Center from May 1990 to January 2002. They had proven GBS in culture or latex agglutination test in CSF. Results : The male to female ratio was 1 : 1.9. There were two cases of early onset type and 27 cases of late onset type. All cases had normal birth weight with full term at delivery. The perinatal predisposing factors were premature rupture of membrane(two cases), and maternal colonization(two cases). The most common presenting symptoms were fever and irritability. Associated diseases were GBS sepsis(21 cases). There was relatively high sensitivity to penicillin derivatives. There were abnormal brain CT or MRI findings in 16 cases(64%), such as infarction, encephalomalatic change, effusion, hydrocephalus, hemorrhage and abscess. The intensive care unit admission rate and the incidence of DIC were higher in the group with complications. Two cases were discharged against advice. Conclusion : We recommend early detection and active treatment in Group B streptococcal meningitis to improve the prognosis.

• Clinical and Experimental Pediatrics
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• v.51 no.4
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• pp.383-390
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• 2008

Purpose : This study was aimed to analyze the clinical characteristics of patients with acute interstitial pneumonia who had presented similar clinical patterns from March to June, 2006 and to describe our experience of treatment and to identify risk factors associated with prognosis. Methods : The clinical characteristics, radiologic and histopathologic findings and response to steroids of 15 patients (non-survival group [n=7] and survival group [control, n=8]) with acute interstitial pneumonia were investigated through the review of medical records. Results : The mean age of the patients was 26 (range: 3-48) months. Cough, cyanosis and fever were frequent symptoms. The most frequent radiologic findings on admission were pneumomediastium and extensive ground glass opacity. Surgical lung biopsy was performed on 8/15 (53.3%) patients and diffuse alveolar damage was found. Mechanical ventilation was applied for 9/15 (60.0%) patients for 40 (range: 1-99) days. Five patients in survival group received steroid treatment and 7 patients in non-survivial group (P=0.20). One patient in survival group received steroid pulse treatment and 4 patients in non-survival group (P=0.12). Seven patients died all of respiratory failure. The survival rate was 53.4%. Conclusion : The patients with acute interstitial pneumonia which occurred on spring 2006 showed high mortality because of rapidly and extensively progressing pulmonary fibrosis and air leakage. Therefore, we should consider surgical lung biopsy and steroid application earlier. We should recognize this acute interstitial pneumonia occurring on spring in domestics and need to investigate the cause and treatment in large scale.

• Korean Journal of Fisheries and Aquatic Sciences
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• v.27 no.4
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• pp.413-433
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• 1994

Jinhae Bay once was a productive area of fisheries. It is, however, now notorious for its red tides; and oxygen deficient water-masses extensively develop at present in summer. Therefore the shellfish production of the bay has been decreasing and mass mortality often occurs. Under these circumstances, the three-dimensional numerical hydrodynamic and the material cycle models, which were developed by the Institute for Resources and Environment of Japan, were applied to analyze the processes affecting the oxygen depletion and also to evaluate the environment capacity for the reception of pollutant loads without dissolved oxygen depletion. In field surveys, oxygen deficient water-masses were formed with concentrations of below 2.0mg/l at the bottom layer in Masan Bay and the western part of Jinhae Bay during the summer. Current directions, computed by the $M_2$ constituent, were mainly toward the western part of Jinhae Bay during flood flows and in opposite directions during ebb flows. Tidal currents velocities during the ebb tide were stronger than that of the flood tide. The comparision between the simulated and observed tidal ellipses showed fairly good agreement. The residual currents, which were obtained by averaging the simulated tidal currents over 1 tidal cycle, showed the presence of counterclockwise eddies in the central part of Jinhae Bay. Density driven currents were generated southward at surface and northward at the bottom in Masan Bay and Jindong Bay, where the fresh water of rivers entered. The material cycle model was calibrated with the data surveyed in the field of the study area from June to July, 1992. The calibrated results are in fairly good agreement with measured values within relative error of $28\%$. The simulated dissolved oxygen distributions of bottom layer were relatively high with the concentration of $6.0{\sim}8.0mg/l$ at the boundaries, but an oxygen deficient water-masses were formed within the concentration of 2.0mg/l at the inner part of Masan Bay and the western part of Jinhae Bay. The results of sensitivity analyses showed that sediment oxygen demand(SOD) was one of the most important influence on the formation of oxygen depletion. Therefore, to control the oxygen deficient water-masses and to conserve the coastal environment, it is an effective method to reduce the SOD by improving the polluted sediment. As the results of simulations, in Masan Bay, oxygen deficient water-masses recovered to 5.0mg/l when the $50\%$ reduction in input COD loads from Masan basin and $70\%$ reduction in SOD was conducted. In the western part of Jinhae Bay, oxygen deficient water-masses recovered to 5.0mg/l when the $95\%$ reduction in SOD and $90\%$ reduction in culturing ground fecal loads was conducted.

• Journal of Chest Surgery
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• v.43 no.4
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• pp.381-386
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• 2010

Background: Sternal wound infection (SWI) is an important complication after cardiac surgery. The aim of this study was to investigate the predictors affecting sternal wound infection and preventive factors including short term Vancomycin therapy in patients who underwent coronary artery bypass grafting (CABG). Material and Method: A retrospective study was done using data collected from January 2001 through December 2007. This included 219 patients who had isolated CABG. The definition of SWI was documentation from a microbiological study and a requirement for simple closure or other surgical revision. Result: The overall incidence of SWI was 7.8% (n=17). The causative organisms were methicillin resistant Staphylococcus aureus (MRSA, n=13), methicillin resistant Staphylococcus epidermidis (n=2), Pseudomonas aeruginosa (n=1), and Candida albicans (n=1). Ten cases had deep sternal wound infection with mediastinitis; 7 cases had a superficial wound infection. Infection-related mortality was low (1/17; 6%). Diabetes mellitus (p=0.006) and smoking history (p=0.020) were factors that predicted high risk. Short term use of vancomycin decreased the incidence of MRSA-associated SWI (p=0.009). For treatment, curettage and rewiring or flap were needed in most cases (88%, n=14). Conclusion: Patients who had diabetes mellitus and a smoking history need careful management. Short term use of vancomycin is effective for prevention of SWI with MRSA.