• 대한정형외과학회지
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• 제55권5호
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• pp.383-396
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• 2020

목적: 중등도 이상의 손상 환자를 대상으로 손상의 중증도에 따른 정형외과적 손상의 손상기전, 부위, 유형, 치료적 접근 및 그 치료결과를 분석하고자 한다. 대상 및 방법: 2014년부터 2019년까지 응급실/외상센터가 운영되지 않은 기간을 제외한 57개월 동안 국립중앙의료원 외상센터로 입원한 손상 중증도 점수(Injury Severity Score, ISS) 9점 이상의 환자들 중 정형외과적 손상이 동반된 778명을 대상으로 후향적 연구를 시행하였다. ISS와 생리학적 지표를 기준으로 한 손상의 중증도에 따라 중등도 손상군(1군, 679명)과 중증 손상군(2군, 99명)으로 분류하고 손상기전, 비정형외과적 손상을 평가하였다. 정형외과적 손상은 침범된 해부학적 영역과 골격구조의 수와 유형을 평가하였고, 치료적 접근 방법을 세분화하여 비교하였다. 치료결과는 재원기간을 포함하여 재원기간 내 발현된 전신 합병증과 사망률을 평가하였고 사망률에 미치는 요인을 분석하였다. 결과: 2군이 보다 젊고, 남성의 빈도가 높았고 고에너지 손상기전 및 동반 손상의 빈도가 유의하게 증가되었다. 정형외과적 손상 중 침범된 골격계의 수는 2군에서 유의하게 많아지면서 하지를 주로 침범한 1군에 비해 2군에서는 골반, 척추, 상지 영역의 침범이 유의하게 증가하였다. 정형외과적 손상은 환자의 임상적 상태에 따라 확정적 또는 단계적 치료가 시행되었으며 다발성 중증 손상을 보이는 2군에서는 일시적 외고정술을 이용한 단계적 수술의 빈도가 유의하게 높았고 1군에서는 생리학적 안정화를 이룬 뒤 확정적 수술을 시행하는 빈도가 유의하게 높았다. 중증도가 높아질수록 재원기간 역시 길어졌으며 재원기간 내 총 전신 합병증은 약 4.9%, 총 사망률는 약 4.5%였다. 중증도가 높아질수록 사망률은 유의하게 높아졌다(1군 2.9%, 2군 15.2%; p<0.0001). 사망률에 미치는 요인 중 고령과 높은 ISS가 중요한 요인으로 확인되었다. 결론: 손상의 중등도가 높을수록 고에너지 손상기전에 의한 손상의 발생 빈도가 높아지며 보다 젊고, 남성의 빈도와 동반 손상의 빈도가 높아졌다. 정형외과적 손상 역시 다발성 손상의 빈도와 중증도가 유의하게 증가되면서 정형외과적 외고정장치를 이용한 내고정술 등이 단계적 치료의 일환으로 시행된 경우가 유의하게 높아지는 경향을 보였다. 또한 재원기간, 전신 합병증 및 사망률 역시 유의하게 증가되는 경향을 보이며, 사망률에는 높은 연령과 ISS가 중요한 영향을 미치는 것으로 확인되었다.

• 한국임상약학회지
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• 제26권2호
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• pp.97-106
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• 2016

Background: Sevelamer is associated with reduced complications of chronic kidney disease-mineral bone disorder (CKD-MBD) resulted from hyperphosphatemia, which may contribute mortality, in CKD patients with dialysis. So far clinical outcomes of sevelamer on mortality and risk of cardiovascular mortality related to CKD-MBD are debating. Purpose of this study was to evaluate the effectiveness of sevelamer HCl on mortality of secondary hyperparathyroidism (SHPT), risk of cardiovascular mortality and, frequency of osteopathy in end stage renal disease (ESRD) patients with dialysis. Methods: We retrospectively reviewed the electronic medical records of 536 patients with ESRD, who were admitted for moderate to severe SHPT, for 36 months. 75 patients who met inclusion criteria were evaluated for the efficacy of sevelamer (mean serum iPTH = 487.5 pg/mL). Results: Sevelamer intervention was not associated with increased three-year survival time compared with non-sevelamers group [average survival month: 30.4 months in sevelamer group, 26.8 months in non-sevelamer group, p = 0.463]. Sevelamer intervention was not associated with significant mortality benefit and cardiovascular mortality benefit as compared to non-sevelamer group [sevelamer group: non-sevelamer group, all-cause mortality (iPTH > 600 pg/mL): 14.3% (1/34): 20% (1/41) p = 0.962, OR = 0.935, 95% CI, 0.058-14.98, heart disease mortality: 6.67% (2/30): 0% (0/32) p = 0.138]. Sevelamer was not associated with significantly lower cumulative incidence of osteopathy compared to non-sevelamer group (sevelamer group: non-sevelamer group, 5.9% (2/34):9.8% (4/41); p = 0.538; OR = 0.578; 95% CI, 0.099-3.367). Conclusion: Sevelamer was not associated with decreased all-cause mortality and risk of cardiovascular mortality compared to non-sevelamer group in ESRD patients with SHPT.

• Asian Pacific Journal of Cancer Prevention
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• 제14권10호
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• pp.5681-5685
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• 2013

Background: To compare breast cancer incidence and mortality trends in Central Serbia between males and females in the period 1999-2009. Materials and Methods: In this descriptive study, mortality data were obtained from the National Statistics Institute and morbidity data were derived from Institute of Public Health of Serbia for the period of interest. Results: Breast cancer is a leading cancer in the female population of Central Serbia, whereas in male population it is not on the list of 10 leading localizations, concerning both incidence as well as mortality. In the period 1999-2009 the average standardized incidence rates of breast cancer were 60.5/100,000 in women and 1.4/100,000 in men, while average standardized mortality rates were 20.4/100,000 and 0.4/100,000. The average standardized incidence and mortality rates were about 45 times higher in females than males. Male breast cancer comprises approximately 2.1% of all breast cancer cases. The average age-specific mortality and incidence rates increased with age in both sexes. In the observed period standardized mortality rates of breast cancer increased significantly only in men ($y=0.320+0.0215{\times}$, p=0.044). Conclusions: The increase of breast cancer incidence in both sexes and mortality in men, indicate an urgent need for Serbian health professionals to apply existing cancer control and preventive measures. Male breast cancer is more present than in other world regions, with an outstanding increase of mortality, which demands a timely identification (screening) and adequate treatment. A national policy including mammography should be considered in the light of the newest findings.

• 대한기관식도과학회지
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• 제10권2호
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• pp.28-34
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• 2004

Background : Esophageal perforation due to a traumatic endoscopy or intubation is exceedingly rare. If riot noticed immediately or treated promptly, however, the morbidity and mortality is significant. We performed a retrospective review of patients with iatrogenic hypopharyngo-esophageal perforation to assess the outcome of current management techniques. Material and Methods : We retrospectively analyzed all cases iatrogenic hypopharyngo-esophageal perforation diagnosed at our hospital from January, 1999, through April, 2004. The study group consisted of 11 patients (4 men) with a mean age of 47.6 years (range, 21-83 yr). We reviewed the 11 patients with perforated injuries of the hypopharynx or esophagus during the diagnostic or therapeutic procedures. Result: Perforations were due to diagnostic gastroscopy ($54.5\%$, 6/11), esophageal dilation ($27.3\%$, 3/11), endoscopic port insertion ($9.1\%$, l/11), and tracheal intrathoracic ($9.1\%$, 1/11). Seven patients had intrathoracic and 4 had cervical perforations. Treatment included incision and drainage (5), resection and reconstruction (4), drainage only (1), and observation (2). Nonfatal complications included transient pneumonia (1), and wound infection (1). They occurred in advanced mediastinal abscess ]patients. Mortality was $9.1\%$ (1/11) in old patient who managed medically in cervical esophageal perforation. Conclusions : Current mortality rates in iatrogenic esophageal perforation were improved compared to previous published rates of $19\%\;to\;66\%$ for all patients with this condition. We concluded that aggressive and definitive surgery for thoracic esophageal perforations improving the survival rate, whether diagnosed early or late.

• Clinical and Experimental Pediatrics
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• 제62권10호
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• pp.386-394
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• 2019

Background: Preterm infants have difficulty maintaining body temperature after birth. However, clinical guidelines advocate that neonatal body temperature should be maintained at 36.5℃-37.5℃. Purpose: We aimed to investigate the incidence of admission hypothermia in very low birth weight (VLBW) infants and to determine the association of admission temperature with in-hospital mortality and morbidities. Methods: A cohort study using prospectively collected data involving 70 neonatal intensive care units (NICUs) that participate in the Korean Neonatal Network. From registered infants born between January 2013 and December 2015, 5,343 VLBW infants born at less than 33 weeks of gestation were reviewed. Results: The mean admission temperature was 36.1℃±0.6℃, with a range of 31.9℃ to 38.4℃. Approximately 74.1% of infants had an admission hypothermia of <36.5℃. Lower birth weight, intubation in the delivery room and Apgar score <7 at 5 minutes were significantly related to admission hypothermia. The mortality was the lowest at 36.5℃-37.5℃ and adjusted odd ratios for all deaths increased to 1.38 (95% confidence interval [CI], 1.04-1.83), 1.44 (95% CI, 1.05-1.97) and 1.86 (95% CI, 1.22-2.82) for infants with admission temperatures of 36.0℃-36.4℃, 35.0℃-35.9℃, and <35.0℃, respectively. Admission hypothermia was also associated with high likelihoods of bronchopulmonary dysplasia, pulmonary hypertension, proven sepsis, pulmonary hemorrhage, air-leak, seizure, grade 3 or higher intraventricular hemorrhage and advanced retinopathy of prematurity requiring laser therapy. Conclusion: A large portion of preterm infants in Korea had hypothermia at NICU admission, which was associated with high mortality and several important morbidities. More aggressive interventions aimed at reducing hypothermia are required in this high-risk population.

• 보건행정학회지
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• 제19권4호
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• pp.18-32
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• 2009

The goal of this study was to predict the health outcomes of lung cancer surgery based on the Charlson comorbidity index (CCI). An attempt was likewise made to assess the prognostic value of such data for predicting mortality, survival rate, and length of hospital stay. A medical-record review of 389 patients with non-small-cell lung cancer was performed. To evaluate the agreement, the kappa coefficient was tested. Logistic-regression analysis was also conducted within two years after the surgery to determine the association of CCI with death. Survival and multiple-regression analyses were used to evaluate the relationship between CCI and the hospital care outcomes within two-year survival after lung cancer surgery and the length of hospital stay. The results of the study showed that CCI is a valid prognostic indicator of two-year mortality and length of hospital stay, and that it shows the health outcomes, such as death, survival rate, and length of hospital stay, after the surgery, thus enabling the development and application of the methodology using a systematic and objective scale for the results.

• Journal of Trauma and Injury
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• 제30권4호
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• pp.126-130
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• 2017

Purpose: Preventable Trauma Death Rate (PTDR) using Trauma and Injury Severity Score (TRISS) has been most widely used as a quality indicator in South Korea. However, this method has a small number of deaths corresponding to the denominator. Therefore, it is difficult to check the change of quality improvement for annual mortality, and there is a disadvantage that variation is severe. Therefore, we attempted to improve the quality of the mortality evaluation by reducing the variation by applying the PARK Index (preventable major trauma death rate, PMTDR) which can increase the number of denominator significantly. And the Save score (S-score) was also examined as another quality indicator. Methods: In the PARK Index, the denominator is number of all patients who have survival probability (Ps) larger than 0.25. Numerator is the number of deaths among these. The PARK Index includes only patients with ISS >15. The S-score is calculated in the same way as the W-score, but the S-score includes only patients with ISS >15, which is a difference from the W-score. Results: PARK Index decreased annually and was 12.9 (37/287) in 2014, 9.6 (33/343) in 2015, and 7.3 (52/709) in 2016. S-score increased annually and was -0.29 in 2014, 4.21 in 2015, and 8.75 in 2016. Conclusions: PARK Index and S-score improved annually. This shows that both quality indicators are improving year by year. PARK Index (PMTDR) has 9.5-fold increase in denominator overall compared to PTDR by TRISS. The S-score used only ISS >15 patients as a denominator. Therefore, there is an advantage that the numerical value change is larger than the W-score. In addition, S-score is not affected by the ratio of major trauma patients to minor trauma patients.

• Journal of Chest Surgery
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• 제49권5호
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• pp.337-343
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• 2016

Background: Recent developments in surgical techniques and hospital care have led to improved outcomes following total anomalous pulmonary venous return (TAPVR) repair. However, the surgical repair of TAPVR remains associated with a high risk of mortality and need for reoperation. We conducted this retrospective study to evaluate mid-term outcomes following in situ TAPVR repair without total circulatory arrest (TCA), and to identify the risk factors associated with surgical outcomes. Methods: We retrospectively reviewed 29 cases of surgical intervention for TAPVR conducted between April 2000 and July 2015. All patients were newborns or infants who underwent in situ TAPVR repair without TCA. Results: Four anatomic subtypes of TAPVR were included in this study: supracardiac (20 cases, 69.0%), cardiac (4 cases, 13.8%), infracardiac (4 cases, 13.8%), and mixed (1 case, 3.4%). The median follow-up period for all patients was 42.9 months. Two (6.9%) early mortalities occurred, as well as 2 (6.9%) cases of postoperative pulmonary venous obstruction (PVO). Preoperative ventilator care (p=0.027) and preoperative PVO (p=0.002) were found to be independent risk factors for mortality. Conclusion: In situ repair of TAPVR without TCA was associated with encouraging mid-term outcomes. Preoperative ventilator care and preoperative PVO were found to be independent risk factors for mortality associated with TAPVR repair.

• Journal of Trauma and Injury
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• 제21권2호
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• pp.78-84
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• 2008

Purpose: Recently, the incidence of blast injury has been on the increase worldwide. The purpose of this study was to evaluate and analyze blast injuries in South Korea. Methods: This was a retrospective multi-center study of blast injuries in three tertiary military centers. The medical records of patients with blast injuries from January 2003 to December 2007 were reviewed. The injury severity was evaluated according to the Injury Severity Score (ISS), the Revised Trauma Score (RTS), and the Trauma Score and the Injury Severity Score (TRISS). Results: This study revealed epidemiological data of blast injury in the three tertiary military hospital. A total of 94 cases of blast injury had occurred. Various body regions were involved. The most frequently injured site was the upper extremity (52.1%). The mechanisms for the blast injuries were primary (41.5%), secondary (74.5%), tertiary (7.4%), and quaternary (29.8%). The mean injury-to-hospital arrival time was $3.2{\pm}1.7hour$. The rate of admission was 88.3%, and the rate of ICU admission was 32.5%. Thirty-six (36) cases required an emergency operation. Most were performed by an Orthopedist (55.6%), an Ophthalmologist (19.4%), or a general surgeon (13.9%). The mortality rate from blast injury was 4.3%. Conclusion: This was the first paper to present data on the type of injury, the site of injury, the cause of death, and the mortality from blast injury in South Korea. Chest injury, brain injury, tertiary injury mechanisms, $ISS{\geq_-}16$, and a Maximal Abbreviated Injury Scale Score $(ABI){\geq_-}4$ were significantly associated with death.

• Acute and Critical Care
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• 제33권4호
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• pp.216-221
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• 2018

Background: In this study, we analyze the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE IV, Simplified Acute Physiology Score (SAPS) 3, and Mortality Probability Model $(MPM)_0$ III in order to determine which system best implements data related to the severity of medical intensive care unit (ICU) patients. Methods: The present study was a retrospective investigation analyzing the discrimination and calibration of APACHE II, APACHE IV, SAPS 3, and $MPM_0$ III when used to evaluate medical ICU patients. Data were collected for 788 patients admitted to the ICU from January 1, 2015 to December 31, 2015. All patients were aged 18 years or older with ICU stays of at least 24 hours. The discrimination abilities of the three systems were evaluated using c-statistics, while calibration was evaluated by the Hosmer-Lemeshow test. A severity correction model was created using logistics regression analysis. Results: For the APACHE IV, SAPS 3, $MPM_0$ III, and APACHE II systems, the area under the receiver operating characteristic curves was 0.745 for APACHE IV, resulting in the highest discrimination among all four scoring systems. The value was 0.729 for APACHE II, 0.700 for SAP 3, and 0.670 for $MPM_0$ III. All severity scoring systems showed good calibrations: APACHE II (chi-square, 12.540; P=0.129), APACHE IV (chi-square, 6.959; P=0.541), SAPS 3 (chi-square, 9.290; P=0.318), and $MPM_0$ III (chi-square, 11.128; P=0.133). Conclusions: APACHE IV provided the best discrimination and calibration abilities and was useful for quality assessment and predicting mortality in medical ICU patients.