• Journal of Chest Surgery
• /
• v.29 no.7
• /
• pp.769-776
• /
• 1996

The application of video-assisted thoracic surgery (VATS) in the examination of the thoracic cavity can be a new option in patients with mediastinal tumor because it provides outstanding visibility of the structures of the mediastinum. By clear viewing through the thoracoscope, a mediastinal tumor can be biopsied or resected, depending on the findings during an operation. We reviewed all patients who underwent curative or diagnostic operations from March 1990 to August 1995 under the impression of a mediastinal mass. The total number of patients were 113 with 59 males and 54 females. Group A underwent resection of tu or by thoracotomy(38 patients: 18 males, 20 females), and group B underwent resection of tumor by VATS (36 patients : 20 males and 16 females). Seven patients in group B were excluded because they underwent thoracotomy due to pleural adhesion or intra-operative bleeding ; therefore, the true VATS group numbered 29 cases. Group C underwent Iymph node biopsy by VATS(33 patients'16 males, 17 females), and group D(6 patients: 5 males, 1 female) underwent Iymph node biopsy through anterior mediastinotomy. The mean age in group A was 36.2 years compared to 41.3 years In group B. We compared operation time, frequency of injection for pain control, duration of chest tube insertion, postoperative hospital stay, and diagnostic yield. In group A, they were 164 minutes, 3.4 times, 5.2 days, and 11.3 days, respectively, in comparison to 152 minutes, 2 times, 4.7 days, and 8.3 days, respectively, in group B. These data revealed that the day of discharge was significantly shorter in group B (p valu : 0.03). In group C, the mean age was 45.8 years (range 1 ∼70). The operation time was from 30 to 335 minutes (mean 105), pain control was required from 0 to 15 times(mean 3.2), and a chest tube was needed for 1 to 36 days (mean 6.1). In group D, mean age was 53.3 years, operation time 121 minutes, pall control injec- tion frequency 2.6 times, and mean chest tube duration 10.5 days. The diagnostic yield in group C was 8 oyo compared to 100 oyo in group D although the number of patients in group D is small.

• Korean Journal of Psychosomatic Medicine
• /
• v.26 no.1
• /
• pp.51-58
• /
• 2018

Objectives : We aimed to investigate the discontinuation rate and reasons of doxepin base prescription pattern in insomnia outpatients of psychiatry department of a university hospital. Methods : 534 patients prescribed doxepin were screened. 201 patients were included and reviewed for their medical records retrospectively. The discontinuation rate and reasons of doxepin after 2 months of prescription were investigated. Patients were divided into three groups according to the prescription patterns. The initial group, prescribed doxepin as the first hypnotic, the add-on group, prescribed doxepin while maintaining existing hypnotics, and the switching group, prescribed doxepin after discontinuation of existing hypnotics. Results : The discontinuation rate after 2 months of prescription of doxepin was 56.2%. There were significant differences in the discontinuation rate among three groups. The initial group had the highest while the add-on group had the lowest (p=0.018). In reasons for discontinuation of doxepin among three groups, lack of efficacy (p<0.001) and adverse events (p<0.001) were significantly higher in the add-on group. In the initial group, patient's refusal (p=0.022) and unknown or loss to follow up (p<0.001) were significantly higher. Conclusions : The results of this study suggested that add-on is superior than switching method and gradual reduction of existing hypnotics is necessary to maintain doxepin treatment and prevent adverse events. Additional large scale prospective studies are needed to evaluate various factors and risks of discontinuation of doxepin.

• Journal of Biomedical Engineering Research
• /
• v.19 no.6
• /
• pp.617-622
• /
• 1998

A cryotherapy system using cold air was developed. The developed system had superior low-temperature characteristics with various flow rates and nozzle sizes, and used R-404A, as a coolant, which has no destructive effects of Ozone layers. Flow rates and the treatment time can be easily altered during the operation. In addition, and alarm system was designed for the overload, overheat, and over-charge of the machine. For clinical applications, skin temperatures, intra-articular temperatures of the knee joint and intra-muscluar temperatures of the gluteal muscles were measured during and after the cryotherapy. After a 5-minute therapy, skin and intra-articular temperatures decreased by $23.3{\pm}4.7 and 4.1 {\pm}1.0^{circ}C$, respectively. A 5-minute cryotherapy was good enough to maintain low intra-articular temperatures for 2-3 hours. Resting intra-muscular temperatures in 2, 4, and 6cm deep in the gluteal muscle were $36.5{\pm}1.2, 36.9{\pm}0.2, 37.1{\pm}0.2^{circ}C$, respectively (p<0.05). Lowest temperatures in 2, 4, and 6cm depth were $35.1{\pm}0.7, 36.2{\pm}0.4, 36.9{\pm}0.3^{circ}C$, respectively (p<0.05). Temperatures after a 2-hour cold air application on the skin and in the muscle in dept도 of 2, 4, and 6cm were $32.2{\pm}1.1, 36.2{\pm}0.5, 36.6{\pm}0.3, 36.9{\pm}0.3^{circ}C$respectively (p<0.05). Temperatures on the skin and in the muscle significantly decreased after 2 hours, compared with before cold air application (p<0.05). The intra-muscular temperature was changed more slowly than the skin temperature, and the deeper the muscle, the lesser temperature changes. The effect of a 5-minute cold air application lasts up to 2 hours, and it seems that the rebound-rise of the temperature dut to the reactive vasodilatation does not occur in the gluteal muscle.

• Journal of Hospice and Palliative Care
• /
• v.8 no.1
• /
• pp.30-36
• /
• 2005

Purpose: Regardless of treatment, brain metastases are associated with a poor prognosis. We aimed to investigate the clinical characteristics of cancer patients with brain mestastases they after admission into a hospice unit and knowing they have received appropriate hospice and palliative care. Methods: We retrospectively reviewed the medical records in 40 cancer patients with brain metastases they after admission into a hospice unit from March in 2003 to March in 2005. Results: There were 20 males (50%) and 20 females (50%), and the median age of the patients was 64 years. The most common cause of brain metastases was lung cancer (22 patients, 55%), followed by stomach cancer (5, 13%) and breast cancer (3, 8%). Sixteen patients (40%) have never been teated and 20 patient have received the chemotherapy for the primary cancer. The most common symptom of cancer patients with brain metastases is headache (12 patients, 30%), followed by mental change (10, 25%), focal weakness (9, 23%) and convulsion (4, 10%). The most prevalent cause for admission was mental change (13 patients, 33%), followed by pain (9 patients, 23%). The reasons for hospice and palliative care were through recommendation of physician (1 patient, 3%), patient and family self (14, 35%) and the others (25, 62%). Twenty five of the others has been referred to hospice and palliative care during conservative management after referral and enrolled at hospice unit. The median hospitalization was 19 days and median survival in hospice and palliative care was 41 days. The median survival was 87 days from the day when the cancer patients have been diagnosed as brain metastases to death. Conclusion: The duration of hospice and palliative care was not enough to care the cancer patients with brain metastases. We suggest physicians, patients and family need the education and promotion for effective hospice and palliative care.

• Journal of Hospice and Palliative Care
• /
• v.4 no.2
• /
• pp.137-144
• /
• 2001

Purpose : Pain is the most serious symptom that cancer patients experience. About $60{\sim}90%$ of advanced cancer patients and four million patients worldwide, according to the WHO statistics, are reported to suffer from cancer pain. Although about $70{\sim}80%$ of the pain could be controlled according to the pain control principles, to our regret, only $30{\sim}40%$ are managed appropriately. This research was aimed to (1) investigates the prevalence of pain among cancer patients, (2) compare patients' perception of pain with physician's recognition and (3) evaluate appropriateness of the doctor's prescription of analgesic. Materials and Methods : Patients with advanced or terminal cancers admitted at department of internal medicine of Seoul National University Hospital for at least 7 days were enrolled. A questionnaire for the patients and the physicians in charge were given and the answers were compared for each other. We also examined their medical records and the physician's orders. Results : Total 59 patients were enrolled. Among them, 43 patients answered the questionnaire, and 27 patients (62.8%) suffered hem cancer pain. The survey also showed that physicians underestimated the severity of pain, overlooked frequently analgesic prescription principle, and that as the patients' pain became severe, the less adequate was pain managements. Conclusion : For cancer patients, pain was frequently overlooked, and treatment still inadequate. Based on this evidence, it seemed that more active practice and education about evaluation and management of cancer pain are needed.

• Clinical and Experimental Pediatrics
• /
• v.48 no.9
• /
• pp.924-928
• /
• 2005

Purpose : Treatment efficacy for children with speech and language delay has been the subject of considerable debate in recent years. We evaluated the clinical features of children with delayed speech and language and their prognoses according to their etiologies after 6 months of speech and language therapy. Methods : From January, 2000 to March, 2004, we retrospectively reviewed 56 children with speech and language delay who were administered speech and language therapy for 6 months in Uijongbu St. Mary's Hospital. Results : Of 56 cases, the proportion of developmental language disorder was 66.1 percent, structural malformation 19.6 percent, mental retardation 12.5 percent, hearing defect 1.8 percent. The ratio of male to female was 4.6 : 1 and the most frequent age group was over 47 months. The mean age of first spontaneous words with useful meaning was 15.9 months. The mean gestational age of the subjects was 39.8 weeks. The proportion of full-term infants was 96.4 percent and of premature infants was 3.6 percent. As for the birth order, the proportion of the first baby was 51.8 percent, the one of second babies it was 42.9 percent, and percent of third babies it was 7.1 percent. After 6 months of language intervention, 32.4 percent of patients with developmental language disorder showed normal linguistic development. All the patients with mental retardation showed sustained language and speech delay. As for the patients with structural malformations, five out of 11 patients showed normal linguistic development. Conclusion : The relatively advanced old age of majority of participants in this study suggests the necessity of screening test for language delay in this local community.

• Korean Journal of Psychosomatic Medicine
• /
• v.5 no.2
• /
• pp.185-194
• /
• 1997

A comparison was made regarding illness behavior among patients with somatoform disorders, depressive disorders and psychosomatic disorders. The subjects consisted of out-patients with somatoform disorders(N=52), depressive disorders(N=52) and psychosomatic disorders(N=51). illness behavior was assessed by illness Behavior Assessment Schedule and the questionnaire about help-seeking behavior. The patients with somatoform disorders and psychosomatic disorders more often affirmed the presence of somatic disease, were more likely to have phobia of disease, had more preoccupation with ideas of disease and more frequently shopped around oriental clinics than the patients with depressive disorders. The patients with somatoform disorders more often attributed its cause to physical factors, less often attributed the origin of affective disturbance to psychological causes, showed Less depression and irritability, and were less likely to accept psychiatric treatment recommended by other physicians than depressive patients. The patients with somatoform disorders were more likely to report having been told that they suffered from a mild illness than those with psychosomatic disorders. The patients with somatoform disorders with psychological problems tended to inhibit expression of their emotion. Female patients with somatoform disorders more often affirmed the presence of psychological disorder and attributed its cause to psychological factors than male ones. These results suggest that in illness behavior, patients with somatoform disorders are different from depressive patients, whereas the former patients are similar to psychosomatic patients except the discrepancy between therapists and patients regarding evaluation of their symptoms. Thus, it is emphasized that first, therapists need to approach patients with somatoform disorders somatically with understanding of their underlying need to deny psychological problems, followed by either psychological or biopsychosocial approach.

• Korean Journal of Psychosomatic Medicine
• /
• v.10 no.2
• /
• pp.154-165
• /
• 2002

Objectives : The purpose of this study was to identify characteristics of depression in cancer patients treated with chemotherapy. Methods : Subjects were 37 cancer inpatients of oncology in Yeungnam university hospital. BDI and ZDS were done and HDS was performed through semistructured interview. Results: 1) There were no significant differences of depression scale score according to sex, education, religion, marital status. 2) The mean scores of BDI, ZDS and HDS in 37 cancer patients were 18.27${\pm}$7.73, 36.51${\pm}$10.82, 15.14${\pm}$6.60, respectively. 3) HDS, ZDS scores were significantly higher in other cancer group receiving high dose chemotherapy. 4) Item score for depressed mood, diurnal variation(p<0.001), dissatisfaction(p<0.01), physical anxiety, decreased libido, sleep disturbance(p<0.05) were significantly higher in other cancer group than others. 5) Eight patients were diagnosed as having major depressive disorder, 11 as adjustment disorder, and 18 patients had no axis I diagnosis. 6) In major depressive disorder group, the score of the depressed mood item in ZDS was high (p<0.05). HDS item score for depressed mood, work difficulty, anxiey(p<0.001), psychomotor retardation(p<0.01) were significantly higher in major depressive disorder group. 7) In patients with adjustment disorder, ZDS item score of constipation(p<0.001), fatigue, anorexia (p<0.01), emptiness, sleep disturbance, dissatisfaction, weight loss(p<0.01) were high. HDS item score of hypochondriasis(p<0.01), agitation(p<0.01), fatigue, decreased libido(p<0.05) were significantly higher in adjustment disorder group. Conclusion : Some psychiatric disorders, such as adjustment disorder and major depressive disorder were common in the cancer patients in chemotherapy. Psychiatric intervention will increase compliance of cancer treatment and improve the quality of life. This study suggests that it would be important to consider the nature of somatic symptoms in diagnosing depression in cancer patients.

• Journal of Korean Orthopaedic Sports Medicine
• /
• v.8 no.2
• /
• pp.102-108
• /
• 2009

Purpose: The purpose of this study is to report a result of the technique that reconstruct posterior cruciate ligament (PCL) and posterolateral corner (PLC) simultaneously using a fresh-frozen Achilles tendon allograft. Materials and Methods: Forty two patients (45 legs) underwent PCL and PLC reconstruction were included. There were 38 males and 4 females. Mean age was 39 years. Used graft was a fresh frozen Achilles tendon allograft, which was divided by two size, larger one (${\emptyset}$ 10 mm) for PCL reconstruction and smaller one (${\emptyset}$ 8 mm) for PLC reconstruction. Arthroscopic reconstruction of the PCL was performed using transtibial, single incision, and single bundle technique with 10mm fresh frozen Achilles allograft tendon first. After PCL reconstruction, reconstruction procedure for posterolateral instability was performed using modified figure of "8" technique using smaller gtaft. For clinical evaluation, range of motion, posterior drawer test, varus stress test, prone external rotation (dial) test, Lysholm score, Tegner activity scale and posterior stress radiograph were used. Mean follow up period was 25 months. Results: Preoperatively posterior drawer test was 5 cases in grade II and 40 cases in grade III posterior instability. At final follow-up 22 cases returned within normal condition, 18 cases grade I and 5 cases grade II posterior instability. Though all patients showed positive result over 10 degrees in dial and varus stress test preoperatively, but only 9 cases showed positive both test at final follow-up. The range of motion deficit over $10^{\circ}$ flexion was 3 cases. Lysholm score was improved from mean 50 preoperatively to mean 83(p<0.05) and Tegner activity scale improved from mean 2.1 preoperatively to mean 4.6(p<0.05). In posterior stress radiographs, posterior displacement was improve from mean 16mm preoperatively to 4.1mm after treatment(p<0.05). All patients had improved compared to their pre-operative status as measured by physical examination such as posterior drawer test, varus stress test, dial test. Conclusion: We had successful results by combined reconstruction of the PCL & PLC with a fresh frozen Achilles tendon allograft in patients with PCL and posterolateral rotatory instability at a time.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.18 no.11
• /
• pp.416-424
• /
• 2017

This study was conducted to examine the awareness of workers in public institutions of automated external defibrillators, their usage intention and related educational experience in an effort to increase the efficiency of education and the rate of automated external defibrillator usage in emergency situations. The subjects in this study were 243 selected. male and female adults who worked in public institutions in Gangwon Province. A survey was conducted from June 13 to August 21, 2016. The statistical analysis was based on the frequency analysis and the $X^2$-test. There were significant differences among the public institution workers awareness of how to use an automated external defibrillator according to gender (${\chi}^2=6.32$, p<0.05) and academic credentials (${\chi}^2=5.91$, p<0.05). Additionally, there were significant differences in usage intention according to academic background (${\chi}^2=5.70$, p<0.05). The most common reason for having no intention to use an automated external defibrillator for patients with cardiac arrest was that the respondents did not know how to use it (31.5%). There were also significant differences in educational experience with automated external defibrillators according to age (${\chi}^2=6.15$, p<0.05), academic credentials (${\chi}^2=11.56$, p<0.01) and career (${\chi}^2=11.92$, p<0.01). The most common form of education that the workers received pertaining to automated external defibrillators was a combination of theoretical and practical education, which represented 55.9%. The findings of the study seem to suggest that workers in public institutions used by many people must receive compulsory standard education regarding automated external defibrillators and try to boost the revival rate of patients with cardiac arrest in real emergency situations.