• Asian Pacific Journal of Cancer Prevention
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• 제17권3호
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• pp.1427-1431
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• 2016

Background: Potential disadvantages of blood transfusion during curative gastrectomy for gastric cancer have been reported, and the role of peri-operative transfusions remains to be ascertained. Thus, the aim of our study was to survey its impact in patients with gastric cancer undergoinging gastrectomy. Materials and Methods: Clinical data of patients receiving curative gastrectomy at Far Eastern Memorial Hospital were obtained. Findings for pre-operative anemia states, pre-, peri- and post-operative transfusion of red blood cell (RBC) products as well as post-operative complication events were collected for univariate analysis. Results: A total of 116 patients with gastric cancer received gastrectomy at Far Eastern Memorial Hospital from 2011 to 2014. Both pre-operative and intra- and post-operative transfusion of RBC products were markedly associated with post-operative infectious events (OR: 3.70, 95% CI: 1.43-9.58, P=0.002; OR: 8.20, 95% CI: 3.11-22.62, P<0.001, respectively). In addition, peri- and post-operative RBC transfusion was significantly associated with prolonged hospital stay from admission to discharge (OR: 8.66, 95% CI: 1.73-83.00, P=0.002) and post-operative acute renal failure (OR: 19.69, 95% CI: 2.66-854.56, P<0.001). Also, the overall survival was seemingly decreased by peri-operative RBC transfusion in our gastric cancer cases (P=0.078). Conclusions: Our survey indicated that peri-operative RBC transfusion could increase the risk of infectious events and acute renal failure post curative gastrectomy as well as worsen the overall survival in gastric cancer cases. Hence, unnecessary blood transfusion before, during and after curative gastrectomy should be avoided in patients with gastric cancer.

• Pediatric Infection and Vaccine
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• 제18권1호
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• pp.80-84
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• 2011

흉벽 천공성 농흉(Empyema necessitatis)은 농흉이 흉막 외의 공간으로 확장되어 나간 것을 말한다. 결핵성 흉벽 천공성 농흉은 결핵의 드문 합병증으로서 특히 소아에서는 더욱 드물다. 본 저자들은 결핵에 노출된 병력이 없던 21개월 남자아이에서 7번째 늑골의 골수염에 동반된 결핵성 흉벽천공성 농흉을 경험하여 이에 대해 보고한다. 우리는 환자의 진단과 치료를 위해 수술적 치료를 시행하였고, 조직을 이용한 PCR 및 분자생물학적 검사에서 M. tuberculosis complex를 확인하여 항결핵제를 이용해 합병증 없이 치료하였다.

• 대한방사선기술학회지:방사선기술과학
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• 제34권1호
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• pp.35-41
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• 2011

항암 치료를 받는 환자들은 장기간의 안정적인 정맥확보를 위해 중심정맥 카테터 삽입이 점차 증가하는 추세로 장기간의 항암제 투여, 종합 비경구적 영양법, 반복적 혈액채취와 항생제 투여, 혈액 투석을 위해 시행되고 있다. 그중 주입구를 완전히 피하에 심는 피하매몰형 중심정맥포트(chemo-port)의 설치가 많이 시행되고 있다. 본 연구에서는 항암치료를 받은 환자 중 중재적 방사선과에서 전형적인 카테터 끝이 열려 있는(non-valved) 포트와 새로운 형태의 카테터 끝이 닫혀 있는(valved) 포트를 삽입했던 환자를 대상으로 발생한 합병증이나 문제점에 관한 후향적 조사를 바탕으로 올바른 피하매몰 중심정맥 포트의 선택 및 관리, 해결 방안을 모색하고자 함이다. 2006년 1월부터 2010년 5월까지 피하매몰 중심정맥포트를 삽입한 438명을 대상으로 하였다. 이중 valved 포트를 삽입한 경우는 109명이었고 non-valved 포트를 삽입한 경우는 329명이었다. 포트의 사용상의 문제점을 의뢰한 56명 중 실제로 발생된 30명의 합병증이나 문제점을 valved. non-valved 포트로 나누어 비교 평가하였다. 포트 시술 후 valved 포트에서 문제점과 합병증이 11.93%, non-valved 포트에서 문제점과 합병증이 5.17% 발생하여 상대적으로 valved 포트에서 문제가 더 많이 발생하였다. Valve사용 유무에 따른 포트 사용 시 두께가 얇은 포트의 사용을 권장하고 시술시 환자 감염이 유발하지 않게 가이드라인을 설정해야 하며 시술이후에도 포트를 사용 시 전용바늘을 사용하고 사용 후 생리식염수의 의한 관 세척 등 포트관리에 체계적인 관리가 필요하다. 추가적인 문제점이 발생 시 원인을 찾아내어 해결책을 제시하고 향후 반복적인 합병증이나 문제점이 발생하지 않게 하여 포트 삽입술의 유용성과 안전성을 증대해야 한다.

• Pediatric Infection and Vaccine
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• 제28권2호
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• pp.66-81
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• 2021

코로나바이러스감염증-19는 전 세계적으로 유행하고 있으며, 2021년 7월 15일 기준으로 1.88억명 이상의 확진자와 406만명 이상의 사망자가 발생하였다. 소아청소년에서는 성인에 비해 비교적 중증 감염 발생이 낮으나, 일부에서는 SARS-CoV-2 감염 약 2-6주후소아다기관염증증후군(multisystem inflammatory syndrome in children, MIS-C)라는 합병증이 발생할 수 있다. MIS-C는 어린영아부터 청소년까지 다양한 연령에서 발생할 수 있으며, 발열을 포함하여 다양한 장기와 관련된 증상을 보일 수 있다. 소화기 및 신경계 증상이 흔하며, 많은 경우 가와사키병과 유사한 피부점막증상 등이 나타난다. 특히 심장관련 증상으로 좌심실 기능저하, 심근염 등이 나타날 수 있으며, 관상동맥확장 및 관상동맥류가 나타날 수 있다. 경우에 따라 저혈압, 쇼크를 동반하며, 중환자실 치료 및 기계환기요법을 요하나, 적절한 치료 후 대체로 회복을 보이는 것으로 보고된다. 이와 같이 MIS-C는 소아청소년에서 SARS-CoV-2 이후 드물게 발생하는 중요한 합병증으로, 임상증상을 잘 인지하고 조기에 적절한 치료를 하는 것이 중요하다. 이에 본 종설에서는 MIS-C의 역학 및 임상 증상, 추정되는 병태생리, 진단적 접근 및 치료에 대해 다루고자 한다.

• Tuberculosis and Respiratory Diseases
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• 제77권4호
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• pp.188-192
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• 2014

We present a case of an unusual infectious complication of a ruptured mediastinal abscess after endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), which led to malignant pleural effusion in a patient with stage IIIA non-small-cell lung cancer. EBUS-TBNA was performed in a 48-year-old previously healthy male, and a mediastinal abscess developed at 4 days post-procedure. Video-assisted thoracoscopic surgery was performed for debridement and drainage, and the intraoperative findings revealed a large volume pleural effusion that was not detected on the initial radiographic evaluation. Malignant cells were unexpectedly detected in the aspirated pleural fluid, which was possibly due to increased pleural permeability and transport of malignant cells originating in a ruptured subcarinal lymph node from the mediastinum to the pleural space. Hence, the patient was confirmed to have squamous cell lung carcinoma with malignant pleural effusion and his TNM staging was changed from stage IIIA to IV.

• Pediatric Infection and Vaccine
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• 제21권3호
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• pp.219-224
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• 2014

Streptococcus bovis에 의한 신생아 침습감염을 보고한 사례는 많지 않으며, 지금까지 보고된 증례는 대부분 Streptococcus pasteurianus가 원인이었다. 저자들은 생후 28일에 열이 나서 온 환자의 혈액과 뇌척수액에서 분리된 균주를 16S rRNA와 tuf 유전자 염기서열분석을 통해 Streptococcus lutetiensis로 동정할 수 있었다. 환자의 혈액에서 배양된 균주는 자동화 장비(VITEK 2)에서 Streptococcus infantarius로 동정되었고 뇌척수액에서 자란 균주는 동정되지 않았다. 환자는 항균제 투여 2일째부터 열이 떨어지고 전신상태가 호전되었으며, 14일간 항균제 사용 후 신경학적 합병증 없이 퇴원하였다. 저자들은 S. bovis군에 의한 침습 감염 환자에서 정확한 균주 동정을 위해 분자유전학적 검사기법이 도움이 될 수 있음을 확인하였고 본 증례의 원인 균주가 신생아 침습감염의 원인으로 알려진 사례가 없어 보고하는 바이다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제34권5호
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• pp.550-554
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• 2008

Bisphosphonates (BPs) are a class of agent used to treat patient with osteoporosis or malignant bone metastases. BPs can be categorized into 2 groups: nitrogen-containing and non-nitrogen containing. Nitrogen-containing BPs are considered to have more toxicity. Despite their clinical benefits, bisphosphonate-related osteonecrosis of jaw(BRONJ) is a significant complication to patients receveing these drugs. Since the first description of BRONJ in 2003 by Marx, the number of reports on BRONJ has been rapidly increasing. BRONJ is considered as an emerging problem in oral & maxillofacial surgery. Generally, osteonecrosis in the maxilla is rare, however BRONJ is found both in the maxilla and the mandible. This is an important feature of BRONJ compared to common infectious osteomyelitis of the jaw. Growing number of case reports, suggest that bisphosphonate therapy may cause exposed, necrotic bone. BRONJ has simillar features compared to IORN (infected osteoradionecrosis). BRONJ has meaningful features established through the interestigation on histopathologic and radiographic findings. These features have an impact on treatment plan and prognosis. This presentation contemplates on features of histopathologic and radiographic findings in bisphosphonate-related osteonecrosis of the jaw.

• Journal of Korean Neurosurgical Society
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• 제41권3호
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• pp.153-156
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• 2007

Objective : Cerebral vasospasm is a devastating medical complication of aneurysmal subarachnoid hemorrhage [SAH]. Therefore, prompt detection of vasospasms in aneurysmal SAH is important to the clinical outcome of the patient. For better prediction and effective management of vasospasms, identifying risk factors is essential. This study is aimed at evaluating the relationship between clinical hematologic values, especially white blood cell count, and cerebral vasospasms. Methods : A retrospective review was conducted on 249 patients with aneurysmal SAH who underwent surgical clipping [230 cases] or endovascular intervention [19 cases] between 2003 and 2005. The underlying clinical conditions assessed were leukocytosis, fever, hypertension, diabetes, smoking, Hunt and Hess grade, Fisher grade, aneurysm location, and direct clipping versus endovascular intervention. Results : Two hundred forty-nine patients were treated for aneurysmal SAH during this period. We selected 158 patients in Hunt and Hess grade I - III. Cases of infectious conditions, rebleeding and other surgical/clinical complications were excluded. Vasospasms occurred $7.0{\pm}3.1$ days after the onset of SAH. There were several independent predictors of vasospasm : Fisher grade III [p=0.002], fever within two weeks on admission [p<0.001], and a serum leukocyte count >$10.8{\times}10^3/mm^3$ on admission [p=0.018]. Conclusion : This study results indicate that leukocytosis and fever increase the risk of vasospasms. However, other known risk factors, such as hypertension and smoking, were not correlated with respect to predicting of cerebral vasospasm. Monitoring the serum leukocyte count may be a helpful and useful marker of vasospasms after aneurysmal SAH.

• Journal of Chest Surgery
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• 제50권3호
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• pp.202-206
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• 2017

Background: Empyema is the collection of purulent exudate within the pleural space. Overall, 36%-65% of patients with empyema cannot be treated by medical therapy alone and require surgery. Multiloculated empyema is particularly difficult to treat with percutaneous drainage. Therefore, we describe our experiences with early aggressive surgical treatment for rapid progressive multiloculated empyema. Methods: From January 2001 to October 2015, we retrospectively reviewed 149 patients diagnosed with empyema who received surgery. The patients were divided into 2 groups according to whether they underwent emergency surgery or not. We then compared surgical outcomes between these groups. Results: The patients in group A (emergency surgery, n=102) showed a more severe infectious state, but a lower complication rate and shorter length of hospital stay. The incidence of lung abscess was higher in group A, and abscesses were associated with diabetes and severe alcoholism. Conclusion: Early aggressive surgical treatment resulted in good surgical outcomes for patients with rapid progressive multiloculated empyema. Furthermore, we suspect that the most likely causes of multiloculated empyema are lung abscesses found in patients with diabetes mellitus as well as severe alcoholism.

• Journal of Nutrition and Health
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• 제6권2호
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• pp.17-24
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• 1973

The function of the liver is so complicated and important that various Hepatic diseases are occured due to functional retardation of liver. Above all, the incidence of Hepatitis and liver cirrhosis among Koreans has shown an increasing tendency recently. 113 cases of Hepatitis and 125 cases of liver cirrhosis which had been admitted, more than 10 days, to KOREA Hospital between November, 1968 and July,1972, were studied through clinic charts. (A) Hepatitis 1) of the 113 cases; 54 cases (47.7%) were Infectious hepatitis; 40 cases (35.4%) were chronic hepatitis 2) of the 113 cases ; 80 cases (70.8%) were male and 33 cases (29.2%) were female; the sex ratio was 2.4 : 1 The ages of the onset of the disease was as follows; 34 cases (30.1%) were among $30{\sim}40$. 3) Patients had abdominal pain (77.9%) anorexia (66.4 %) and general weakness(82.3%) as symptom and jaundice (94.7%) hepatomegaly (76.1%) as sign 4) 57 cases of all had complication 26 cases (45.6%) were parasite, 12 cases (21.1%) were diabeties mellitus. 5) 99 casea (87.6%) of all were improved and recovered. (B) Liver Cirrhosis 1) Etiologic factors are hepatitis (56cases) and alcoholics (28 cases). 2) of the 125 cases, 84 cases (67.2%) were male and 41 cases (32.8%) were female; the sex ratio was 2 : 1 The age of the onset of the disease was as follows; 47 cases (37.6%) were among 41-50. 3) Patients had symptoms: indigestion (64.8%), Abdominal pain (60%), general wenkness (35.2%) and signs; Hepatomegaly (61.6%) Ascites (59.2%), Jaundice(56.8%). 4) 107 cases of all had complications; Hepatic coma was 20 cases (18.7 %), Ascites was 16 cases (15.0%). 5) 69 cases (55.2%) were improved. (c) Treatment of Hepatitis and cirrhosis. 1) Absolutely (bed) rest. 2) A well-balanced diet adequate in calorie value, showed be given (High Carbohydrate, High Protein, High vitamin diet) if the patient's appetite is good and easily digested. 3) Drugs; (1) Vitamins (2) Digestants (3) Tranquize