• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.21 no.1
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• pp.43-50
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• 2018

Purpose: Clostridium difficile colonization and infection are commonly associated with poor outcomes in patients with pediatric inflammatory bowel disease (PIBD). We aimed to investigate the prevalence of C. difficile colonization and infection at the time of diagnosis and to evaluate risk factors associated with the development of C. difficile infection during the course of PIBD treatment. Methods: We retrospectively enrolled a total of 59 children who were newly diagnosed with PIBD at the tertiary medical center. All patients underwent C. difficile toxin assays and cultures initially and at every follow-up during the disease course. Kaplan-Meier survival analysis and Cox regression test were used for statistical analysis. Results: Initial cultures for C. difficile were positive in 13 (22.0%) of 59 PIBD patients, whereas initial toxin assays were positive in 3 patients (5.1%). During treatment, C. difficile cultures converted to positive in 28 (47.5%) in addition to 13 patients who were initially culture-positive, and C. difficile toxins converted to positive in 13 (22.0%) in addition to 3 originally toxin-positive patients. Antibiotic usage alone was significantly associated with the development of C. difficile colonization (p=0.011), and the length of hospitalization was associated with the development of C. difficile infection (p=0.032). Conclusion: C. difficile colonization and infection occur frequently during the disease course of PIBD. Antibiotic usage and longer hospital stay were significant risks factors for the conversion of C. difficile status in PIBD patients undergoing treatment.

• Clinical and Experimental Pediatrics
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• v.58 no.12
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• pp.478-483
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• 2015

Purpose: Information on the clinical features of lung abscess, which is uncommon in children, at hospitalization is helpful to anticipate the disease course and management. There is no report concerning lung abscess in Korean children. We aimed to identify the clinical characteristics of pediatric lung abscess and compare the difference between primary and secondary abscess groups. Methods: The medical records of 11 lung abscess patients (7 males and 4 females) from March 1998 to August 2011 at two university hospitals were retrospectively reviewed. The clinical characteristics, symptoms, underlying disease, laboratory and radiologic findings, microbiological results, and treatments were examined. Results: Six patients had underlying structural-related problems (e.g., skeletal anomalies). No immunologic or hematologic problem was recorded. The mean ages of the primary and secondary groups were 2.4 and 5.3 years, respectively, but the difference was not statistically significant. The mean length of hospital stay was similar in both groups (22.8 days vs. 21.4 days). Immunologic studies were performed in 3 patients; the results were within the normal range. Most patients had prominent leukocytosis. Seven and 4 patients had right and left lung abscess, respectively. Staphylococcus aureus, Streptococcus pneumoniae, and antimycoplasma antibodies were detected in both groups. Two patients with primary lung abscess were administered antibiotics in the absence of other procedures, while 8 underwent interventional procedures, including 5 with secondary abscess. Conclusion: The most common symptoms were fever and cough. All patients in the primary group were younger than 3 years. Structural problems were dominant. Most patients required interventional procedures and antibiotics.

• Journal of Korean Academy of Nursing
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• v.42 no.2
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• pp.181-189
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• 2012

Purpose: This study was done to compare breast feeding rates and factors influencing feeding practice between late preterm ($34{\leq}GA<37$) and preterm infants (GA<34). Methods: A survey was done of 207 late preterm and 117 preterm infants in neonatal intensive care units (NICU) of 4 university hospitals in D city. Data were collected from July 2009 to June 2010 from 324 medical records in the NICU. Breast-feeding at home was checked either by telephone survey or questioning during hospital visits. Results: Rate of breast feeding for late preterm infants was significantly lower than for preterm infants. There was no significant difference in breast-feeding at home. We found differences in factors influencing breast feeding between the two groups. Factors influencing feeding for late preterm infants were type of delivery, mothers' occupation, feeding type during hospitalization, time elapse from hospital discharge, total admission days, infant's body weight at first feeding and length of NPO (nothing by mouth). Factors influencing feeding for preterm infants were birth order, maternal disease and obstetric complications, and one-minute Apgar score. Conclusion: Results of the study show low rates of breast-feeding for late preterm infants indicating a need for breast-feeding education for mothers of these infants.

• Archives of Plastic Surgery
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• v.42 no.3
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• pp.321-326
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• 2015

Background The acellular dermal matrix (ADM)-assisted breast reconstruction technique is widely known, but discouraging results due to early postoperative complications have been reported. As the literature identifies seroma as the most common issue after breast surgery without identifying its pathogenesis, we aimed to report the trend of postoperative daily serum collection after ADM-assisted breast reconstruction and compare it with data in the literature in order to discover more about this little-known topic. Methods A retrospective study on 28 consecutive patients who received ADM-assisted breast reconstruction between February 2013 and February 2014 was performed. In order to reduce the number of variables that could affect serum production, only one brand of ADM was used and all tissues were handled gently and precisely. The daily drainage volume was recorded per patient during the first four days of hospitalization. Likewise, postoperative complications were noted during routine follow-up. Results In total, five (17.9%) bilateral and 23 (82.1%) unilateral ADM-assisted breast reconstructions (33 implants) were performed. The mean age, body mass index, and length of hospital stay were 53.6 years, $21.3kg/m^2$, and 4.5 days, respectively. One major complication led to implant loss (3.0%), and nine minor complications were successfully treated with ambulatory surgery (27.3%). Serum collection linearly decreased after 24 hours postoperatively. Conclusions Daily drainage decreased following the theoretical decline of acute inflammation. In concordance with the literature, daily serum production may not be related to the use of ADM.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.3 no.1
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• pp.47-55
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• 2000

Purpose: The aim of this research is to examine the abnormal liver function complicated with Kawasaki disease (KD) and to analyze its clinical characteristics and complications. Methods: Ninty eight cases were diagnosed as having KD, among which thirty four cases had abnormal alanine aminotransferase (ALT) (>30 IU/L). These abnormal ALT cases were evaluated in terms of age and sex distribution, major symptoms, complications, laboratory and histopathologic findings. Results: Male to female ratio was 2.4:1 and most patients (91.2%) were under 5 years of age. Cervical lymphadenopathy was observed in 3 cases (8.8%); and recurred cases were two (5.8%). Average fever duration was 8 days; average length of hospitalization was 9 days; and average recovery period was 13 days. Immediately after admission, positive CRP was observed in 31 cases (91.2%), leukocytosis (> $10,000/mm^3$) in 26 cases (76.0%), thrombocytosis (> $450,000/mm^3$) in 7 cases (20.6%), and anemia (<10 gm/dl) in 7 cases (20.6%), respectively. GB hydrops or cholecystitis were noted in 3 cases (8.8%), abnormal ECG finding in 1 case (2.9%), coronary dilatation or aneurysm in 2 cases (5.9%). Liver biopsy was done in four cases and revealed mild infiltration of lymphocytes on the portal area and mild bile duct proliferations. Conclusion: The abnormal liver function was noted in 34.7% of KD patients, and subsided all within one month. But the liver function test should be checked closely in patients of the abnormal liver function test complicated with KD despite of its good prognosis.

• Journal of Chest Surgery
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• v.49 no.4
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• pp.287-291
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• 2016

Background: Spontaneous pneumomediastinum (SPM) is an uncommon disorder with only a few reported clinical studies. The goals of this study were to investigate the clinical manifestations and the natural course of S PM, as w ell as examine the current available treatment options for SPM. Methods: We retrospectively reviewed 91 patients diagnosed with SPM between January 2008 and June 2015. Results: The mean age of the patients was $22.7{\pm}13.2years$, and 67 (73.6%) were male. Chest pain (58, 37.2%) was the predominant symptom. The most frequent precipitating factor before developing SPM was a cough (15.4%), but the majority of patients (51, 56.0%) had no precipitating factors. Chest X-ray was diagnostic in 44 patients (48.4%), and chest computed tomography (CT) showed mediastinal air in all cases. Esophagography (10, 11.0%), esophagoduodenoscopy (1, 1.1%), and bronchoscopy (5, 5.5%) were performed selectively due to clinical suspicion, but no abnormal findings that implicated organ injury were documented. Twelve patients (13.2%) were discharged after a visit to the emergency room, and the others were admitted and received conservative treatment. The mean length of hospital stay was $3.0{\pm}1.6days$. There were no complications related to SPM except for recurrence in 2 patients (2.2%). Conclusion: SPM responds well to conservative treatment and follows a benign natural course. Hospitalization and aggressive treatment can be performed in selective cases.

• The Journal of Korean Medicine
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• v.38 no.3
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• pp.185-196
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• 2017

Backgrounds: Inpatient Classification System for Korean Medicine (KDRG-KM) was developed and has been applied for monitoring the costs of KM hospitals. Yet severity of patients' condition is not applied in the KDRG-KM. Objectives: This study aimed to develop the severity classification methods for KDRG-KM and assessed the explanation powers of severity adjusted KDRG-KM. Methods: Clinical experts panel was organized based on the recommendations from 12 clinical societies of Korean Medicine. Two expert panel workshops were held to develop the severity classification options, and the Delphi survey was performed to measure CCL(Complexity and Comorbidity Level) scores. Explanation powers were calculated using the inpatient EDI claim data issued by hospitals and clinics in 2012. Results: Two options for severity classification were deduced based on the severity classification principle in the domestic and foreign DRG systems. The option one is to classify severity groups using CCL and PCCL(Patient Clinical Complexity Level) scores, and the option two is to form a severity group with patients who belonged principal diagnosis-secondary diagnosis combinations which prolonged length of stay. All two options enhanced explanation powers less than 1%. For third option, patients who received certain treatments for severe conditions were grouped into severity group. The treatment expense of the severity group was significantly higher than that of other patients groups. Conclusions: Applying the severity classifications using principal diagnosis and secondary diagnoses can advance the KDRG-KM for genuine KM hospitalization. More practically, including patients with procedures for severe conditions in a severity group needs to be considered.

• Biomedical Science Letters
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• v.17 no.4
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• pp.329-336
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• 2011

The female has previously been shown to be an independent risk factor for mortality and morbidity after coronary artery bypass grafting surgery (CABG). The aim of this retrospective study is to evaluate gender differences of the perioperative outcomes in elderly patients underwent CABG. Data for seventy elderly patients (>70 years) that underwent CABG (between January 2005 and July 2011) were divided into two groups: male patients (n=33, male group) and female patients group (n=37, female group). Heights, body weights, body surface area and coronary artery obstruction rate (right coronary artery territory) in the female group were lower than those of the male group ($P$ <0.05). History of hypertension, hyperlipidemia, congestive heart failure and percutaneous coronary artery intervention in the female group was higher than that of the male group ($P$ <0.05). Total cholesterol and brain natriuretic peptide levels in the female group were higher than those of the male group ($P$ <0.05). Platelet count in the female group was higher than the male group at preoperative (Pre-OP) period ($P$ <0.05). Erythrocyte count, hematocrit and hemoglobin levels in the female group were lower than those of the male group at Pre-OP period ($P$ <0.05). But, erythrocyte count, hematocrit and hemoglobin levels in the female group were higher than those of the Male group at postoperative (Post-OP) period ($P$ <0.05). Left ventricular ejection fraction in the female group was higher than the male group at Post-OP period ($P$ <0.05). Hospital stay length in the female group was higher than the male group ($P$ <0.05). Post-OP bleeding volume and incidence of ventricular premature contraction in the female group were lower than those of the male group ($P$ <0.05). These results suggest that despite female gender have a greater risk factors and require a longer hospitalization than male, there was no significant difference incidence of mortality and complication.

• Journal of the Korea Convergence Society
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• v.10 no.6
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• pp.365-379
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• 2019

This review aimed to analyze characteristics and performances of patient and family-centered care interventions and evaluate the convergence effectiveness. Randomized controlled trials were searched, selected, data extracted and quality-assessed using the Risk of Bias in 15 databases. Characteristics suggested from 21 studies were provision of information, education, communication and family and friend participation. There were 89 measurement variables of performances. Patient outcome was measured by mortality, length of hospitalization, etc., indicated as significantly improved in 18 studies. This review has provided evidence that patient and family-centered care improved experience and performance of diverse patients, families and health-care providers. There is need to convergence adopt patient and family-centered care and conduct evidence-based studies for improvement of quality of healthcare and patient safety in the future.

• Journal of Gastric Cancer
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• v.13 no.4
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• pp.255-262
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• 2013

Purpose: Robotic surgery for gastric cancer is a promising alternative to laparoscopic surgery, but the data are limited. We aimed to evaluate whether gaining experience in robotic gastrectomy could improve surgical outcomes in the treatment of gastric cancer. Materials and Methods: Two hundred and seven consecutive cases of patients with clinical stage I gastric cancer who underwent robotic surgery at the National Cancer Center of Korea between February 2009 and February 2012 were retrospectively reviewed. Surgical outcomes were analyzed and compared between the initial 100 and later 100 cases. Results: Seven patients required conversion to open surgery and were excluded from further analysis. The mean operating time for all patients was 248.8 minutes, and mean length of hospitalization was 8.0 days. Twenty patients developed postoperative complications. Thirteen were managed conservatively, while 6 had major complications requiring invasive procedures. One mortality occurred owing to myocardial infarction. Operating time was significantly shorter in the latter 100 cases than in the initial 100 cases (269.9 versus 233.5 minutes, P<0.001). The number of retrieved lymph nodes was significantly greater in the latter cases (35.9 versus 39.9, P=0.032). The hospital stay of patients with complications was significantly longer in the initial cases than in the latter cases (16 versus 7 days, P=0.005). Conclusions: Increased experience with the robotic procedure for gastric cancer was associated with improved outcomes, especially in operating time, lymph node retrieval, and shortened hospital stay of complicated patients. Further development of surgical techniques and technology might enhance the role of robotic surgery for gastric cancer.