• Clinical and Experimental Pediatrics
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• 제45권2호
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• pp.199-207
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• 2002

Purpose : Since the successful application of total atrio-pulmonary connection(TAPC) to patients with various types of physiologic single ventricles in 1971, post-operative survival rates have reached more than 90%. However some patients have been shown to present with late complications such as right atrial thrombosis, atrial fibrillation and protein losing enteropathy eventually leading to re-operation to control the long-term complications. The aim of this study is to review the results of total cavo-pulmonary connection(TCPC) in cases with late complications after TAPC. Methods : Between Jan. 1995 and Dec. 2000, 6 patients(5 males and 1 female) underwent cardiac catheterization $11{\pm}3$ months after conversion of previous TAPC to TCPC. We compared the hemodynamic and morphologic parameters before and after TCPC and also assessed the clinical outcomes. The indications for TAPC were tricuspid atresia in 4 cases and complex double-outlet right ventricle with single ventricle physiology in 2 cases. Results : There was no peri-operative mortality and all patients were clinically and hemodynamically improved at a mean follow-up of 11 months(range : 4 to 13). However, protein losing enteropathy recurred in 2 patients; this was were successfully treated with subcutaneous administration of heparin. Right atrial pressure before TCPC was $18.0{\pm}3.6mmHg$, but baffle pressure, corresponding to right atrial pressure decreased to $14.8{\pm}3.6mmHg$ after TCPC. The size of the pulmonary arteries did not regress after TCPC. Conclusion : The conversion of TAPC to TCPC improves clinical and hemodynamic status by decreasing the right atrial pressure and by providing a laminar cavo-pulmonary flow which enhances the effective pulmonary circulation in the so-called Fontan circulation.

• The Journal of Industrial Distribution & Business
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• 제1권1호
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• pp.33-41
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• 2010

In the age of globalization, effective and efficient corporate management is becoming more important as domestic and international business circumstances changes. In the middle of endless changes in business circumstances, fast reaction to customers and market, and offering customized goods and service became essential. In this respect, CRM designed to utilize customer information scientifically and systematically, has become an essential system and marketing strategy to enhance corporate competitiveness. CRM has placed the importance of customers in the front of marketing and has focused every process and business minds on customers. Recent change in the market and the trend of establishing and introducing CRM system has lead us to concentrate on the introduction of CRM in the financial institutions. This study searched for several views about CRM in academic and industrial papers. Through theoretical approach on CRM, the background of the introduction of CRM, the purpose of CRM, the characteristic and application of CRM, and the expected effect of CRM will be discussed. This study is focused on financial institutions where CRM is widely used. And through documents about examples of the introduction of CRM, the status of the establishment of domestic CRM and the necessity and trend of CRM will be discussed. Also the problem of CRM in the financial institutions and the improvement of CRM in domestic banks will be analyzed. When discussing CRM in the financial area, customers are the main source of corporate profit and through relationship management with the customers enhancing loyalty and maximizing profit can be obtained. Especially in CRM in financial institutions, maintaining existing customers makes higher profit ratio, so repurchasing and cross selling becomes important for obtaining lifetime value of existing customers who contribute to most of the profit of corporations. As a result, CRM should be completely customer oriented. CRM in financial institutions is not merely marketing work, but organizational competence which is made up of standardized work process through total process integration inside the corporation. Corporations which plan to introduce CRM should analyze the characteristics and conditions of corporations and establish purpose and strategy of CRM. And they need long term view to find out the factors which best fit for the introduction of CRM. To enable this, strategy composed of daily marketing activity and CRM concept is necessary. Also continued improvement through drill and training for operating organization should be followed to maintain CRM well. And corporate culture must settle customer as the center of corporate value. The race for introducing and improving CRM has already begun. CRM should not be regarded as a choice. It should be accepted as something essential. In this reality financial institutions should solve subdivision problem of customers and necessity of customers with the mind of 'customer's profit is my profit'. Customer focused management should not be emphasized only by words. Efforts like viewing from the customer's point must be nurtured to provide methods to help customers. That is, we should not just follow what is done in foreign countries. We should solve the problem of our customers according to the situation of our country, our industry, our corporation. Then we can gain the trust of customers, and the value derived from the customers will become the background of CRM which will lead the corporation to success.

• Journal of Korean Neurosurgical Society
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• 제30권3호
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• pp.349-357
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• 2001

Purpose : Meningeal hemangiopericytoma(M-HPC), characterized by a high local recurrency and metastatic potential, is a rare neoplasm arising from perivascular pericytes. A retrospective study was performed to identify the recurrence and extraneural metastasis in M-HPC. Materials and Methods : We reviewed the records of 31 M-HPC patients treated from 1982 through 1999 at our institution. The time to recurrence and the various parameters affecting recurrence were determined. Extreneural metastasis was also analyzed. Results : The rate of local recurrency was 38.7%(12/31). The overall average recurrence-free period(RFP) before the first recurrence was 104 months, with overall recurrence-free rates(RFRs) at 5 and 10 years after first surgery of 59.2% and 33.6%, respectively. Of the 12 patients who experienced local recurrence, 4 had recurrences 5 years later after the first surgery. Complete excision at the first operation significantly extended the average time before first recurrence from 43 to 111 months. The 5-year RFRs for the groups of complete excision and incomplete excision were 72.7% and 20.8%, respectively(p=0.0060). Although there was no statistical significance, complete excision followed by adjuvant radiotherapy of more than 50Gy extended the RFP. The 5-year RFRs for the groups of complete excision and complete excision with adjuvant radiotherapy were 70.3% and 100%, respectively(p=0.3359). Four patients(12.9%) presented one or more extraneural metastases that were developed at an average of 107 months after the first operation with the 5- and 10-year metastasis rates of 4.4% and 24.9%, respectively. Conclusions : M-HPC has a propensity to recur either locally or at distant sites after surgical resection. Complete excision is the most important factor to reduce recurrence. However, even with complete excision, adjuvant radiotherapy of more than 50Gy significantly reduces the risk of recurrence. Local and distant recurrences may occur after a prolonged disease-free interval, emphasizing the need for long-term follow-up.

• Journal of Chest Surgery
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• 제41권6호
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• pp.742-746
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• 2008

Background: The surgical treatment of pectus carinatum is usually a modified Ravitch operation that consists of complete costal cartilage resection and sternal wedge osteotomy. We tried a simple and easy technique that is resection of only deformed, protruded costal cartilage and pre-sternal compression with using a stainless steel bar and this is done without sternal osteotomy. Therefore, we performed partial cartilage resection and pre-sternal compression with a stainless steel bar and we observed the effects and the efficiency of treatment. Material and Method: From July, 2006 to June, 2008, 10 patients with pectus carinatum underwent our modified technique of pectus carinatum surgery. The effects of surgery and the complications were reviewed. Result: 5 patients with only pectus carinatum underwent our modified technique of pectus carinatum surgery. 5 patients with pectus carinatum and pectus excavatum underwent our modified technique of pectus carinatum surgery and Nuss surgery. The mean patient age was 13.4+3.3 years old. The mean operation time was 137.6+22.9 minutes for the pectus carinatum patients and 234.0+36.5 minutes for the pectus carinatum and pectus excavatum patients. The mean length of hospitalization was 11.8+1.0 days. The Haller pectus index of pectus carinatum was $2.10{\pm}0.21$ preoperatively and this was increased to $2.53{\pm}0.07$ postoperatively. The only complication was simple partial wound disruption in 1 patient. Conclusion: We performed partial cartilage resection and pre-sternal compression with a stainless steel bar in 10 patients with pectus carinatum and its effects were good. Our modified technique of pectus carinatum is easy and simple as compared with the Ravitch operation. But removal of the stainless steel bar has not yet been performed for these patients and long-term follow up is needed to accurately evaluate the. effects of this surgery in many surgical cases.

• Radiation Oncology Journal
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• 제14권2호
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• pp.137-147
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• 1996

Purpose : This report is the result f retrospective analysis for children who received prophylactic cranial irradiation combined with intrathecal chemotherapy. Materials and Methods : Ninety children with ALL who had got bone marrow remission after induction chemotherapy received PCI. All but 3 children were treated with a dose of 1800 cGy as a standard regimen. While the PCI was given, all patients received intrathecal chemotherapy. Results : Nine of 90 patients experienced CNS relapse during the duration of follow-up ranged from 36 to 96 months (median 60 months). Three children experienced BM relapse prior to CNS relapse. Therefore, CNS relapse rate as the first adverse event was $6.7\%$. Median time interval of CNS relapse was 16 months from the first day of hematologic complete remission. Eighty-nine percent of patients who had CNS relapse were associated with hematologic relapse. and $78\%$ of CNS relpase occurred during maintenance chemotherapy (on-therapy relapse). The CNS RFS at 2 and 5 years are $68\%$ and $42\%$, respectively with median of 43 months. The Prognostic factors affecting CNS RFS are initial WBC count (cut-off point of 50,000/ul), FAB subtype and CALGB risk criteria. The DFS at 2 and 5 years are 61 and $39\%$, respectively with median of 34 months. The prognostic factors affecting DFS are initial WBC count (cut-off point of 50,000/ul), FAB subtype, POG and CALGB risk criteria. Conclusions : In our study, $6.7\%$ of CNS relapse rate as a first adverse event was comparable with other studies. Various risk criteria was based on age at diagnosis and initial WBC count such as POG and CALGB criteria, had prognostic significance for CNS RFS and DFS. Prospective randomized trial according to prognostic subgroup based on risk criteria and systematic study about neuropsychologic function for long term survivors, are essential to determine the most effective and least toxic form of CNS prophylaxis.

• Radiation Oncology Journal
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• 제27권1호
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• pp.10-14
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• 2009

Purpose: This study was designed to evaluate the effectiveness and prognostic factors for patients treated with postoperative radiation therapy following surgery or with radiation therapy alone for squamous cell carcinoma of the esophagus. Materials and Methods: We retrospectively analyzed 132 esophageal cancer patients treated with postoperative radiation therapy following surgery or patients who were treated with radiation therapy alone at our institution from 1989 to 2006. Thirty-five patients had stage II disease, 88 patients had stage III disease and nine patients had stage IV disease. Tumors were located at the upper esophagus in 18 patients, the mid esophagus in 81 patients and the distal esophagus in 33 patients. Sixty patients were treated with radiation therapy alone and 72 patients were treated with postoperative radiation therapy following surgery. Eight patients received a dose less than 40 Gy and 78 patients received a dose of 40 to 50 Gy. The remaining 46 patients received a dose of 50 to 60 Gy. The majority of patients who underwent postoperative radiation therapy received a dose of 45 Gy. Results: Actuarial survival rates for all of the patients at two years and five years were 24% and 5%, respectively. The median survival time was 11 months. Survival rates for patients who underwent postoperative RT at two years and five years were 29% and 8%, respectively. The corresponding survival rates for patients who received radiation alone were 18% and 2%, respectively. Survival rates at two years and five years were 43% and 15% for stage II disease, 22% and 2% for stage III disease and 0% and 0% for stage IV disease, respectively; these findings were statistically significant. Two-year survival rates for patients with upper, middle and distal esophageal cancer were 19, 29% and 22%, respectively. Although there was a trend of slightly better survival for middle esophageal tumors, this finding was not statistically significant. Complete response to radiation was achieved in 13 patients (22%) and partial response to radiation was achieved in 40 patients (67%) who received radiation alone. No response to radiation was noted in seven patients (12%). A statistically significant difference in survival rates was seen between patients that had a complete response and patients that had a partial response. Two-year survival rates for patients that had a complete response versus patients that had a partial response were 31% and 17%, respectively. There were no survivors for patients with no response as determined at two-year follow-up. Conclusion: We conclude that radiation therapy is an effective treatment for esophageal cancer. Stage and response to radiation therapy were noted to be prognostic factors. A more effective treatment modality is needed to improve long term survival because of the relatively dismal prognosis for this tumor.

• Journal of Gastric Cancer
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• 제6권2호
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• pp.76-83
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• 2006

Purpose: Endoscopic incision and submucosal dissection (EISD) is a technique that is being implemented for the resection of gastric adenomas and early gastric cancer (EGC). Since EISD requires a high degree of skill and experience, and due to its association with a moderate risk of gastrointestinal bleeding, its use has been limited. The objective of this study is to investigate the clinical benefits of EISD based upon clinical data on the EISD procedure. Materials and Methods: This study was conducted at Soonchunhyang University Hospital and it included 179 gastric adenoma and early gastric carcinoma lesions from 164 patients who had undergone an EISD from February 2003 to May 2005. Results: Among the total of 179 lesions, the distributions of EGC and adenomas were 70.3% (126/179) and 23.4% (42/179) respectively. The sizes of lesions were divided into 10 mm or less, $11{\sim}20\;mm,\;21{\sim}30\;mm$ and greater than 31 mm and each rates are 10.0% (18/179), 46.3% (83/179), 30% (50/179) and 15.0% (28/179). Among 120 cases which could be measured depth of lesion in according to pathologic findings, m1 (0.8%, 1/120), m2 (38.3%, 46/120), m3 (25%, 57/120), sm1 (11.7%, 14/120), sm2 (1.6%, 2/120) were diagnosed as early stages of gastric cancer. The complete resection rate was 85.2% (150/176) and en-bloc resection rate was 96.0% (169/176). Complications as such as perforation and bleeding developed in 4.4%(8/179) and 21.2% (38/179), respectively. Conclusion: EISD is an effective in the endoscopic treatment for gastric adenoma and early gastric cancers. However, further evaluation of this method and long-term follow-up will be necessary for an evaluation of the recurrence rate after resection of a tumor.

• Journal of The Korean Astronomical Society
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• 제29권spc1호
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• pp.63-64
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• 1996

The nature of distant faint blue field galaxies remains a mystery, despite the fact that much attention has been devoted to this subject in the last decade. Galaxy counts, particularly those in the optical and near ultraviolet bandpasses, have been demonstrated to be well in excess of those expected in the 'no-evolution' scenario. This has usually been taken to imply that galaxies were brighter in the past, presumably due to a higher rate of star formation. More recently, redshift surveys of galaxies as faint as B$\~$24 have shown that the mean redshift of faint blue galaxies is lower than that predicted by standard evolutionary models (de-signed to fit the galaxy counts). The galaxy number count data and redshift data suggest that evolutionary effects are most prominent at the faint end of the galaxy luminosity function. While these data constrain the form of evolution of the overall luminosity function, they do not constrain evolution in individual galaxies. We are carrying out a series of observations as part of a long-term program aimed at a better understanding of the nature and amount of luminosity evolution in individual galaxies. Our study uses the luminosity-linewidth relation (Tully-Fisher relation) for disk galaxies as a tool to study luminosity evolution. Several studies of a related nature are being carried out by other groups. A specific experiment to test a 'no-evolution' hypothesis is presented here. We have used the AUTOFIB multifibre spectro-graph on the 4-metre Anglo-Australian Telescope (AAT) and the Rutgers Fabry-Perot imager on the Cerro Tolalo lnteramerican Observatory (CTIO) 4-metre tele-scope to measure the internal kinematics of a representative sample of faint blue field galaxies in the red-shift range z = 0.15-0.4. The emission line profiles of [OII] and [OIII] in a typical sample galaxy are significantly broader than the instrumental resolution (100-120 km $s^{-l}$), and it is possible to make a reliable de-termination of the linewidth. Detailed and realistic simulations based on the properties of nearby, low-luminosity spirals are used to convert the measured linewidth into an estimate of the characteristic rotation speed, making statistical corrections for the effects of inclination, non-uniform distribution of ionized gas, rotation curve shape, finite fibre aperture, etc.. The (corrected) mean characteristic rotation speed for our distant galaxy sample is compared to the mean rotation speed of local galaxies of comparable blue luminosity and colour. The typical galaxy in our distant sample has a B-band luminosity of about 0.25 L$\ast$ and a colour that corresponds to the Sb-Sd/Im range of Hub-ble types. Details of the AUTOFIB fibre spectroscopic study are described by Rix et al. (1996). Follow-up deep near infrared imaging with the 10-metre Keck tele-scope+ NIRC combination and high angular resolution imaging with the Hubble Space Telescope's WFPC2 are being used to determine the structural and orientation parameters of galaxies on an individual basis. This information is being combined with the spatially resolved CTIO Fabry-Perot data to study the internal kinematics of distant galaxies (Ing et al. 1996). The two main questions addressed by these (preliminary studies) are: 1. Do galaxies of a given luminosity and colour have the same characteristic rotation speed in the distant and local Universe? The distant galaxies in our AUTOFIB sample have a mean characteristic rotation speed of $\~$70 km $s^{-l}$ after correction for measurement bias (Fig. 1); this is inconsistent with the characteristic rotation speed of local galaxies of comparable photometric proper-ties (105 km $s^{-l}$) at the > $99\%$ significance level (Fig. 2). A straightforward explanation for this discrepancy is that faint blue galaxies were about 1-1.5 mag brighter (in the B band) at z $\~$ 0.25 than their present-day counterparts. 2. What is the nature of the internal kinematics of faint field galaxies? The linewidths of these faint galaxies appear to be dominated by the global disk rotation. The larger galaxies in our sample are about 2"-.5" in diameter so one can get direct insight into the nature of their internal velocity field from the $\~$ I" seeing CTIO Fabry-Perot data. A montage of Fabry-Perot data is shown in Fig. 3. The linewidths are too large (by. $5\sigma$) to be caused by turbulence in giant HII regions.

• The Journal of the Korean bone and joint tumor society
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• 제16권1호
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• pp.1-7
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• 2010

Purpose: With advances in various treatment modalities, limb salvage surgery has been commonly used in osteosarcoma of extremities. An alternative method for skeletal reconstruction is reimplantation of the tumor bearing bone following extracorporeal irradiation (ECI). We report the long-term results of ECI autograft in aspect of the oncological and functional outcomes, and complications. Materials and Methods: We retrospectively reviewed 31 osteosarcoma patients who underwent reconstruction with ECI between July 1995 and January 2006. There were 24 males and 7 females with a mean age of 24 (7-74 years) and a mean follow-up of 117 months (17-177 months). Twenty-five cases were reconstructed with ECI autograft, 6 cases with ECI autograft-prosthesis composite. The pathologic subtypes were conventional in 29 cases, periosteal in 1 case, and parosteal in 1 case. The most common location of tumor was distal femur (15 cases) followed by humerus (3), proximal fibula (3) and proximal tibia (3). Musculoskeletal Tumor Society (MSTS) score was used for functional evaluation. The overall survival rate, local recurrence, complications were analyzed. Results: The overall survival rate was 80.6% and the disease-free survival rate was 64.5%. Five patients died of distant metastasis. One patient required above-knee amputation due to local recurrence. All of them, twenty-three complications occurred, which included nonunion in 7 cases, deep infection in 5 cases, joint instability in 4 cases, metal failure in 2 cases, Limb-length discrepancy (LLD) in 2 cases, periprosthetic fracture in 1 case, epiphyseal collapse in 1, local recurrence in 1 case. The mean MSTS functional score was 62.5%. Conclusion: Extracorporeal irradiated autograft can be achieved relatively good result in aspect of oncological and functional aspect, but is needed to be additional research about occurring many complications. The reconstruction with ECI after intercalary or fragmentary resection is effective reconstruction in aspect of oncological and functional result, complications.

• Clinical and Experimental Pediatrics
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• 제45권8호
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• pp.1016-1023
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• 2002

Purpose : Brain tumors are the most common solid tumor in children. We retrospectively investigated the clinical characteristics of pediatric brain tumors, such as age, sex, tumor site and survival, as seen in a single institution over the last 15 years. We tried to evaluate the role of chemotherapy on the survival of some brain tumors. Methods : Three hundred fifty four children with primary brain tumor who were treated at Severance Hospital from Jan. 1985 to Sep. 2001 were enrolled. Results : Pediatric brain tumors were found most frequently in 10-15 years of age group(35.3%) and the ratio of male to female was 1.3 : 1. Supratentorial tumors(52%) were more frequent than infratentorial tumors(48%). Medulloblastoma/primitive neuroectodermal tumor(PNET) was the most common type(24.6%), followed by cerebellar astrocytoma(14.1%). Ten year survival rate of medulloblastoma, cerebellar astrocytoma and cerebral astrocytoma were 59.4%, 79.3% and 71%, respectively. The prognosis for brain stem glioma and glioblastoma multiforme were still grim with a 10 year survival rate of 12.7% and 13.3%, respectively. The addition of chemotherapy for high grade medulloblastoma led to an improved 10 year survival rate of 54.5%, compared with 40% without chemotherapy. Conclusion : The combined use of chemotherapy and radiation and surgery improved survival rate of pediatric brain tumors in our study. Chemotherapy for high grade medulloblastoma improved the 10 year survival rate. Further data analysis of the treatment modalities will lead to better comparisons.