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Clinical Results and Risk Factor Analysis of Surgical Treatment for Esophageal Perforation (식도천공의 수술적 치료의 임상결과와 위험인자 분석)

  • Cho, Sung-Woo;Hong, Ki-Woo;Kim, Shin;Lee, Hee-Sung;Kim, Hyoung-Soo;Lee, Jae-Woong;Choi, Goang-Min;Shin, Yoon-Cheol;Shin, Ho-Seung;Lee, Won-Yong
    • Journal of Chest Surgery
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    • v.41 no.3
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    • pp.347-353
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    • 2008
  • Background: Esophageal perforation is an emergency that. requires early diagnosis and effective treatment. A delay in diagnosis and treatment. significantly increases morbidity and mortality. Material and Method: Thirty-seven patients with esophageal perforation were surgically treated at our institutions between January 1990 and December 2006. We retrospectively reviewed the results of surgical treatment for esophageal perforation to understand the risk factors affecting survival inpatients. Result: Patients ranged in age from 21 to 87 years, with an average age of $52.7{\pm}16.98$ years. Thirty-one of the patients were men and six were women. There were 23 patients (62%) with spontaneous perforations, 10 patients (27%) with a traumatic perforation, and 4 patients (11%) with an iatrogenic perforation. The site of esophageal perforation was the cervical esophagus in 5 patients, the thoracic esophagus in 31 patients, and the abdominal esophagus in one patient. Twenty-nine patients underwent primary closure of the perforation and five patients had T-tube drainage. Exclusion-diversion procedures were performed in two patients and an esophagectomy was performed in one patient. There were six cases of mortality (16.22%) and 25 cases of postoperative complications in 15 patients (40.5%). Patients that were treated later than 24 hours after detection of the perforation showed a statistically significant high morbidity and mortality rate (p<0.05). Conclusion: The most important risk factor of esophageal perforation was the time interval between detection of the perforation and the initiation of treatment. A prompt diagnosis and effective treatment are necessary to decrease morbidity and mortality.

The Recurrence and Survival after Complete Resection of Esophageal Cancer (완전 절제된 식도암의 재발과 생존에 대한 임상적 고찰)

  • 김형수;유정우;김관민;심영목
    • Journal of Chest Surgery
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    • v.36 no.6
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    • pp.411-417
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    • 2003
  • Esophageal cancer is an aggressive disease with a poor prognosis. Recently, neoadjuvant therapy been used in an attempt to increase the long term survival but has not been shown as a clear advantage. We reviewed the recurrence and survival after complete resection of esophageal cancer without neoadjuvant therapy. Material and Method: From December 1994 to December 2001, 182 consecutive patients who underwent intrathoracic esophagectomy, transthoracic esophagogastrostomy and two-field lymph node dissection for esophageal canter without neoadjuvant therapy were studied retrospectively. Result: There were 167 men and 15 women. The median age was 65 years (range, 40 to 90 years). The tumor was located in the upper third part of the esophagus in 7 patients (3.8%), middle third in 86 (47.3%), and lower third in 89 (48.9%). The postsurgical stage were as follows: stage 0 in 2 patients (1.1%), stage I in 32 (17.6%), stageIIA in 47 (25.8%), stage IIB in 25 (13.7%), stage III in 54 (29.7%), stage IVA in 10 (5.5%), and stage IVB in 12 (6.6%). The in-hospital mortality rate was 3.8% (7 patients) and complications occurred in 65 patients (35%), Follow-up was complete in 95.6%. The recurrence occurred in 56 patients (30.8%) and the overall 5-year disease free rate was 55%. The overall 5-year survival rate was 57%; it was 80% for patients in stage I, 65% in stage IIA, 58% in stage IIB, 48% in stage III, and 40% in stage IVB. The overall 5-year survival rate of patients with postoperative adjuvant therapy was 59% compared to 34% in patients without postoperative adjuvant therapy (p<0.05). Conclusion: The most effective therapy for esophageal cancer may be complete resection. More aggressive surgical therapy and adjuvant therapy may improve the long-term survival, even for advanced stage esophageal cancer.

The Evaluation of Clinical Usefulness on Application of Myocardial Extract in Quantitative Perfusion SPECT (QPS 프로그램에서 Myocardial extract 적용에 따른 임상적 유용성 평가)

  • Yun, Jong-Jun;Lim, Yeong-Hyeon;Lee, Mu-Seok;Song, Hyeon-Seok;Jeong, Ji-Uk;Park, Se-Yun;Kim, Jae-Hwan;Kim, Jeong-Uk
    • The Korean Journal of Nuclear Medicine Technology
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    • v.15 no.2
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    • pp.88-93
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    • 2011
  • Purpose: As to analytical method of data, the AutoQUANT software in which it is used quantitative rating of the myocardial perfusion SPECT are reported that there is a difference. Therefore the measured value error of the mutual program is expected to be generated even if the quantitative analysis is made data of the same patient. The purpose of this study is to offer the comparative analysis of myocardial extract method in Quantitative Perfusion SPECT. Materials and methods: We analyzed the 51 patients who were examined by Tc-99m MIBI gated myocardial SPECT in nuclear medicine department of Pusan National University Hospital from June to December 2010(34 men, 17 women, mean age $66.5{\pm}9.9$). We acquired the extracted image in myocardial extract protocol. QPS program that uses the AutoQUANT software measured TID(Transient Ischemic Dilation), ESD(Extent of Stress Defect), SSS(Summed Stress Score). Then analyzed the results. Results: The correlation of appyling myocardial extract is TID(r=0.98), ESD(r=0.99), SSS(r=0.99). In the 95% confidence limit, there was no satistically significant difference(TID p=0.78, ESD p=0.31, SSS p=0.19). After blinding test with a physician for making a qualitative analysis, there was no difference. Conclusion: Quantitative indices in QPS program showed good correlation and the results showed no statistically signigicant difference. The variance between method was small. therefore, the functional parameters by each method can be used interchangeably. Also, we expect patient's satisfaction.

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Association Analysis of MUC5AC Promoter Polymorphism with Asthma (MUC5AC 프로모터의 유전자 다형성과 천식과의 연관성)

  • Han, Seon-Sook;Sung, Ji Hyun;Lee, Mi-Eun;Lee, Seung-Joon;Lee, Sung Joon;Kim, Woo Jin
    • Tuberculosis and Respiratory Diseases
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    • v.63 no.3
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    • pp.235-241
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    • 2007
  • Background: Airway mucus hypersecretion plays an important role in the pathogenesis of asthma, and is associated with the induction of MUC5AC expression in airway secretion. The MUC5AC gene is highly polymorphic; however, there are few studies about the association between the polymorphisms of the MUC5AC gene and asthma susceptibility or asthma phenotypes. We have investigated the association of MUC5AC promoter polymorphisms with the risk of asthma and asthma phenotypes. Methods: We determined the genotypes of the MUC5AC promoter (-1274G>A) in 78 asthma patients and in 78 age, sex-matched control individuals in the Korean population. Genomic DNAs from blood were analyzed by PCR and RFLP (restriction fragment length polymorphism) determination. We examined $FEV_1$, total eosinophil count, serum IgE level, $PC_{20}$ and the presence of atopy (by a skin test) in asthma patients. Results: The mean age of the patients was $47.7{\pm}16.1$ years and 38.5% were men, and the mean $FEV_1$ was $84.4{\pm}22.3%$ of predicted in the asthma patients. The -1274G>A polymorphism of the MUC5AC promoter in asthma patients was not significantly different as compared with normal individuals (GG 57.7%, AG 34.6% and AA 7.7% in asthma patients vs. GG 56.4%, AG 38.5% and AA 5.1% in control subject, p = 0.752, Cod). Several clinical parameters in asthma patients such as $FEV_1$, total eosinophil count, serum IgE level, $PC_{20}$ and the presence of atopy, were not associated with the -1274G>A polymorphism of the MUC5AC promoter. Conclusion: The -1274G>A single nucleotide polymorphism (SNP) frequency of the MUC5AC promoter was not associated with asthma in a Korean population.

Comparison of Accommodative System according to the Material and Font Size of Near Visual Media (근거리 시각매체의 재질과 글자크기에 따른 조절시스템의 비교)

  • Ha, Na-Ri;Kim, Chang-Jin;Jung, Su A;Choi, Eun Jung;Kim, Hyun Jung
    • Journal of Korean Ophthalmic Optics Society
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    • v.19 no.2
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    • pp.217-224
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    • 2014
  • Purpose: This study was conducted to compare and analyze the accommodative system (accommodative response and accommodative lag) according to the material and font size of near visual media that we often encounter in daily life. Methods: Forty adult men and women aged 20 to 30 who not had specific ocular diseases and refractive surgery experience were examined to measure and compare the accommodative response according to the material of near visual media (print paper, newspaper, magazine, the I-Phone, LCD monitor) and font size (6, 8, 10, 12) by using both eyes open-view auto-refractometer. Results: The accommodative stimulus was $2.28{\pm}0.11D$ and the accommodative response was $1.66{\pm}0.30D$. The accommodative lag namely the difference between accommodative stimulus and accommodative response was $0.62{\pm}0.28D$. The accommodative response according to material of visual media using LCD monitor was $1.35{\pm}0.26D$ (p=0.00) and using the I-Phone was $1.55{\pm}0.25D$ (p=0.04). Both of them were statistically significant lower. The accommodative lag using LCD monitor was $0.93{\pm}0.24D$ (p=0.00) and using the I-Phone was $0.73{\pm}0.25D$ (p=0.04) and they were statistically significant higher. The accommodative response and accommodative lag according to font size were not statistically significant (p>0.05). Conclusions: During near working, the accommodative system was more affected by material than font size of visual media. Especially, visual media of non-luminous material (print paper, newspaper, magazine) are considered fewer burdens on eyes than luminous material (I-Phone, LCD monitor) in terms of accommodative system.

The Mid-Term Outcome Evaluation of Community Organization: Three-year Experience of Health Plus Happiness Plus Projects in Gyeongsangnam-Do (지역사회조직화 전략의 중간 결과평가: 경남 건강플러스 행복플러스 사업 3년 경험)

  • Kim, Jang-Rak;Jeong, Baekgeun;Park, Ki-Soo;Kang, Yune-Sik
    • Journal of agricultural medicine and community health
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    • v.39 no.3
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    • pp.146-160
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    • 2014
  • Objective: This study was performed to explore the effectiveness of community organization as a strategy for health promotion. Methods: We used data from community health interviews from 6 administrative sections (eup, myeon, or dong) with high mortality from August to October, conducted once in both 2010 and 2013 as part of the Health Plus Happiness Plus Projects based on the concept of community empowerment in Gyeongsangnam-do Province. For 2010, the study subjects comprised a systematic sampling of 220 adults from each of the six sections for a total of 1320 subjects, and for 2013, 200 from each section for a total of 1200 subjects. We compared main health behavior indicators and empowerment score between these two years. Results: Smoking prevalence in men was 47.4% in 2013, and 47.7% in 2010, respectively. Prevalence of walking 5 days or more per week was 35.6% in 2013, significantly lower than 46.2% in 2010. Also, during that period, both biennial health examination rate and biennial gastric cancer screening rate among those 40 years of age and over significantly increased from 57.7% to 63.6% and from 49.3% to 55.0%, respectively. Mean empowerment score at the community level significantly increased from 12.6 to 14.0. Conclusions: This study suggests that the three-year implementation of community organization might have helped to increase the participation rate of biennial health examinations including cancer screenings in the community. However, this was not the case for smoking cessation and walking. Further studies are needed for evidence-based health promotion.

Oral Hygiene Management and Factor Analysis of the Community People (일부지역 주민들의 구강환경관리 및 요인분석)

  • Park, Hyang-Sook;Kim, Jin-Soo;Kim, Jin-Mi;Kim, Yoon-Sin
    • Journal of dental hygiene science
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    • v.10 no.1
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    • pp.11-16
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    • 2010
  • The subjects of this study were patients at scaling practice, the total number of the subjects was 249 of 138 men and 111 women. The results were analyzed using SPSS 12.0. 1. In oral health care, among tooth brushing methods, scrub method was found to be 65.9%(164 patients), and 83.9%(209 patients) did not use oral care aids. 2. Mean calculus index was $0.57{\pm}0.22$. 3. For calculus index per tooth brushing method, there was statistically significant difference in all of the upper jaw, the lower jaw, the anterior portion, and the posterior portion(p < 0.05). 4. For calculus index per frequency of tooth brushing, there was statistically significant difference in the upper jaw, the lower jaw, and the posterior portion(p < 0.05). 5. For calculus index per time of tooth brushing and per use of oral care aids, there was statistically significant difference in all of the upper jaw, the lower jaw, the anterior portion, and the posterior portion(p < 0.05). 6. For factors influencing calculus index, as a result of applying stepwise method based on 0.05 of significance level, age, use of oral care aids, sex, and time of tooth brushing were found to influence calculus index. Final regression model was calculus index = $0.362^*age+0.216^*$use of oral care aids - $0.161*sex-0.127^*$time of tooth brushing, and explanatory power of the model was 23.4%. $0.362^*age+0.216^*$use of oral care aids - $0.161^*sex-0.127^*$time of tooth brushing, and explanatory power of the model was 23.4%.

Personnel's Perception toward Conducting an Autopsy in General Hospital (대학병원 직원들의 부검에 대한 인식도)

  • Lee, Ho-Beom;Kwak, Jyung-Sik
    • Journal of forensic and investigative science
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    • v.2 no.2
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    • pp.30-49
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    • 2007
  • An autopsy is a postmortem assessment or examination of a body to determine cause of death or manner of death. The author had surveyed Personnel's perception toward conducting an autopsy in general hospital with autopsy at YeungNam University Medical Center, Daegu, Korea from April, to May, 2007. The total number of 286 personnel consisted of 121 men(42.3%), 165 women(57.7%). There were 57 doctors(19.9%), 71 nurses(24.8%), 83 medical technicians (29.0%), 58 office workers(20.3%), and 17 others(5.9%). 61.4% of doctors had an experience of education for autopsy more than 2 times, but nurses(1.4%), medical technicians(15.7%), office workers(1.7%), and others(5.9%) had little experience. Response of conducting an autopsy for sudden death of respondent or respondent's family member was 59.6% of doctors, 22.5% of nurses, 39.8% of medical technicians, 41.4% of office workers, and 35.3% of others. Response of conducting an autopsy for sudden death of respondent's companion was 66.7% of doctors, 33.8% of nurses, 39.8% of medical technicians, 43.1% of office workers, and 17.6% of others. Response of conducting an autopsy for sudden death of patients in general hospital was 50.9% of doctors, 8.5% of nurses, 19.3% of medical technicians, 24.1% of office workers, and 17.6% of others. Survey about a proper institution for autopsy showed 73.7% of doctors for department of forensic medicine in medical school, and 62.0% of nurses, 59.0% of medical technicians, 46.6% of office workers, and 58.8% of others for National Institute of Scientific Investigation. Most of the respondents agreed with the forensic pathologist as the director of autopsy:98.2% of doctors, 94.4% of nurses, 96.4% of medical technicians, 89.7% of office workers, and 88.2% of others. Survey for necessity for autopsy showed responsiveness of doctors, 23.9% of nurses, 47.0% of medical technicians, 34.5% of office workers, and 23.5% of others. Survey for donation of him- or herself after death to the medical school or institution for the death investigation revealed responsiveness of 22.8% of doctors, 11.3% of nurses, 24.1% of medical technicians, 22.4% of office workers, and 23.5% of others. The result of the survey questionnaire showed more negative awareness for autopsy in nurses, medical technicians, office workers, others and than doctors. To improve the negative awareness for autopsy and settle proper postmortem inspection system, education of professional manpower for forensic medicine and inaction of law which is adequate for the actual circumstance of Korea should be considered.

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Influences of the devastated forest lands on flood damages (Observed at Chonbo and the neighbouring Mt. Jook-yop area) (황폐임야(荒廢林野)가 수해참상(水害慘狀)에 미치는 영향(影響) (천보산(天寶山)과 인접(隣接) 죽엽산(竹葉山)을 중심(中心)으로))

  • Chung, In Koo
    • Journal of Korean Society of Forest Science
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    • v.5 no.1
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    • pp.4-9
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    • 1966
  • 1. On 13 September 1964 a storm raged for 3 hours and 20 minutes with pounding heavy rainfalls, and precipitation of 287.5 mm was recorded on that day. The numerous landslides were occured in the eroded forest land neighbouring Mt. Chunbo, while no landslides recorde at all on Mt. Jookyup within the premise of Kwangnung Experiment Station, the Forest Experiment Station. 2. Small-scalled Landslides were occured in 43 different places of watershed area (21.97 ha.) in which the survey had already been done, in and around Mt. Chunbo (378 m a.s.l.). The accumulated soil amount totaled $2,146,56m^3$ due to the above mentioned landslides, while soil accumulated from riverside erosion has reached to $24,168.79m^3$, consisting of soils, stones, and pebbles. However, no landslides were reported in the Mt. Jook yup area because of dense forest covers. The ratio of the eroded soil amount accumulated from the riversides to that of watershed area was 1 to 25. On the other hand, the loss and damage in the research area of Mt. Chonbo are as follows: 28 houses completly destroyed or missing 7 houses partially destroyed 51 men were dead 5 missing, and 57 wounded. It was a terrible human disaster However, no human casualties were recorded at all, 1 house-completly destroyed and missing, 2 houses-partially destroyed. Total:3 houses were destroyed or damaged, in The area of Mt. Jookyup 3. In the calculation of the quanty of accumulated soil, the or mula of "V=1/3h ($a+{\sqrt{ab}}+b$)" was used and it showed that 24, 168.79m of soil, sands, stones and pebbles carried away. 4. Average slope of the stream stood 15 at the time of accident and well found that there was a correlation between the 87% of cross-area sufferd valley erosion and the length of eroded valley, after a study on regression and correlation of the length and cross-area. In other works, the soil erosion was and severe as we approached to the down-stream, counting at a place of average ($15^{\circ}1^{\prime}$) and below. We might draw a correlation such as "Y=ax-b" in terms of the length and cross-area of the eroded valley. 5. Sites of char-coal pits were found in the upper part of the desert-like Mt. Chunbo and a professional opinion shows that the mountain was once covered by the oak three species. Furthermore, we found that the soil of both mountains have been kept the same soil system according to a research of the soil cross-area. In other words, we can draw out the fact that, originally, the forest type and soil type of both Mt. Chunbo (378m) and Mt. Jookyup (610m) have been and are the same. However, Mt. Chunbo has been much more devastated than Mt. Jookyup, and carried away its soil nutrition to the extent that the ratios of N. $P_2O_5K_2O$ and Humus C.E.C between these two mountains are 1:10;1:5 respectively. 6. Mt. Chunbo has been mostly eroded for the past 30 years, and it consists of gravels of 2mm or larger size in the upper part of the mountain, while in the lower foot part, the sandy loam was formulated due to the fact that the gluey soil has been carried and accumulated. On the hand, Mt. Jookyup has consitantly kept the all the same forest type and sandy loam of brown colour both in the upper and lower parts. 7. As for the capability of absorbing and saturating maximum humidity by the surface soil, the ratios of wet soil to dry soil are 42.8% in the hill side and lower part of the eroded Mt. Chunbo and 28.5% in the upper part. On the contrary, Mt. Jookyup on which the forest type has not been changed, shows that the ratio in 77.4% in the hill-side and 68.2% in the upper part, approximately twice as much humidity as Mt. Chunbo. This proves the fact that the forest lands with dense forest covers are much more capable of maintaining water by wood, vegitation, and an organic material. The strength of dreventing from carring away surface soil is great due to the vigorous network of the root systems. 8. As mentioned above, the devastated forest land cause not only much greater devastation, but also human loss and property damage. We must bear in mind that the eroded forest land has taken the valuable soil, which is the very existance of origin of both human being and all creatures. As for the prescription for preventing erosion of forest land, the trees for furtilization has to be planted in the hill,side with at least reasonable amount of aertilizer, in order to restore the strength of earth soil, while in the lower part, thorough erosion control and reforestation, and establishments along the riversides have to be made, so as to restore the forest type.

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The Utility of Scalene Lymph Node Biopsy in the Diagnosis of Sarcoidosis (유육종증 진단에서의 사각근 림프절 생검의 유용성)

  • Chung, Won-Sang;Kim, Young-Hak;Song, Young-Joo;Kim, Ji-Hoon;Kim, Hyuck
    • Journal of Chest Surgery
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    • v.43 no.6
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    • pp.694-699
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    • 2010
  • Background: In addition to clinical and radiographic findings, a histopathologic examination is important in the diagnosis of sarcoidosis. This study evaluated the diagnostic usefulness of a scalene node biopsy in patients with suspected sarcoidosis. Material and Method: We studied 35 patients who underwent scalene node biopsy because of suspicion of sarcoidosis on a chest x-ray and a computerized tomogram between 2001 and 2009, regardless of symptoms. Result We studied 15 men and 20 women whose mean age was $41.51{\pm}11.21$ years (25~64). Three among the 35 were diagnosed with tuberculosis and 27 with sarcoidosis, resulting in a diagnostic yield of 84.4%. The mean lymph node diameter size was 1.3 (${\pm}0.12$) (0.3~3.6 cm) cm. We divided the group of participants according to stage - whether on chest x-ray the lung was affected or not (stage 0, 1 and stage 2, 3). We divided lymph node sizes as well - whether they were larger than 1 cm or smaller than 1 cm. For these subgroups, there were no significant differences in diagnostic yield (p=0.604) (p=0.084). There were no complications or mortality. Conclusion: Scalene node biopsies are simply done under local anesthesia, without major complications. They have a high diagnostic yield regardless of the stages of the disease and lymph node size. We conclude that scalene node biopsy is a good alternative to other biopsy methods in sarcoidosis.