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Clinical Study of the Treatment of Chronic Empyema with Open Window Thoracostomy: 10 Years Experience (개방식 배농술을 이용한 만성 농흉 치료의 임상적 고찰 - 10년 경험 -)

  • Kim, Young-Kyu;Kim, Yeong-Dae
    • Journal of Chest Surgery
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    • v.40 no.11
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    • pp.765-769
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    • 2007
  • Background: The curative treatment of choice for empyema is decortication of the pleura. The risks of this treatment however are increased for the patient with reduced pulmonary function, complicated calcification or septic shock. In the past, open window thoracostomy was a final stage treatment for chronic empyema. Relatively safe treatment of empyema could be achieved in difficult cases with a closure of the open window after open drainage and use of a myocutaneous flap (one stage or staged). Material and Method: A retrospective study of the cause, progression and final outcome of empyema patients who received open window thoracostomy was performed. 21 patients were followed from 1995 to 2004 in the department of Thoracic and Cardiovascular Surgery in the College of Medicine, Pusan National University. Result: The average age of the patients was $57.5{\pm}15.5$ years (range $25{\sim}78$ years), of whom 16 (76.2%) were men and five (23.8%) were women. Pulmonary function test results showed an average FEV1 of $1.58{\pm}0.49 L$. The type of empyema was tuberculous empyema in 13 cases (61.9%), aspergillosis in three cases (14.3%), parapneumonic empyema in three cases (14.3%) and post-resectional empyema in two cases (10%). Bronchopulmonary fistula was seen in 14 cases. Eight cases were complicated by severe calcification of the pleura. For the four cases of bronchopulmonary fistula, the patients' serratus anterior muscle was covered in their first operation. The average number of ribs resected was $4{\pm}1$. Closure of the open window thoracostomy was performed in 12 cases. The average time to closure after open drainage was $10.22{\pm}3.11$ months and the average defect of the empyemal cavity before the final operation was $330{\pm}110 cc$. Among the 12 cases, there were two cases of spontaneous closure. In two cases closure was only achieved by using the reserved skin fold during the first surgery. Of the remaining eight cases, in seven we used the myocutaneous flap (four cases of lattisimus dorsi muscle and three cases of pectoralis major muscle), and in one case we used soft tissue. As regards complications of the closure, tissue necrosis occurred in one case, which led to failed closure, and there was one case of abdominal hernia in the rectus abdominis muscle flap. One patient died within 30 days of the surgery and one patient died of metastatic cancer. Conclusion: A staged operation with a final closure using open window thoracostomy, which consists of open drainage, transposition of the muscle and a myocutaneous flap, can be a safe and effective option for the chronic empyema patient who is difficult to cure with traditional surgical methods.

Correlation of Clinical Outcome and Cuff Integrity after Open Repair in Large and Massive Rotator Cuff Tears (대형 및 광범위 회전근 개 파열의 개방적 봉합술 후 임상적 결과와 회전근 개 연속성(integrity)의 상관 관계)

  • Noh, Haeng-Kee;Wang, Joon-Ho;Kim, Dong-Hwee;Park, Jong-Woong;Kim, Jae-Gyoon;Park, Jung-Ho
    • Clinics in Shoulder and Elbow
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    • v.10 no.1
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    • pp.65-72
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    • 2007
  • Purpose: To evaluate the relationship between the clinical outcome and the cuff integrity following open repair in large and massive rotator cuff tears using ultrasonography as an imaging modality. Material and Methods: From November 2001 to April 2005, 17 cases(16 patients) who had open repair of tear measuring more than 3cm were assessed with minimal follow-up of 12 months in this study. 6 cases had a large tear and 11 cases a massive tear. There were 6 men and 11 women with a mean age of 52 years at surgery (range, 33 to 72 years). The evaluation consisted of the preoperative and postoperative shoulder scores according to UCLA shoulder scoring system and Visual analogue scale (VAS). Ultrasonography was performed by a experienced musculoskeletal physician at a minimum of 12 months postoperatively to evaluate the postoperative cuff integrity. Results: Retear were detected in four of seventeen cases. Regardless of the presence of recurrent tear, 14 cases had UCLA score of more than 29 points (good grade). All 17 had an improvement in the functional score, which increased from an average of 15.1 to 31.2 points. All cases showed pain relief and five cases had no pain. Sixteen cases except one had the range of motion of forward elevation above $90^{\circ}$. Conclusion: Open rotator cuff repair in large and massive tears showed low retear rate. At a minimum of twelve months follow-up, all cases had improvement on UCLA score, pain relief, increased range of motion of the shoulder regardless of retear. And the correlation between recurrent tear and function score was not statistically significant.

Trends and Refractive Status of Cataract Surgery - An Optometry Clinic-Based Survey in Chungbuk (백내장 수술 경향과 굴절상태 - 충북 지역의 안경원 중심으로 조사)

  • Kim, Hyeong-Su;Son, Jeong-Sik;Yu, Dong-Sik
    • Journal of Korean Ophthalmic Optics Society
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    • v.18 no.2
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    • pp.143-148
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    • 2013
  • Purpose: The aim of this study was to investigate the distribution of age and gender, types of intraocular lens (IOL), and refractive errors in subjects who had cataract surgery. Methods: 2,217 subjects who had cataract surgery were surveyed at an optometry clinic in Chungbuk from 2010 to 2012. Information about IOL was obtained from case history, reflective and retroillumination images IOL by auto refracto-keratometer. Refractive errors were determined by objective and subjective refraction. Results: The mean age of the subjects was $71.74{\pm}10.62$ years. The number of cataract surgeries increased from 524 persons in 2010 to 888 persons in 2012. Of the subjects surveyed, 52 persons (2.3%) were under the 40 years of age, 144 persons (6.5%) were in 50s, 404 persons (18.2%) were in 60s, 1,132 persons (51.1%) were in 70s, 485 persons (21.9%) were in above 80s. Cataract surgery was significantly prevalent in more female (1,338 persons, 60.4%) than in male (879 persons, 39.6%). Types of IOL were 2,141 persons (96.6%) for monofocal lens, special IOLs such as multifocal, accommodative and toric lens were 76 persons (3.4%). The distribution of refractive errors after cataract operation were 1,588 eyes (38.5%) for simple myopic astigmatism, 327 eyes (7.9%) for simple hyperopic astigmatism, 601 eyes (14.6%) for mixed astigmatism, 1,240 eyes (30.0%) for myopia, 136 eyes (3.3%) for hyperopia, and 234 eyes (5.7%) for emmetropia. The uncorrected and best corrected visual acuity of the subjects were $0.55{\pm}0.25$ and $0.80{\pm}0.23$, respectively. Conclusions: The prevalence of cataract surgery increased with age until 70s years of age, it was more prevalent in men than women over 60s, and frequency of special types of IOL were low. Most cataract surgeries left residual refractive errors. Therefore even after cataract surgery it may need spectacles for better vision at either distance or near.

Prevalence of Hypertension Among the Aged in Urban Area (일부 도시노인들의 고혈압증 유병률)

  • Kim, Suck-Bum;Kang, Pock-Soo;Chung, Jong-Hak
    • Journal of Yeungnam Medical Science
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    • v.4 no.1
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    • pp.123-128
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    • 1987
  • To estimate the prevalence of hypertension among the aged in urban area, the blood pressure was examined on the subjects of 565 men and 762 women of 65 years old and older among the residents of Nam-Ku and Soosung-Ku in Taegu between January and December, 1986. The mean systolic blood pressure was $136.0{\pm}25.01mmHg$ in male and $133.0{\pm}24.56mmHg$ in female. The mean diastolic blood pressure was $83.7{\pm}14.41mmHg$ in male and $82.4{\pm}14.43mmHg$ in female. There was no significant differences between male and female in both mean systolic and diastolic blood pressure. According to WHO category, the prevalence of pure systolic hypertension (${\geq}$160/<95mmHg) was 7.8% in male and 6.8% in female. The prevalence of pure diastolic hypertension(<160/${\geq}$95mmHg) was 6.0% in male and 3.9% in female. The prevalence of both systolic and diastolic hypertension (${\geq}160/{\geq}95mmHg$) was 13.5% in male and 12.9% in female. According to joint National Committee category, the percentage of normal blood pressure (/<90mmHg) was 46.7% in male and 50.8% in female. The prevalence of mild hypertension (/90=104mmHg) was 34.5% in male and 34.6% in female. The prevalance of moderate hypertension (/105=144mmHg) was 5.1% in male and 2.5% in female. The prevalence of severe hypertension (/${\geq}$115mmHg) was 2.3% in male and 3.0% in female. The prevalence of borderline isolated systolic hypertension (140-159/<90mmHg) was 9.0% in male and 6.6% in female. The prevalence of isolated systolic hypertension (${\geq}$160/<90mmHg) was 2.3% in male and 2.5% in female.

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MMPI and SCL-90-R Profiles in Patients with Sleep-Related Breathing Disorder (수면관련 호흡장애 환자의 MMPI 및 SCL-90-R 반응 특성)

  • Kim, Kyoung-Woo;Yoon, Seok-Joon;Yang, Chang-Kook;Han, Hong-Moo
    • Korean Journal of Psychosomatic Medicine
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    • v.10 no.1
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    • pp.37-47
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    • 2002
  • Objective : Previous studies have suggested an association between sleep-related breathing disorder (SRBD) and several psychological problems, and there were increasing recognition of the link. The purpose of this study is to evaluate the characteristic profiles of MMPI and SCL-90-R in patients with SRBD. Methods : This study consisted of 80 SRBD patients(73 men, 7 women) referred from Sleep Disorder Clinic of Dong-A University Hospital, Busan, Korea. Basic informations including demographic findings and physical examination were collected. Subjects completed the Epworth Sleepiness Scale(ESS), Minnesota Multiphasic Personality Inventory(MMPI), and Symptom Check List-90-Revision (SCL-90-R) prior to standard overnight polysomnography that was performed at hospital sleep laboratory. SRBD was divided into two groups of primary snoring(PS) and obstructive sleep apnea(OSA) according to polysomnographic findings. Results : SRBD showed significant elevation rate of Hs, D, and Hy scales of MMPI and SOM scale of SCL-90-R, which exceeded the rate expected in normal individuals(>5%, 2SD). On comparison of clinical scales of SCL-90-R, OSA group had significantly greater mean score than that of PS group in terms of O-C, DEP, PAR, GSI(p<0.05), SOM and PST(p<0.01). OSA group also showed significantly higher elevation rate in Hs scale of MMPI and SOM scale of SCL-90-R than that of PS. Among OSA group, three scales of MMPI(D, Pt, Si) and three scales of SCL-90-R(ANX, PAR, PSDI) had significant correlation with some PSG variables including total sleep time and sleep efficiency. Among PS group, two scales of MMPI(Hy and Pt), elevation rate of MMPI scales and three scales of SCL-90-R(I-S, PAR, PSDI) had significant correlation with some PSG variables including sleep efficiency, sleep latency and REM sleep percent. Conclusion : The above results suggest that SRBD show neurotic profiles in MMPI and SCL-90-R. This study also clearly indicates that PS group are suffered from clinically meaningful psychiatric symptoms, which are quantitatively lessened but qualitatively similar as compared to that of OSA group.

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Evaluation of the dietary quality and nutritional status of elderly people using the Nutrition Quotient for Elderly (NQ-E) in Seoul (노인 영양지수 (NQ-E)를 이용한 서울 일부지역 노인의 식생활 및 영양 상태 평가)

  • Ham, Sun-Wook;Kim, Kyung-Hee
    • Journal of Nutrition and Health
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    • v.53 no.1
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    • pp.68-82
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    • 2020
  • Purpose: This study evaluated the dietary quality and nutritional status of elderly people using the Nutrition Quotient for Elderly (NQ-E). Methods: The participants were 204 elderly people over 65 years of age (38 men and, 166 women) in Seoul. The dietary information was analyzed using a questionnaire of NQ-E, which consisted of 19 checklist items, and 24-recall test data. The NQ-E scores and its four factors, including 'balance', 'moderation', 'diversity', and 'dietary behavior' factors, were calculated according to general characteristics of the subjects. The subjects were divided into the 'monitoring needed group' (62 > NQ-E score) and the 'good group' (62 ≤ NQ-E score) according to their NQ-E score. Results: The mean NQ-E score of the total subjects was 61.9, which was within the mediumhigh grade. The scores of balance, moderation, and dietary behavior factors were within the medium-high grade, while the score of the diversity factor was within the medium-low grade. The NQ-E score was 54.8 in the monitoring needed group and 69.3 in the good group. For the score of the diversity factor, the elderly living alone had a significantly lower score than the score for the elderly living with a spouse. The female subjects showed significantly higher scores of moderation and dietary behavior factors than did the male subjects. The daily intakes of vitamin A, thiamin, riboflavin, vitamin C and calcium in the monitoring needed group were significantly lower than those in the good group. The nutrient adequacy ratios (NAR) of vitamin A, thiamin, riboflavin, vitamin C and calcium in the monitoring needed group were significantly lower compared to the scores of the good group. The indexes of nutritional quality (INQ) of vitamin A, thiamin, riboflavin, vitamin C, calcium and potassium were less than 1 for all the subjects. The monitoring needed group had a significantly lower consumption of total foods, vegetables and mushrooms than the good group. As a result, the nutritional status of the monitoring needed group was significantly lower than that of the good group. Conclusion: The results of this study show that NQ-E would be a useful tool for assessing the dietary quality of the elderly. In conclusion, a focused-nutrition education program and a useful guideline are needed for promoting the health and nutritional status in elderly people.

Perceptions of Body Shape and Weight Control in Individuals Consuming Weight-Control or Functional Health Foods (체중조절용 조제식품과 다이어트 건강기능식품 섭취자의 체형 및 체중조절 인식에 관한 연구)

  • Lee, Hyo-Jin;Won, Hye-Suk;Kwak, Jin-Sook;Kim, Mi-Kyung;Kwon, O-Ran
    • Journal of Nutrition and Health
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    • v.44 no.3
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    • pp.243-254
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    • 2011
  • The purpose of this study was to investigate the general characteristics, body shape, and perceptions of weight control in individuals consuming functional health foods and weight-control foods. The survey was conducted between April 15 and June 17, 2010 among 199 (57 males and 142 females; age range, 25-45 years) in Seoul and Gyeonggi-do, who experienced eating functional health foods or weight control foods during the past year (June 2009 to June 2010). The subjects were divided into a weight-control food group (89 adults) and a functional health food group (110 adults). The subjects were comprised of a high proportion of aged (average age, $34.2{\pm}5.9$ years), graduates (71.9%), and married (65.8%) individuals. In the weight control food group, gender, age, and educational background were similar and the ratios of service/technical employees, college students, and normal-weight individuals [body mass index (BMI), < 23] were high. BMI was significantly different by gender (p < 0.001), age (p < 0.01), marital status (p < 0.001), and job type (p < 0.001). Self-perceived health status showed a higher response for "in good health" in the 35-44 year old group than that in the 25-34 year old group (p < 0.05). Male group satisfaction for body shape was significantly higher than that in the female group. The main reason for going on a diet was significantly different by gender (p < 0.05) and BMI (p < 0.01). The main motives for dieting were "because I am not at an ideal weight" and "because of the social atmosphere and the attention of others " in men, but "can't wear the clothes I want" in women (p < 0.01). The most preferable product type related to the two groups was significantly different by job (p < 0.001) and BMI (p < 0.05). However, no significant differences were observed for questions about body shape perception and weight control. Consumers who had different general characteristics and used diet products perceived body shape and weight control differently. Additionally, no meaningful differences were observed when the results were categorized by product type, except job and BMI, but the distribution of consumer characteristics showed different tendencies. These results can be utilized as basic data for developing new diet products to help people control their weight more scientifically and appropriately in the future.

Sex Steroid Hormone and Ophthalmic Disease (성호르몬과 안질환)

  • Kim, Jin-Ju;Yu, Hyeong-Gon;Ku, Seung-Yup
    • Clinical and Experimental Reproductive Medicine
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    • v.37 no.2
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    • pp.89-98
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    • 2010
  • Sex and its tropic hormones influence the lacrimal system, corneal anatomy and disease, aqueous humor dynamics and glaucoma, crystalline lens and cataract, and retinal disease. Dry eye occurs especially frequently during pregnancy, oral contraceptive use, and after menopause, during which androgen levels decrease. Androgen control development, differentiation, and lipid production of sebaceous glands throughout the body, and androgen deficiency also leads to meibomian gland dysfunction and evaporative dry eye. On the other hand, estrogen causes a reduction in size, activity, and lipid production of sebaceous glands. Sex and its tropic hormones also influence the corneal anatomy and disease, and corneal thickening occurred on the second day of the menstrual cycle and around the time of ovulation and appeared to be related to estrogen levels. Fuchs' dystrophy is more commonly seen in postmenopausal women than men and may be linked to hormonal changes that occur with aging. In addition, overexpression of estrogen and progesterone receptors in the conjunctiva of vernal keratoconjunctivitis patients. Serum progesterone levels also may be associated with intraocular pressure especially in pregnant women, and for the women. For women with cataracts, hormone levels were typical of menopause, and there was a significant negative correlation between estradiol and follicular stimulating hormone levels. In addition, serum testosterone levels are associated with the development of diabetic retinopathy. Although the role of sex hormones on the eye is largely unknown, and the results should be interpreted with caution until replicated, the functions of sex hormones in ocular disease remains to be investigated, because they may be involved in structure and function of the ocular components, which are important in the pathogenesis of ocular disease.

Clinical Experience of Nephron Sparing Surgery for Renal Tumor with a Normal Opposite Kidney (대측 신장이 정상인 신종양 환자에서 신보존수술의 임상 경험)

  • Lee, Jun-Young;Kim, Jung-Hyun;Lee, Kang-Min;Moon, Ki-Hak;Jung, Hee-Chang;Park, Tong-Choon
    • Journal of Yeungnam Medical Science
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    • v.16 no.1
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    • pp.94-100
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    • 1999
  • The aim of this retrospective study was to determine whether a nephron sparing surgery might be feasible in patients with a small solid renal tumor. Materials and methods: Between 1988 and 1999, 21 patients with a radiologically detectable small solid renal tumor underwent enucleoresection, wedge resection and polar segmental nephrectomy. The mean age of the 11 men and 10 women in this study was 43 years (range 14 to 68). According to the preoperative radiological diagnosis, 15 among the 21 patients were considered to have renal cell carcinoma, 4 were considered to have angiomyolipoma, and in the remaining 2 patients, radiological differentiation of renal tumors was difficult. Among 15 patients considered to have renal cell carcinoma, 14 were found to have renal cell carcinoma and the remaining one patient was diagnosed as having oncocytoma on pathologic examination. Radiological determination of angiomyolipoma in four patients was confirmed to be correct on pathological examination. The 2 patients whose radiological diagnose was difficult were found to have cavernous hemangioma and angiomyolipoma. One patient with renal cell carcinoma developed arteriocaliceal fistula, the only immediate complication in this series and underwent nephrectomy on postoperative 10th day. The mean follow up duration for the 14 patients with renal cell carcinoma was 18.6 months (range:1-103). There was no other tumor involvement in the resection margins following the nephron sparing surgery. These results suggest that nephron sparing surgery provides an effective treatment for patients with a single, small, unilateral, localized renal tumor. Longer follow-up is suggested for more definite verification of the role of nephron sparing surgery.

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Korean Art from the view of foreigners in Korea from the period of independence to 1950s (광복 후부터 1950년대까지 한국에서 활동한 외국인이 본 한국미술)

  • Cho, Eun-Jung
    • The Journal of Art Theory & Practice
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    • no.4
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    • pp.123-144
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    • 2006
  • Foreigners who arrived in Korea after the age of enlightenment were Japanese, Chinese and 'Westerners' who were Europeans and Americans. The westerners were diplomats who visited Korea for colonization or for increasing their economical profits by trading after the spread of imperialism, and tourists curious of back countries, artists, explores and missionaries to perform their roles for their religious beliefs. They contacted with Korean cultural and educational people as missionaries and instructors during Japanese colonial period. In 1945, the allied forces occupied Korea under the name of takeover of Japanese colony after Japan's surrender and the relation between foreigners and Korean cultured men enter upon a new phase. For 3 years, American soldiers enforced lots of systems in Korea and many pro-American people were educated. This relationship lasted even after the establishment of the government of Korean Republic and especially, diplomats called as pro-Korean group came again after Korean War. Among them, there were lots of foreigners interested in cultures and arts. In particular, government officials under American Forces who were influential on political circles or diplomats widened their insights toward Korean cultural assets and collected them a lot. Those who were in Korea from the period of independence to 1950s wrote their impressions about Korean cultural assets on newspapers or journals after visiting contemporary Korean exhibitions. Among them, A. J. McTaggart, Richard Hertz and the Hendersons were dominant. They thought the artists had great interests in compromising and uniting the Orient and the West based on their knowledge of Korean cultural assets and they advised. However, it was different from Korean artist's point of view that the foreigners thought Korean art adhered oriental features and contained western contents. From foreigners' point of view, it is hard to understand the attitude Korean artists chose to keep their self-respect through experiencing the Korean war. It is difficult to distinguish their thought about Korean art based on their exotic taste from the Korean artists' local and peninsular features under Japanese imperialism. We can see their thought about Korean art and their viewpoint toward the third world, after staying in Korea for a short period and being a member of the first world. The basic thing was that they could see the potentialities through the worldwide, beautiful Korean cultural assets and they thought it was important to start with traditions. It is an evidence showing Korean artists' pride in regard to the art culture through experiencing the infringement of their country. By writing about illuminating Korean art from the third party's view, foreigners represented their thoughts through it that their economical, military superiority goes with their cultural superiority. The Korean artist's thought of emphasizing Korean history and traditions, reexamining and using it as an original creation may have been inspired by westerners' writings. 'The establishment of national art' that Korean artists gave emphasis then, didn't only affect one of the reactions toward external impact, 'the adhesion of tradition'. In the process of introducing Korean contemporary art and national treasure in America, different view caused by role differences-foreigner as selector and Korean as assistant-showed the fact evidently that the standard of beauty differed between them. By emphasizing that the basis to classify Korean cultural assets is different from the neighborhood China and Japan, they tried to reflect their understanding that the feature of Korean art is on speciality other than universality. And this make us understand that even when Korean artists profess modernism, they stress that the roots are on Korean and oriental tradition. It was obviously a different thought from foreigners' view on Korean art that Korean artists' conception of modernism and traditional roots are inherent in Korean history. In 1950s, after the independence, Korea had different ideas from foreigners that abstract was to be learned from the west. Korea was enduring tough times with their artists' self-respect which made them think that they can learn the method, but the spirit of abstract is in the orient.

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