• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.26 no.4
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• pp.386-394
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• 2022

Splenic artery steal syndrome (SASS) is a cause of graft hypoperfusion leading to the development of biliary tract complications, graft failure, and in some cases to retransplantation. Its management is still controversial since there is no universal consensus about its prophylaxis and consequently treatment. We present a case of SASS that occurred 48 hours after orthotopic liver transplantation (OLTx) in a 56-year-old male patient with alcoholic cirrhosis and severe portal hypertension, and who was successfully treated by splenic artery embolization. A literature search was performed using the PubMed database, and a total of 22 studies including 4,789 patients who underwent OLTx were relevant to this review. A prophylactic treatment was performed in 260 cases (6.2%) through splenic artery ligation in 98 patients (37.7%) and splenic artery banding in 102 (39.2%). In the patients who did not receive prophylaxis, SASS occurred after OLTx in 266 (5.5%) and was mainly treated by splenic artery embolization (78.9%). Splenic artery ligation and splenectomies were performed, respectively, in 6 and 20 patients (2.3% and 7.5%). The higher rate of complications registered was represented by biliary tract complications (9.7% in patients who received prophylaxis and 11.6% in patients who developed SASS), portal vein thrombosis (respectively, 7.3% and 6.9%), splenectomy (4.8% and 20.9%), and death from sepsis (4.8% and 30.2%). Whenever possible, prevention is the best way to approach SASS, considering all the potential damage arising from an arterial graft hypoperfusion. Where clinical conditions do not permit prophylaxis, an accurate risk assessment and postoperative monitoring are mandatory.

• The Korean journal of internal medicine
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• v.39 no.2
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• pp.295-305
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• 2024

Background/Aims: The prognosis of patients with idiopathic pulmonary fibrosis (IPF) and respiratory failure requiring mechanical ventilation is poor. Therefore, mechanical ventilation is not recommended. Recently, outcomes of mechanical ventilation, including those for patients with IPF, have improved. The aim of this study was to investigate changes in the use of mechanical ventilation in patients with IPF and their outcomes over time. Methods: This retrospective, observational cohort study used data from the National Health Insurance Service database. Patients diagnosed with IPF between January 2011 and December 2019 who were placed on mechanical ventilation were included. We analyzed changes in the use of mechanical ventilation in patients with IPF and their mortality using the Cochran-Armitage trend test. Results: Between 2011 and 2019, 1,227 patients with IPF were placed on mechanical ventilation. The annual number of patients with IPF with and without mechanical ventilation increased over time. However, the ratio was relatively stable at approximately 3.5%. The overall hospital mortality rate was 69.4%. There was no improvement in annual hospital mortality rate. The overall 30-day mortality rate was 68.7%, which did not change significantly. The overall 90-day mortality rate was 85.3%. The annual 90-day mortality rate was decreased from 90.9% in 2011 to 83.1% in 2019 (p = 0.028). Conclusions: Despite improvements in intensive care and ventilator management, the prognosis of patients with IPF receiving mechanical ventilation has not improved significantly.

• Journal of Food Hygiene and Safety
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• v.34 no.1
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• pp.40-51
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• 2019

Ginseng has a unique production system that is different from those used for other crops. It is subject to the Ginseng Industry Act., requires a long-term cultivation period of 4-6 years, involves complicated cultivation characteristics whereby ginseng is not produced in a single location, and many ginseng farmers engage in mixed-farming. Therefore, to bring the production of Ginseng in line with GAP standards, it is necessary to better understand the on-site practices of Ginseng farmers according to established control points, and to provide a proper action plan for improving efficiency. Among ginseng farmers in Korea who applied for GAP certification, 77.6% obtained it, which is lower than the 94.1% of farmers who obtained certification for other products. 13.7% of the applicants were judged to be unsuitable during document review due to their use of unregistered pesticides and soil heavy metals. Another 8.7% of applicants failed to obtain certification due to inadequate management results. This is a considerably higher rate of failure than the 5.3% incompatibility of document inspection and 0.6% incompatibility of on-site inspection, which suggests that it is relatively more difficult to obtain GAP certification for ginseng farming than for other crops. Ginseng farmers were given an average of 2.65 points out of 10 essential control points and a total 72 control points, which was slightly lower than the 2.81 points obtained for other crops. In particular, ginseng farmers were given an average of 1.96 points in the evaluation of compliance with the safe use standards for pesticides, which was much lower than the average of 2.95 points for other crops. Therefore, it is necessary to train ginseng farmers to comply with the safe use of pesticides. In the other essential control points, the ginseng farmers were rated at an average of 2.33 points, lower than the 2.58 points given for other crops. Several other areas of compliance in which the ginseng farmers also rated low in comparison to other crops were found. These inclued record keeping over 1 year, record of pesticide use, pesticide storages, posts harvest storage management, hand washing before and after work, hygiene related to work clothing, training of workers safety and hygiene, and written plan of hazard management. Also, among the total 72 control points, there are 12 control points (10 required, 2 recommended) that do not apply to ginseng. Therefore, it is considered inappropriate to conduct an effective evaluation of the ginseng production process based on the existing certification standards. In conclusion, differentiated certification standards are needed to expand GAP certification for ginseng farmers, and it is also necessary to develop programs that can be implemented in a more systematic and field-oriented manner to provide the farmers with proper GAP management education.

• Journal of the Korean Society for Marine Environment & Energy
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• v.19 no.4
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• pp.332-340
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• 2016

Sunken ships cause damage to the environment due to the dispersal of fuel oil and harmful cargo goods in the hull. Since the sunken ship is mostly flooded by the seabed, it tends to be in a relatively stable condition. However, the heavy body, together with the load of remaining goods in the cargo hold, the constant contact with the seabed, and ocean currents and tidal waves, can affect dispersal of residual fuel oils out of the sunken ship. Corrosion of the sunken ship starts upon sinking, decreasing the thickness of the hull structure and sub-materials. Therefore, it is necessary to assess the structural stability against the potential breakdown of the sunken ship. Whilst evaluating the danger of the sunken ship, this result should be reflected in 'the possible discharge'. This study was undertaken to suggest a procedure for a step by step evaluation to assess the structural stability a sunken ship. The structural stability assessment to estimate the collapsibility of the hull was structure targeted at the sunken ship 'No. 7 HaeSung', which was classified as the prime example for the intensive management of sunken ships. This study was undertaken to suggest a procedure for a step by step evaluation to assess the structural stability a sunken ship and to propose a method to conduct a structural safety assessment that estimates the collapsibility of the hull by targeting the sunken ship 'No. 7 HaeSung',which was classified as the prime example for the intensive management of sunken ships. The collapsibility of the hull structure was estimated Based on the damage size of the hull structure, and the corrosion rate of the hull structure and sub-materials due to the seawater after sinking. It was confirmed that there was a low possibility of the total destruction of the hull structure at the current time. However, there is a high possibility in the potential failure of the hull structure due to increased rate of corrosion thereafter. Therefore, we believe continuous study on influence of corrosion and marine environment change to sunken ship's structural safety is necessary.

• Clinical and Experimental Pediatrics
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• v.48 no.7
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• pp.731-736
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• 2005

Purpose : Acute pyogenic osteomyelitis is uncommon in children. Delayed diagnosis and inappropriate treatment are leading to growth failure and deformation. We review the clinical manifestations and treatment of acute osteomyelitis in children according to age. Methods : A retrospective analysis was made of 32 patients who underwent antibiotic management or operation between Aug 1989 and Dec 2003 for acute pyogenic osteomyelitis in age from 0 to 15 years old. Results : The study group was composed of 21 boys and 11 girls. The subjects were divided into four groups according to age : 0-1 yr(n=6), 1-5 yr(n=11), 6-10 yr(n=8), and 11-15 yr(n=7). Nineteen cases were diagnosed in Winter. Femur was the most common infected site(37.5%). There were no predisposing factor in 17 patients, and 7 of 15 patients had trauma history. Sepsis was important predisposing factor in neonates. The chief complaints were pain, swelling and fever. S. aureus(61%) is the most common organism. Twenty-nine patients were treated with operation and concomitant antibiotics. Two cases had sequelae in follow-up period : One is avascular necrosis of femur and the other is discrepancy of leg length. Conclusion : In our review, because of poor prognosis in septic neonates, we recommend to treat actively neonatal sepsis and prevent or detect osteomyelitis early. Because most of patients were diagnosed and treated in orthopedic surgery, the rate of operation was too high. So, protocol for further evaluation and management of acute osteomyelitis in pediatric patients were needed.

• Clinical and Experimental Pediatrics
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• v.46 no.12
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• pp.1230-1234
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• 2003

Purpose : The aim of this study is to evaluate the value of lung biopsies for the management of children with lung disease. Methods : We retrospectively reviewed 19 lung biopsies done at Asan Medical Center, Seoul between 1993 and 2001. Data gathered included demographic information, underlying conditions, diagnosis before biopsy, final diagnosis, change in therapy, morbidity and mortality. Results : Nineteen patients underwent lung biopsy. Among them, 13 patients were male and six patients were female; the median age was 3.6 years(0.8 to 8.6 years). Twelve patients underwent open lung biopsies and seven patients had thoracoscopic biopsies. The overall diagnosis rate was 95 %. The most common diagnosis was interstitial lung disease(12 patients, 64%) and infection was detected in four patients(21%). The biopsy-proven bronchiolitis obliterance was confirmed in two of seven patients suspected by CT findings. Specific treatment was changed after biopsy in 16 patients (85%). The morbidity & overall mortality rates of the patients were 5%(one patient) and 21%(four patients) respectively. Only one complication was seen : empyema. The causes of death were acute respiratory distress syndrome(one patient), respiratory failure(two patients), and septicemia(one patient). Conclusion : The lung biopsy is a safe procedure and it contributes to more accurate diagnosis and proper management of pediatric lung diseases. We recommend lung biopsies should be considered more positively in the diagnosis of pediatric lung diseases.

• Journal of Distribution Research
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• v.17 no.5
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• pp.129-146
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• 2012

Recently, Korea became the 7th country in the world which has got into the 20-50 clubs that means the population is 50 million and per capital income is $20,000. From the view point of the retail industry, it suggests that Korea should have its own self-sufficient market by itself. With abundant labor and increased disposable income, it made the consumer's needs change. Responding to the change, retail and F&B oriented retail malls are now starting to add culture, art and entertainment facilities in the configurations. Such complexity and variety of the shopping malls became trendy and many shopping complexes are scheduled to open in the near future across the country. Due to above reasons, it became the common trend to develop shopping complex all over the cities now. However, the history of the shopping mall in Korea is much shorter than developed countries such as America and Japan. Thereby, a lot of problems, trial and error have occurred in the process of developing and operating them. If development of shopping complex failed, it would return lots of damages to the stakeholder. Therefore, the corporations should develop the mall properly and government might support positively. In this study, we would like to propose on how all the mall should be developed and well managed and what are the ways for the vitalizing factors of the shopping complex after benchmarking other shopping mall cases. Through the case study, we realized that the most crucial factors for vitalizing shopping complex were interior design, merchandising and how well they operate the mall. In case of the failed shopping mall, developers sell each store to individual proprietors and never take care of them after they get the profit, which make it hard to have integrated marketing strategies. That causes the overall slump of the mall. Corporations developing the mall should operate it as well, so that it could be possible to make the mall consistently well managed and promoted. There is a certificate for the shopping mall expert in The States and Japan. However, we do not have this kind of certificate. In fact, if we judge the capability of a person who is involved in the shopping mall industry, we usually measure how many years they stick to the same industries and that is not equally the same as their competence. Therefore it is necessary to organize "Shopping Mall Associate" and introduce shopping mall license for the mall expert. Due to retail trends, we can easily see a lot of shopping facilities all over the cities but not every mall is able to be successful. We think it's essential that the government should certify the malls which are qualified for the design, merchandising and proficiency of the operation. For the qualified mall, the government could confer a benefit on the company such as reducing corporation taxes. In multi-complex shopping mall it is possible to make convenient for customers. However, if a mall failed to succeed, it would be disaster. To build a shopping complex, developers should invest huge money even take out loan so that many people would be connected to the project, which may affect their whole financial conditions. In addition, only qualified corporation should develop and operate shopping complex and the government must support and aid the developers in order to make a better shopping environment in which customers might be happy during their shopping experience.

• Tuberculosis and Respiratory Diseases
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• v.43 no.1
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• pp.14-21
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• 1996

Objectives: Although outbreak of MDR Tb has been a recent problem in western countries, it has been a longstanding problem in Korea. The poor outcome of MDR Tb is mainly due to poor compliance, high rate of side reaction of secondary drugs, and limitation in number of available drugs. Thus, to improve the outcome of MDR Tb, it is crucial to make individualized adequate prescription based on the knowledge of the patterns of resistance to each drugs in the community as well as the natural history. The purpose of present study is to evaluate the clinical features of Korean MDR Tb patients including patterns of drug resistance and success rate of treatment which was prescribed according to the sensitivity tests. Methods: Retroscpective analysis of 71 Korean patients with MDR Tb was made. All strains isolated from patients showed resistence to at least two first line drugs. Patients profile, previous treatment history, patterns of drug resistance, outcome of treatment was analysed. Initial treatment regimen was selected according to the previous treatment history and was modified according to the sensitivity reports. The regimen was composed to include at least 4 sensitive drugs when possible. Results: The patients showed resistance to 4.1 drugs on average. 90% of them were resistant to INH and RFP. Among 71 patients, 35 patients(49%) had cavitary lesions in CXR. Treatment outcome was analysed in 55 patients. 35 patients(67%) were improved after treatment and 18 patients(33%) showed treatment failure. 5 patients showed primary resistance. Treatment outcome could be evaluated in 4 of them and all showed improvement after treatment. 14 patients(20%) had to change their regimens due to drug side effects. The most frequent side effect was elevation of liver enzymes(6 patients). Others included dizziness, hyperuricemia, tinnitus, skin rash, GI troubles. More than 50% of side effects developed within 3 months. In repeated drug sensitivity test, the concordance rate of resistance to INH was 100% and RFP 98%. EMB, PZA showed 80% concordance rate. But in the other drugs, the concordances were less than 50%. Operation was done in 5 patient - 1 patients as a adjunctive means of chemotherapy -. In that case, negative conversion of sputum AFB was done. Conclusion: 2/3 patients of multidrug-resistant tuberculosis were improved by appropriate prescription and regular medication suggesting that more aggressive management and monitoring is indicated in multidrug-resistant tuberculosis.

• Asia-Pacific Journal of Business Venturing and Entrepreneurship
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• v.11 no.5
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• pp.29-43
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• 2016

The Lean Startup, a methodology for minimizing failure rate of startups, has been receiving attention since its publication in 2011. Although it has been receiving enormous attention as an effective methodology of startups' growth and the emergence of unicorn companies, it is undeniable that the theoretical research and cases on this topic have not been fully accumulated in Korea. Progress of management theory has been made when combining the theory and case studies. In this paper, we thus excavated the 'Cardoc' case, which has applied the lean startup concept to the entire process of service and customer development from the inception of its product design. The following are the findings of the case. First, for the successful application of lean startup, it is essential that all team members to understand the lean startup concept and are willing to apply it thoroughly to the business management. Second, the prompt launching of MVP(Minimum Viable Product) is more important than table discussion. Third, it is crucial to select the appropriate key metrics and analytic tools for effective learning. Fourth, startup must scale up promptly as soon as it verifies the product-market fit through the BML(Build-Measure-Learn) iteration cycle. Fifth, all new business expansion should be lean. Cardoc is currently testing new MVPs in order to move onto the next scale-up process with huge investments in newly added segments. This study is meaningful in that it elaborates the representative case of a Korean startup that has applied the lean startup strategy under the circumstance of insufficient discussion of Korean startup cases in comparison with growing attention both in concept development and case accumulation abroad. We hope that this paper can be a stepping stone for future relevant research on the implementation of lean startup methodology in Korea.

• Journal of Chest Surgery
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• v.38 no.5 s.250
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• pp.335-348
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• 2005

Background: This retrospective review examines the preoperative condition, postoperative course, mortality and cause of death for the patients who underwent modified Blalock-Taussig shunt for complex congenital heart defects in early infancy. Material and Method: Fifty eight patients underwent modified Blalock-Taussig shunts from January 2000 to November 2003. The mean age at operation was $23.1\pm16.2$ days ($5\~81\;days$), and the mean body weight was $3.4\pm0.7\;kg\;(2.1\~4.3\;kg)$. Indications for surgery were pulmonary atresia with ventricular septal defect in 12 cases, pulmonary atresia with intact ventricular septum in 17, single ventricle (SV) in 18, and hypoplastic left heart syndrome (HLHS) in 11. Total anomalous pulmonary venous return (TAPVR) was associated with SV in 4 cases. Result: There were 11 ($19.0\%$) early, and 5 ($10.6\%$) late deaths. Causes of early death included low cardiac output in 9, arrhythmia in 1, and multiorgan failure in 1. Late deaths resulted from pneumonia in 2, hypoxia in 1, and sepsis in 1. Risk factors influencing mortality were preoperative pulmonary hypertension, metabolic acidosis, use of cardiopulmonary bypass, HLHS and TAPVR. Twenty four patients ($41.4\%$) had hemodynamic instability during the 48 postoperative-hours. Six patients underwent shunt revision for occlusion, and 1 shunt division for pulmonary overflow. Conclusion: Modified Blalock-Taussig shunt for complex congenital heart defects in early infancy had satisfactory results except in high risk groups. Many patients had early postoperative hemodynamic instability, which means that continuous close observation and management are mandatory in this period. Aggressive management may appear warranted based on understanding of hemodynamic changes for high risk groups.