• Journal of Gastric Cancer
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• v.9 no.3
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• pp.136-142
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• 2009

Purpose: This clinical study was conducted to evaluate the predictive value of tumor markers for recurrence and the clinical significance of false positive findings after curative gastrectomy in patients with gastric cancer. Materials and Methods: Two hundred ninety patients with gastric cancer who underwent gastrectomy with curative intent were evaluated retrospectively. We analyzed the correlations between changes in tumor markers (CEA, CA 19-9, AFP, and CA-125) and clinicopathologic data, and basis for changes in tumor markers without recurrence during the follow-up period. Results: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of tumor markers for recurrence were 75.0%, 64.6%, 23.1%, 94.8%, and 65.9% respectively. Among 36 patients with recurrences, 10 patients (27.8%) had elevated tumor markers prior to positive findings on imaging studies, while 13 patients (36.1%) had concomitant elevation in tumor markers. At least 1 of the 4 tumor markers increased in 90 of 290 patients during the follow-up period; however, there was no evidence of tumor recurrence. Twenty patients had persistently elevated tumor markers, while the tumor marker levels in 70 patients returned to normal level within $9.08\pm7.2$ months. The patients with pulmonary disease, hepatobiliary disease, diabetes, hypertension, or herbal medication users had elevated tumor markers more frequently than patients without disease (P<0.001). Conclusion: Although detecting recurrence of gastric cancer with tumor markers may be useful, false positive findings of tumor markers are common, so surgeons should consider other chronic benign diseases and medical conditions when tumor markers increase without evidence of recurrence.

• Journal of Gastric Cancer
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• v.8 no.3
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• pp.160-165
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• 2008

Purpose: With the introduction of H. pylori eradication and proton pump inhibitor, the operative treatments for the acute or chronic complications of peptic ulcer, such as perforation, bleeding and stricture, have decreased. Also owing to the development of non-operative treatment such as interventional endoscopic treatment, the surgical approach to the acute complications, like perforation and bleeding, has diminished. The non-operative treatments for the stricture and obstruction of chronic peptic ulcer in part related to discontinuation of medication have not been satisfactory. We analyzed the clinical outcomes of the patients who underwent operative treatment for outlet obstruction with peptic ulcer. Materials of Methods: From January 1994 to December 2007, we reviewed 31 patients who had been operated on at the National Medical Center for peptic ulcer obstruction. We excluded the cases of adhesive obstructions that were caused by a former ulcer operation and also the cases of obstructions found during emergency operations for treating perforation and bleeding. We classified the surgical treatment group into the bypass operation group and the surgical resection group. We evaluated the effects of the operations by the Visick score. The recurrences were confirmed only by the endoscopic observation of peptic ulcer. Results: The number of patients in the bypass operation group was 6 (19.4%) and that of resection group was 25 (80.6%). The mean age was 57.5 (25~81) years. The number of male patients was 29 (93.5%) and the number of females was 2 (6.5%). The mean symptom duration was 29.6 months. There were 19 smokers (61.3%), 6 NSAID users (19.4%) and 7 H. pylori positive patients (22.6%). Two patients underwent endoscopic balloon dilatation with no success. The locations of lesion were the stomach, the duodenum and both in 9, 20 and 2 cases, respectively. There were operative complications in 13 cases (41.9%), recurrent ulcers in 2 cases (6.5%), and reoperations in 4 cases. The mean Visick score was 1.8 (1~4). There were no statistically significant clinicopathologic differences between the bypass operation group and the resection group. The two groups had 1 case each of recurrence. Although the bypass group had a greater complication rate (83.3%) than the resection group (32%), this was not statistically meaningful (P=0.175). The mean Visick score was 3.0 in the bypass group and 1.6 in the resection group, so the resection group was better (P=0.001). Conclusion: For a case of chronic peptic ulcer with outlet obstruction, even though it has been reported that endoscopic balloon dilatation worked well, surgery is still regarded as an important treatment. If you consider the patients' satisfaction and the difficulty of diagnosing malignant ulcers, surgical resection should be recommended more often than a bypass operation.

• Journal of agricultural medicine and community health
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• v.12 no.1
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• pp.80-93
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• 1987

Mass chemotherapy of Clonorchis sinensis infection in Korea was started in 1982 with 40mg/kg body weight single dose administration scheme of praziquantel. The purpose of this study was to investigate the efficiency of current mass chemotherapy project and compare the epidemiological changes in endemic area of Ckmorchis sinensis. This study was performed at Kimhae-city and Samrangjin-eup of Miryang-gun, Kyongnam province, highly endemic area of C. sinensis located southeastern part of Korea from July to October of 1986. The therapy project of Kimhae area was performed in 1984, whereas that of Samrangjin was done in 1985 by stool examination of the Korea Association for Parasite Eradication(KAPE) and drug administration of local health centre. The results obtained were as follows; 1) As a results of stool examination from 234 specimens obtained in Kimhae area, the infection rate has decreased to 34.2%from 45.6p in 1983, but the infection rate of C. sinensis from 341 specimens obtained in Samrangjin area did not decrease (58.1%in 1986 490%in 1983). 2) The study in Kimhae area showed that the average EPG decreased remarkably from 4,858 to 1,340 and those classified above the category of heavy infection decreased also from 14.0pp to 1.7%. The study in Samrangjin area showed that the average EPG did decrease drastically from 9,597 to 6,498 and those classified above the category of heavy infection did not go down drastically from 25.2% to 14.2%. 3) The study in Kimhae area showed decrease of Cs.$D._{50}$ in comparison to that in 1983, wheareas Cs.$D._{50}$ in Samrangjin area showed no much difference compared to that in 1983. The intensities of endemicity were represented with the regression equation calculated with the cumulative percentages of EPG count. Regression equation was Y=4.49+1.19 log x in Kimhae area and Y=3.66+127 log x in Samrangjin area. 4) The two stage catalytic model was applied and the calculation lead to the equation $Y=5.33(e^{-0.018t}-e^{-0.016t})$ in Kimhae area and $Y=1.25(e^{-0.010t}-e^{-0.018t})$ in Kimhae area and $Y=125(e^{-0.010t}-e^{-0.050t})$ in Samrangjin area 5) The infection rate of cercaria in P.manchouric-us studied in Kimhae area showed 1.25% which is not much different from that in previous years, wheareas the infection rate of metacercaria in P. parva studied in the same area this year showed 2.5-20.2/gm of flesh in comparison to 64/gm of flesh in 1983. 6) Data of C. sinensis infection on the reservoir host in Kimhae area showed 4 out of 18 dogs, 1 out of 18 rats and that in Samrangjin area showed 2 out of 18 dogs respectively. 7) Among the inhabitants who were under mass chemotherapy in Kimhae area, 71out of them, upon stool examination, showed infection rate of 66.2% and those classified above the category of heavy infection, 2.4%. In comparison to infection rate of 33.7% and those classified above the category of heavy infection, which is 1.0%, obtained from those not under mass chemotherapy showed higher infection rate and somewhat equal distribution of intensity of infection. The above statements reflect the fact that individual therapy besides mass chemotherapy was prevalent in that area. 8) On the other side, the studies in Samrangjin area showed infection rate of 68.7% and those above the category of heavy infection, which is 6.1%, in comparison to infection rate of 58.3% and those above the category of heavy infection, which is 16.5%, in those not under mass chemotherapy. the above reflects that although a good deal of inhabit-ants were classified under light or moderate infection category, those above the category of heavy infection, yet, numbered a lot, and individual chemotherapy has not been going on. In conclusion, it was suggested that the number of reinfected inhabitants among those under mass chemotherapy were numerous. Accordingly, the reinforcement of health education should be followed with mass chemotherapy. The facts of high infection rate exemplified by 65% and high number of those above the category of heavy infection in Samrangjin area say that reevaluation of dosage, number of medication and intervals should be necessarily made.

• Journal of agricultural medicine and community health
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• v.24 no.2
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• pp.315-329
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• 1999

Recently, dissatisfaction with aspects of health care has been complemented by directly at complaints such as informal, formal and litigation. But some people take action and other not in spite of feeling of dissatisfaction. This study was to investigate an accounts of patient's disagreement with doctor's care from a community sample, and make a distinction between felt disagreement and disagreement actions. This study was done in six hundred forty residents in Sungjoo County of Kyungbuk Province and Nonman city of Chungnam Province. The questionnaires of interview included sociodemographic data, health status data, a nature of patient's disagreement with doctor and actions taken following or during the disagreement episode. Approximately sixteen percent of sample reported a disagreement, and nine percent reported action taken following or during the disagreement episode. Age, educational attainment, income and area were significantly related with experience of disagreement episode in univariate analysis. In people who experienced the disagreement episode, nearly forty-one percent reported on disagreement about the diagnosis related, twenty-eight percent reported doctor-patients relationship related, twenty percent reported treatment related, and eleven percent reported prescription drug related. In people who experienced actions taken following or during the disagreement episode, nearly fifty-four percent acted as 'sought a second opinion or visit other doctor', thirty-six percent acted as 'verbally challenged the doctor', thirty-two percent acted as 'stopped prescribed treatment or medication', twenty-nine percent acted as 'made repeat visits to the same doctor', twenty-five percent acted as 'eventually left and changed doctor'. Results of multivariate analysis, age, marital status, have or haven't chronic disease, and general satisfaction with health service were significantly related with experience of disagreement episode and marital status was significantly related with experience of actions taken following or during the disagreement episode. This study is experimental and exploratory trial about a relationship between patient's disagreement with doctor and actions taken following or during the disagreement episode in some community of Korea. We find that patient's disagreement with doctor and actions taken following or during the disagreement episode is latent in our community. We suggest that the relationship between felt disagreement and disagreement action is more complicated and worthy of further study.

• Sleep Medicine and Psychophysiology
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• v.16 no.2
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• pp.65-73
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• 2009

Objectives: The purpose of this study was to assess the clinical and polysomnographic characteristics of Korean patients with obstructive sleep apnea syndrome (OSAS), especially in relation to differences due to age and gender. Methods: All subjects were consecutive patients who were proven to have OSAS with nocturnal polysomnography. They were interviewed with a structured interview format including sociodemographic information, past medical history, medication, and sleep-related history. Simultaneously, they were also given Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) to answer in order to check subjective sleep quality and subjective sleepiness. Results: Mean age of the 308 subjects was $49.5{\pm}$13.3 years, with 77.6% of the subjects being males and 22.4% of the subjects being females. The aging effects on the sleep architecture in Korean OSAS corresponded with normal aging, but with the effect of OSAS itself superimposed, the extent of aging effects was more marked than that of normal aging. The severity of Korean patients of OSAS was not correlated with age. When divided into age subgroups, significant correlation was found between RDI and BMI in patients of each subgroup of those in the 4th to 7th decades. The oldest subgroup (>70 years) described their subjective sleep quality as poorer than any other age subgroups, despite of less subjective drowsiness. The severity of OSAS and the change of sleep architecture of male subjects turned out to be severer than those of female ones. The female/male ratio of the subjects tended to increase with aging. Conclusions: The aging effect on the sleep architecture in Korean OSAS seems to be a mixture of the changes by normal aging and sleep disorder per se. The severity of OSAS was not correlated with age, but highly correlated with BMI. The severity of OSAS and the change of sleep architecture of male patients were severer than those of female ones.

• Journal of Oral Medicine and Pain
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• v.33 no.1
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• pp.15-26
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• 2008

Purpose : To investigate the actual conditions of diagnosis and treatment of oral medicine inpatient with systemic disease. Methods : A total of 110 subjects, inpatient due to systemic disease for diagnosis and treatment of oral disease was requested to answer the medical history and dental treatment record. Results : Systemic disease is composed of Non-insulin-dependent diabetes mellitus 26%, Cerebral infarction 25.2%, Intracerebral hemorrhage, Polyarthrosis, Coxarthrosis 4.7%, Nerve root and plexus disorders, Hypertensive heart and renal diseases, Ankylosing spondylitis 2.4%. Chief complain of oral disease is composed of toothache 28.6%, routine check 23%, tooth mobility 8.7%, hypersensitivity 7.1%, periodontal bleeding 6.4%. Oral disease is composed of Gingivitis and periodontal diseases 28.9%, Dental caries 17.1%, Diseases of pulp and periapical tissues 15.1%, Diseases of salivary glands 10.5%, Other diseases of hard tissues of teeth 8.6%, Within Normal Limit 5.3%. Treatment of oral disease is composed of periodontal treatment 17.95%, rejection of treatment 16.67%, medication for halitosis & dry mouth 13.46%, extraction 12.18%, prosthetic treatment 8.97%. Chief complain in oral medicine is composed of oral soft tissue problem 6.4%, craniomandibular disorders 5.6%, halitosis 4%, total 16%. Conclusion : These findings indicate that inpatient due to the systemic disease is significantly correlated to the oral disease. The patients of oral disease interrelationship between inpatient and outpatient of systemic disease should be validated by future research.

• Journal of Korean Medicine Rehabilitation
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• v.26 no.2
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• pp.105-121
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• 2016

Objectives The purpose of this study was to compare the effects between the degree of herniated intervertebral lumbar disc (HIVD) at L4-5 level and improvement of low back pain treated by Korean Medicine therapy. Methods 567 patients who received inpatient treatment from May 2014 to December 2015 in the Daejeon-Jaseng of Korean Medicine Hospital were divided into 6 groups by the degree of HIVD at L4-5 level confirmed with a Lumbar spine magnetic resonance imaging. All patients received a combination of treatment including acupunture, chuna manual therapy, pharmacopunture, herbal medication. They were compared and analyzed on the basis of improvement between measuring Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), EuroQol-5 Dimension Index (EQ5D Index) as they were hospitalized and as they were discharged. The statistically significance was evaluated by SPSS 23.0 for windows. Results After treatment, Normal stage on Intervertebral Lumbar Disc at L4-5 level group's Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), EuroQol-5 Dimension Index (EQ5D Index) improvement was $1.30{\pm}1.62$, $4.52{\pm}11.82$ and $0.04{\pm}0.11$ respectively. Bulging group's improvement was $3.25{\pm}2.81$, $8.28{\pm}13.02$ and $0.09{\pm}0.17$ respectively. Spinal canal occupying ratio (SOR) less than 20 group's improvement was $2.15{\pm}1.92$, $11.79{\pm}17.81$ and $0.13{\pm}0.23$ respectively. SOR 20 to less than 40 stage group's improvement was $2.13{\pm}1.92$. $10.79{\pm}15.93$ and $0.10{\pm}0.26$ respectively. SOR 40 to less than 60 group's improvement was $2.16{\pm}2.24$, $9.80{\pm}16.62$ and $0.15{\pm}0.25$ respectively. Surgery group's improvement was $2.47{\pm}2.21$, $11.64{\pm}18.53$ and $0.15{\pm}0.27$ respectively (p<0.03). But there was no statistically significance between 6 group's improvement after treatment (p>0.05). Conclusions After inpatient treatment by Korean Medicine therapy, Most patient's pain, disability and Health Related Quality of Life was improved significantly. But there was no statistically correlation between the degree of HIVD at L4-5 level and improvement of low back pain. So We think that future research of higher quality and correct statistics shall be necessary.

• Journal of Korean Medicine Rehabilitation
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• v.23 no.4
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• pp.213-223
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• 2013

Objectives Low back pain (LBP) is one of the most common reason for people in Korea to visit Korean medical institutions. To assess actual amounts of use in the treatment of LBP in Korean medicine and to provide objective base line data for policy decision making, research regarding the current state of LBP patients' treatment in Korean medical institutions are in need. Methods The current study was designed as a retrospective chart review to investigate descriptive characteristics of LBP patients. The clinical records of 304 patients who were hospitalized for the treatment of LBP in Korean rehabilitation medicine inpatient clinics of five different Korean medicine hospitals were analyzed. The percentage of patient characteristics such as sex, age, average duration of admission, insurance type, diagnosed LBP related disease code, and rates of interventions applied were assessed. Results 1. The female sex was significantly predominant among patients with LBP : 105 patients (34.5%) were male and 199 patients (65.5%) were female. Percentage of the patients' age appeared as followed : 76 people (25.0%) were in their 50s, 64 people (21.1%) were in their 40s, 51 people (16.8%) were in their 30s, 37 people (12.2%) were in their 60s, and 33 people (10.9%) were in their 70s. Approximately half of the total LBP patients investigated were older than 50. 2. The average duration of admission was 16.2 days. Approximately one third (30.3%) of the patients were hospitalized for 8 to 14 days. 3. Female patients tended to stay admitted in hospitals slightly longer than male patients. Elderly (age 60~79) patients stayed in hospitals longer (17.8 days) compared to younger (age 20~39) patients (13.5 days). 4. More than half of the patients (171 cases, 56.3%) had their hospital bills covered with automobile insurance. 40.1% (122 cases) of the patients had medical insurance to cover their hospital bills. The average duration of admission of patients who had automobile insurance was 14.2 days, while that of the patients who had medical insurance was 18.4 days. 5. "Sprain and strain of the lumbar spine and pelvis" was the most commonly used (195 cases, 64.1%) disease code in patients with LBP. Patients diagnosed as "lumbar and other intervertebral disc disorders with radiculopathy" required the longest admission duration (22.1 days). 6. Herbal medication was applied to all of the patients during admission. Acupuncture was applied to all of the patients except one case diagnosed as spinal stenosis. Physical therapy, cupping therapy, moxibustion therapy, chuna therapy, and pharmacopuncture therapy were applied to 94.7, 92.8, 85.2, 83.9, and 49.7% of the patients, respectively. 7. There were certain differences among Korean medicine hospitals in terms of the LBP patients' duration of admission, type of insurance, frequency of the disease code use, type of intervention applied. Conclusions It is thought that the current study can be used as reference data in assessing the current state of LBP treatment in Korean rehabilitation medicine and a basis for future research. Provided improvements of certain limitations of the current study in future researches, such data would act as better base line data in policy decision making.

• Tuberculosis and Respiratory Diseases
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• v.47 no.5
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• pp.629-641
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• 1999

Background: Corticosteroid is most potent and effective anti-inflammatory medication currently available and inhaled form has been used in the long-tenn control of asthma. Fluticasone propionate(Flixotide/Flovent: FP) is highly potent and topically active inhaled corticosteroid and has at least twice the potency of beclomethasone dipropionate(BDP) in the control of asthma. The aim of this study was to compare the efficacy of FP and BDP in several aspects. Method: Fifty patients with asthma were treated in a randomized, parallel group study of 4 weeks duration. During 2-week run-in period $\beta_2$-agonist was administered. After run-in period, FP $500{\mu}g/day$ was administered via Diskhaler or BDP $800{\mu}g/day$ via reservoir dry-power device. During the run-in and treatment period, morning and evening peak expiratory flow rate(PEFR) were measured daily. Daytime and nighttime asthma symptoms, daytime and night-time rescue bronchodilator use were checked daily. $FEV_{1.0}$ and FVC were measured biweekly in both groups. Results: Three patients treated with FP and seven patient treated with BDP were dropped out. Therefore forty patients completed the study. Morning and evening PEFR was increased and diurnal variation of PEFR decreased significantly in both groups. $FEV_{1.0}$ increased significantly in FP treatment group but not in BDP group. There were also improvements in daytime and night-time asthma symptoms, daytime and night-time rescue bronchodilator use in both groups after treatment There were no significant difference between groups in any of the efficacy parameters. Therapeutic effects were demonstrated earlier in patient treated with FP than BDP. Conclusion: In this study, $500{\mu}g/day$ fluticasone propionate was as effective as $800{\mu}g/day$ beclomethasone dipropionate in the control of asthma. Therapeutic effects were demonstrated earlier in patient treated with FP than BDP without adverse effect.

• Tuberculosis and Respiratory Diseases
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• v.51 no.4
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• pp.334-345
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• 2001

Background : Pulmonary tuberculosis(TB) is still prevalent and remains a significant clinical problem for the elderly. However, the disease presents in many ways, and there are frequent adverse drug reactions that may prevent the early diagnosis and treatment of elderly TB patients compared to the young. The purpose of this study was to determine whether or not there are any differences in the clinical feature of pulmonary tuberculosis(TB) in both the diagnosis and treatment between the young (less than 64 years) and the elderly (65 years and more). Methods : The medical records of 125 young and 70 elderly pulmonary TB patients, who were diagnosed with and treated for pulmonary TB at the Seoul Municipal Boramae Hospital from November 1991 to January 1997, were analyzed retrospectively. Results : Anorexia(12% vs. 31.4%), general weakness (20.0% vs. 54.3%), dyspnea(21.6% vs. 37.1%) and an abnormal mentality (0.8% vs. 15.7%) were more frequent presenting symptoms in elderly TB patients, whereas hemoptysis (32.8% vs. 10.0%) and fever (BT > $37^{\circ}C$, 58.4% vs. 35.7%) were more frequent in the young. The elderly had a higher number of cardiovascular and chronic obstructive pulmonary diseases as underlying illnesses. In chest PA, there were no differences in the location of the TB lesion, but the appearances were initially diagnosed more frequently as pneumonia or lung cancer (8.8% vs. 30.0%, p<0.05) in the elderly. There was no difference in the detection rate of acid fast bacilli(AFB) in the sputum between the two groups. There were no differences in the treatment response and follow-up loss. However, adverse drug reactions (13.6% vs. 45.7%, p<0.05), and changes in medication (4.9% vs. 25.7%, p<0.05) during treatment occurred more frequently in the elderly. One among the 125 young patients died from tuberculosis whereas 6 among the 70 elderly patients died from the disease. Conclusion : Because the clinical and radiological presentations were more atypical, a sputum AFB smear and culture should be done immediately in the elderly who are TB. The elderly experienced more frequent adverse drug reactions and mortality during treatment, but the response to treatment was good and rapid.