• Journal of Gastric Cancer
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• v.8 no.4
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• pp.256-261
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• 2008

Purpose: Intra-abdominal fluid collection is one of the risk factors associated with postoperative morbidity or mortality for patients who undergo gastric cancer surgery. The aim of this study was to analyze the clinicopathological characteristics of the patients with postoperative intra-abdominal fluid collection and to identify the indications for inserting a percutaneous drain (PCD) in patients with intra-abdominal fluid collection. Materials and Methods: Among the 1,277 patients who underwent operations for gastric cancer at Seoul National University Hospital between April 2005 and July 2006, the data of 117 patients with an intra-abdominal fluid collection were reviewed. Results: The number of patients' with pathologic stage I, II, III and IV disease was 42 (36.8%), 23 (20.2%), 16 (14%) and 33 (28.9%), respectively. Forty-three patients (36.3%) underwent PCD insertion and the other 43 patients received conservative management. A univariate analysis of multiple clinical variables revealed that age, gender, diabetes, liver disease, lymph node dissection, the pathologic stage and the body mass index (BMI, $kg/m^2$) were not significantly associated with PCD insertion (P>0.05). However, the univariate analysis showed that two characteristics were associated with a significantly high incidence of PCD insertion: a diameter of an intra-abdominal fluid collection greater than 4 cm and infectious signs such as leukocytosis, fever and bacteremia. Conclusion: About two thirds of the intra-abdominal fluid collections after surgery for gastric cancer were managed with only conservative method without other morbidities of mortality. Surgeons should consider performing PCD insertion if the largest diameter of an intra-abdominal fluid collection is over 4 cm or if infectious signs are seen.

• Journal of Chest Surgery
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• v.32 no.3
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• pp.294-298
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• 1999

Background: Video-assisted thoracoscopic surgery(VATS) has been established as a new method for treatment of spontaneous pneumothorax. We compared the clinical results of VATS with those of thoracotomy performed during the recent 5 years. Material and Method: We analyzed 126 patients whose medical records were available among the 154 patients who underwent operations for spontaneous pneumothorax from 1992 to 1996. The mean age was 27.1 years(15 to 75 years). 87 patients were operated on by VATS(Group A) and the other 39 by thoracotomy(Group B). The mean follow-up period was 14.7 months. Result: The operation time was shorter in group A than in group B(90.6${\pm}$38.6minutes: 117.2${\pm}$58.9minutes, p<0.05). The duration of postoperative hospital stay was shorter in group A than in group B(6.7${\pm}$4.2: 9.4${\pm}$3.3 days, p<0.05). The amount of analgesics(nalbuphin HCl, ketoprofen) used postoperatively were 2.4${\pm}$2.8 ampules in group A, which is less than the 6.5${\pm}$5.6 ampules in group B(p<0.05). The number of staples used in group A was smaller(2.7${\pm}$1.3 in group A, 1.76${\pm}$1.1 in group B, p<0.05). The duration of chest tube indwelling(4.3${\pm}$4.0 days in group A, and 5.6${\pm}$3.0 days in group B, NS), the recurrence rate(13.8% in group A, 2.6% in group B, NS), and the duration of air leakage(1.3${\pm}$3.3 days in group A, and 1.0${\pm}$2.5days in group B, NS) were not statistically different between the two groups. Conclusion: The application of VATS for the treatment of spontaneous pneumothorax has brought in better clinical results(shorter operation time, shorter hospital stay, less pain, and better cosmetic merits) than the thoracotomy without increasing any morbidity. However no advantages in recurrence rates and duration of postoperative air leakages are revealed.

• Journal of Arbitration Studies
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• v.24 no.2
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• pp.33-52
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• 2014

Although climate change is a global scale question, some concerns have been raised that principles of investment arbitration may not adequately address the domestic implementation of climate change measures. A recent ICSID investment arbitration of Vattenfall v. Germany with regard to the investor's alleged damages from the phase-out of nuclear plants is a salient climate change case. The 2005 Kyoto Protocol was made to reduce greenhouse gas emissions and it provides a number of flexible mechanisms such as Joint Implementation (JI) and Clean Development Mechanism (CDM). Implementation of the Kyoto Protocol allows dispute settlement through investor-state arbitration. Any initiation of stricter emission standards can violate the prohibition on expropriations in investment agreements, regardless of the measures created to reduce greenhouse gas emissions. The effect-based expropriation doctrine can charge changes to existing emission standards as interference with the use of property that goes against the legitimate expectation of a foreign investor. In regulatory chill, threat of investor claims against the host state may preclude the strengthening of climate change measures. Stabilization clauses also have a freezing effect on the hosting state's regulation and a new law applicable to the investment. In the fair and equitable standard, basic expectations of investors when entering into earlier carbon-intensive operations can be affected by a regulation seeking to change into a low-carbon approach. As seen in the Methanex tribunal, a non-discriminatory and public purpose of environmental protection measures should be considered as non-expropriation in the arbitral tribunal unless its decision would intentionally impede a foreign investor's investment.

• Pediatric Infection and Vaccine
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• v.14 no.2
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• pp.162-170
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• 2007

Purpose : While cases of vancomycin-resistant enterococci (VRE) have increasingly been reported worldwide since it was first reported in the late 1980s, there have been few systemic studies on the pediatric population. The purpose of this study is to contribute to the planning of VRE prevention by investigating the prevalence, risk factors and transmission of VRE infection. Methods : We studied 230 patients under age 15 years who were isolated VRE between January 2001 and December 2006 retrospectively. The patients were classified into the intensive care unit (ICU) and the non-ICU groups. We reviewed the procedures before VRE detection as well as antibiotic sensitivity of detected organisms. Results : The number of VRE-isolation cases was higher in the ICU group than the non-ICU group. Instances of VRE-isolation were also more prevalent in patients who underwent operations or active procedures while taking 3rd-generation cephalosporins or glycopeptides. Almost all antibiotics except tetracycline were resistant to VRE. The proportion of 3rd-generation cephalosporin use was higher than those of any other antibiotics before VRE detection. Additionally, the use of 3rd-generation cephalosporins has increased annually, but that of glycopeptides had decreased in 2006. Also, the rates of VRE isolation have been increasing since 1998. Conclusion : VRE infection is increasing in pediatric population. Strict adherence to appropriate infection control guidelines for the prevention of VRE transmission in hospitals, and tracking of VRE colonization through active surveillance in high risk units are recommended.

• Tuberculosis and Respiratory Diseases
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• v.59 no.6
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• pp.613-618
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• 2005

Background : Recently, medical treatment of multi-drug resistant pulmonary tuberculosis has been unsuccessful. Through analyzing the cases with surgical treatment, we hope to provide some help in treating multi-drug resistant pulmonary tuberculosis in the future. Material and Method : A retrospective review was performed with 138cases of surgical treatment of multi-drug resistant tuberculosis during 10years from January 1994 to December 2003 at National Masan Hospital. Results : The ratio of men to women, 5.1:1 indicates that there were more incidences in men. The number of the resistant drugs was 5.3 with a mean age of 42.6 years. Cavitary lesions on the plain chest X-rays were seen in 94cases (68.1%). 128cases had positive sputum culture preoperatively. Types of operations were 24 pnemonectomies, 83 lobectomies, 10 bilobectomies, 19 lobectomies with segmentectomies or wedge resections, 1 wedge resection, and 1 carvenoplasty. There was no death after operation. There were 6cases of air leakage over a week, 6cases of postoperative bleeding, 8cases of bronchopleural fistula and empyema, 16cases of dead space, 1case of atelectasis, 1case of wound infection, 1case of cyst as postoperative complication. Postoperative complication showed higher long-term negative conversion rate of 92.8%. Conclusion : There has been many discussions about operative indications, postoperative drug regimens, length of postoperative chemotherapy. In our study, we showed higher long-term success rate of postoperative chemotherapy with pulmonary resection on multi-drug resistant pulmonary tuberculosis.

• Journal of Korea Entertainment Industry Association
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• v.13 no.2
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• pp.145-154
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• 2019

The purpose of this study is to investigate the performance, learning motivation and satisfaction of the students who take the university 's Lifelong Education Program. The research method was interviewed. The results are as follows. In terms of operations; First, the awareness of the kindness of employees of the college lifelong education institute needs to be strengthened at the beginning of the school year. Second, in the operation of the College Lifelong Education Center, the support such as the parking fee should be extended to the students. Third, lifelong education facilities should be supplemented. In terms of participation motivation; First, it can be seen that there are the most learners who want to do complementary learning. Most of them are people who look back on their lives and prepare for their future directions. Second, as the life span of human beings became longer, the economic preparation for life became necessary. Thus, all learning tends to be perceived as a preparation for economic income. Third, most people who participate in lifelong education are very interested in health. Therefore, it is necessary to increase the motivation for participation by expanding health related programs. In terms of satisfaction; First, it depends on the purpose of the individual. Satisfaction was high for those who aimed at hobbies and relationships, and satisfaction for those who aimed for economic activities was low. Second, it is also necessary to consider the instructor 's instructional process. In other words, lifelong learners tend to be adults, so little complaints are not revealed. Therefore, I would like to ask the lecturers to advance the education for the class. The implications for the improvement direction of the lifelong education center are as follows; First, we need to drastically reduce the number of programs overlapping with other universities and conduct research to develop new programs. In order to do this, it is necessary to continuously carry out a survey of demanders' needs. Second, it is necessary to find the appropriate place for program operation considering the movement distance of learners. It should be avoided that the program should be operated with the existing university facilities. Third, universities' lifelong education should go to education that includes college students.

• Journal of the Korean Orthopaedic Association
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• v.54 no.1
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• pp.1-8
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• 2019

Globally, the elderly population is increasing rapidly, which means that the number of deformity correction operations for elderly spine deformity patient has increased. On the other hand, for aged patients with deformity correction operation, preoperative considerations to reduce the complications and predict a good clinical outcome are not completely understood. First, medical comorbidity needs to be evaluated preoperatively with the Cumulative Illness Rating Scale for Geriatrics or the Charlson Comorbidity Index scores. Medical comorbidities are associated with the postoperative complication rate. Managing these comorbidities preoperatively decreases the complications after a spine deformity correction operation. Second, bone densitometry need to be checked for osteoporosis. Many surgical techniques have been introduced to prevent the complications associated with posterior instrumentation for osteoporosis patients. The preoperative use of an osteogenesis inducing agent - teriparatide was also reported to reduce the complication rate. Third, total body sagittal alignment need to be considered. Many elderly spine deformity patients accompanied degenerative changes and deformities at their lower extremities. In addition, a compensation mechanism induces the deformed posture of the lower extremities. Recently, some authors introduced a parameter including total body sagittal alignment, which can predict the clinical outcome better than previous parameters limited to the spine or pelvis. As a result, total body sagittal alignment needs to be considered for elderly spine deformity patients after a deformity correction operation. In conclusion, for elderly spine deformity patients, medical comorbidities and osteoporosis need to be evaluated and managed preoperatively to reduce the complication rate. In addition, total body sagittal alignment needs to be considered, which is associated with better clinical outcomes than the previous parameters limited to the spine or pelvis.

• Korean journal of food and cookery science
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• v.21 no.3 s.87
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• pp.290-300
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• 2005

Increased sanitation management of foodservice establishments is required because most of the reported foodborne-disease outbreaks were in the foodservice industry. The purpose of this study was to determine the important control points for good sanitation. In this study, we inspected twenty foodservice establishments in Seoul, Kyunggi, Kyungnam with a self-developed monitoring tool. These foodservice establishments included secondary schools, universities, and industries. Six of them had appointed as the HACCP-certified establishments from the Korea Food and Drug Administration. The inspection was conducted from June to August in 2002. The inspection tool consisted of nine dimensions and sixty-five items. The dimensions were 'personal sanitation', 'supply of raw food', 'food storage', 'handling of raw food and ready-to-eat', 'cleaning and sterilization', 'waste control', 'pest control', and 'control of establishment and equipment' The highest possible score of this inspection tool is 105 points. Statistical data analysis was completed using the SPSS Package(11.0) for descriptive analysis Kruskal-Wallis. The score for the secondary schools (83.6 points) was higher than for the others and number of in compliance item was 50.9 on average. Therefore, we concluded that the secondary schools' sanitation condition was good. The foodservice establishments acquired HACCP certification was 89.7 points, which was significantly higher than that of establishments not applying foodservices in total score. Instituting the HACCP system in a foodservice is very effective for sanitation management. Many out of the compliance observations were found in the dimensions of 'waste control', 'control of establishment and equipment', and 'supply of raw food' 'Clean condition of refrigerator' item was $65\%$ out of the compliance that was the highest percent in this study. 'Notify and observance of heating/reheating temperature' was $45\%$ out of compliance. Items which were over $30\%$ out of compliance were 'sterilization of knifes and chopping boards in cooking', 'education of workers', 'maintain refrigerator temperature blow $5^{\circ}C$', and 'countermeasure of infection workers' In the results, most of the foodservice establishments were poorly managed in temperature control and cross-contamination. The important control points revealed in this study were preventing contamination, cooking temperature compliance, management of raw food and refrigerator. Therefore foodservice establishments should pay attention to education and training about important control points. The systematic sanitation management monitoring tool developed in this study can be effectively applied for conducting self-inspection and improving the sanitary conditions of their own foodservice operations.

• Journal of Chest Surgery
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• v.42 no.4
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• pp.473-479
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• 2009

Background: Retrograde autologous priming (RAP) is known to be useful in decreasing the need of transfusions in cardiac surgery because it prevents excessive hemodilution due to the crystalloid priming of cardiopulmonary bypass circuit. However, there are also negative side effects in terms of blood conservation. We analyzed the intraoperative blood-conserving effect of RAP and also investigated the efficacy of autotransfusion and ultrafiltration as a supplemental method for RAP. Material and Method: From January 2005 to December 2007, 117 patients who underwent isolated coronary artery bypass operations using cardiopulmonary bypass (CPB) were enrolled. Mean age was 63.9$\pm$9.1 years (range 36$\sim$83 years) and 34 patients were female. There were 62 patients in the RAP group and 55 patients in he control group. Intraoperative autotransfusion was performed via the arterial line. RAP was done just before initiating CPB using retrograde drainage of the crystalloid priming solution. Both conventional (CUF) and modified (MUF) ultrafiltrations were done during and after CPB, respectively. The transfusion threshold was less than 20% in hematocrit. Result: Autotransfusions were done in 79 patients (67.5%) and the average amount was 142.5$\pm$65.4 mL (range 30$\sim$320 mL). Homologous red blood cell (RBC) transfusion was done in 47 patients (40.2%) and mean amount of transfused RBC was 404.3$\pm$222.6 mL. Risk factors for transfusions were body surface area (OR 0.01, 95% CI 0.00 $\sim$ 0.63, p=0.030) and cardiopulmonary bypass time (OR 1.04, 95% CI 1.01 $\sim$ 1.08, p=0.019). RAP was not effective in terms of the rate of transfusion (34.5% vs 45.2%, p=0.24). However, the amount of transfused RBC was significantly decreased (526.3$\pm$242.3ml vs 321.4$\pm$166.3 mL, p=0.001). Autotransfusion and ultrafiltration revealed additive and cumulative effects decreasing transfusion amount (one; 600.0$\pm$231.0 mL, two; 533.3$\pm$264.6 mL, three; 346.7$\pm$176.7 mL, four; 300.0$\pm$146.1 mL, p=0.002). Conclusion: Even though RAP did not appear to be effective in terms of the number of patients receiving intraoperative RBC transfusions, it could conserve blood in terms of the amount transfused and with the additive effects of autotransfusion and ultrafiltration. If we want to maximize the blood conserving effect of RAP, more aggressive control will be necessary - such as high threshold of transfusion trigger or strict regulation of crystalloid infusion, and so forth.

• Journal of Chest Surgery
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• v.35 no.9
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• pp.643-652
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• 2002

As the prevalence of coronay artery disease is increasing, the surgical treatment has been universalized and operative outcome has been improved. We analyzed the short and mid-term results of 292 CABGs performed in Kangdong Sacred Heart Hospital. Material and Method: From June 1994 to December 2001, 292 patients underwent coronary artery bypass grafting. There were 173 men and 119 women and their ages ranged from 39 to 84 years with a mean of $61.8{\pm}9.1$ years. We analyzed the preoperative risk factors, operative procedures and operative outcome. In addition, we analyzed the recurrence of symptoms, long-term mortality and complications via out-patient follow-up for discharged patients. Result: Preoperative clinical diagnoses were unstable angina in 137(46.9%), stable angina in 34(11.6%), acute myocardial infarction in 40(13.7%), non-Q myocardial infarction in 25(8.6%), postinfarction angina in 22(7.5%), cardiogenic shock in 30(10.3%) and PTCA failure in 4(1.4%) patients. Preoperative angiographic diagnoses were three-vessel disease in 157(53.8%), two-vessel disease in 35 (12.0%), one-vessel disease in 11(3.8%) and left main disease in 89(30.5%) patients. We used saphenous veins in 630, internal thoracic arteries in 257, radial arteries in 50, and right gastoepiploic arteries in 2 distal anastomoses. The mean number of distal anastomoses per patient was $3.2{\pm}1.0$ There were 18 concomitant procedures ; valve replacement in 8(2.7%), left main coronary artery angioplasty in 6(2.1%), patch closure of postinfarction ventricular septal defect(PMI-VSD) in 2(0.7%), replacement of ascending aorta in 1(0.3%) and coronary endarterectomy in 1(0.3%) patient. The mean ACC time was $96.6{\pm}35.3 $ minutes and the mean CPB time was $179.2{\pm}94.6$ minutes. Total early mortality was 8.6%, but it was 3.1% in elective operations. The most common cause of early mortality was low cardiac output syndrome in 6(2.1%) patients. The stastistically significant risk factors for early mortality were hypertension, old age($\geq$ 70 years), poor LV function(EF＜40%), congestive heart failure, preoperative intraaortic balloon pump, emergency operation and chronic renal failure. The most common complication was arrhythmia in 52(17.8%) patients. The mean follow-up period was $39.0{\pm}27.0$ months. Most patients were free of symptoms during follow-up. Fourteen patients(5.8 %) had recurrent symptoms and 7 patients(2.9%) died during follow-up period. Follow-up coronary angiography was performed in 13 patients with recurrent symptoms and they were managed by surgical and medical treatment according to the coronary angiographic result. Conclusion: The operative and late results of CABG in our hospital, was acceptable. However, There should be more refinement in operative technique and postoperative management to improve the results.