• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.10 no.2
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• pp.201-211
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• 1999

Objectives：This study investigated the characteristics of detained delinquent adolescents and variables related to the repeated crime during 6 months after release. Methods：The socio-demographic and crime-related characteristics of 73 detained adolescents were evaluated by semi-structured interviews and police records, and the psychological characteristics of them measured by the MMPI. We also compared the characteristics between subjects with and without repeated crime during 6 months after release. Results：1) Most of detained adolescents had families with low socioeconomic status(77%) and broken families(48%). Sixty-six percent of them were dropped out of school. The most frequent crime pattern was theft(49%), and with accomplice(77%). Seventy-five percent of total subjects had the records of previous conviction. Of the previous convictions, seventy-eight percent was same with the present crimes. 2) Subjects with repeated crime during 6 months after release were younger and had higher T-score on Pa scale of MMPI than the subjects without repeated crime. More adolescents with repeated crime had broken families than those without repeated crime. They also showed the crime-related characteristics of higher percent of theft among crime patterns, higher incidence of previous conviction, younger age of the first crime, and shorter crime-free duration from the last to present crime. Conclusion：These results of present study suggest that the development and the persistence of adolescent delinquency would be resulted from interaction of factors of individual, family, school, and community. By the comparison between subjects with and without repeated crime, it was found that familial dysfunction, younger age at first crime, presence of previous conviction might be the risk factors for repeated delinquency. To prevent repeated crime of delinquent adolescents more effectively, early therapeutic intervention and the development of programs to help adaptation in school and community would be essential.

• Tuberculosis and Respiratory Diseases
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• v.40 no.2
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• pp.177-184
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• 1993

Background: Accurate staging of bronchogenic carcinoma is important in determining resectability and metastasis of tumor to the subcarinal nodes is generally believed to indicate poor prognosis. The technique of Transbronchial needle aspiration (TBNA) has offered a safe & effective way to asscess mediastinal lymph node involvement in the staging of lung cancer. We performed TBNA in patients who were suspected lung cancer to evaluate the clinical usefulness of the TBNA. Method: TBNA of the subcarinal lymph node was performed at the time of initial diagnostic bronchoscopy in 60 patients with suspected lung cancer, and 42 cases of histologically proved bronchogenic cancer were analized. Results: The frequency of adequate samples by transbronchial needle aspiration (TBNA) was 81% and the positive rate of malignant cells by TBNA was 14.7%. There were no differences in positive rates by tumor cell types. In patients with thickened carina on bronchoscopy, the TBNA was positive in 33.3% as compared to 5.3% of normal carina on bronchoscopy, and the difference was statistically significant (p<0.05). In patients with enlarged subcarinal lymph node on chest CT, the positive rate of malignant cells (50.0%) was higher than that of normal sized subcarinal lymph node on chest CT (4.8%) (p<0.01). There were no specific complications in the TBNA procedure. Conclusion: TBNA is a relatively safe procedure and it offers the possibility of avoiding the cost and morbidity of surgical staging in patients especially whose carina is thickened on bronchoscopy and whose subcarinal LN was enlarged on chest CT.

• Tuberculosis and Respiratory Diseases
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• v.40 no.6
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• pp.669-676
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• 1993

Background: DNA content analysis of human solid tumor is now widely performed by flow cytometric study. One of the most interesting and potentially important observation in this field is that proliferative activity(S-Phase fraction of cell cycle) may profoundly affect prognosis. Method: S-Phase fraction(SPF) have been measured by flow cytometric method using tumor cells isolated from paraffin embedded tissue. To evaluate the prognostic significance, SPF of squamous lung cancer cell was assessed in 21 patients who died without any specific treatment. Results: 1) Mean survival time of squamous lung cancer patients was 225(${\pm}162$) days. Survival time were shortened, when TNM stage and PS scale were advanced. 2) Mean value of SPF of squamous lung cancer patients was 23.4(${\pm}11.3$)%. SPF had nothing to do with advance of TNM stage and PS scale. 3) Mean survival time of high SPF group(more than 20% of cell proliferation cycle) and low SPF group were 153(${\pm}99$) days and 342(${\pm}180$) days(p<0.01). In each identical TNM stage and PS scale, there were also statistic significant differences in mean survival time between high and low SPF group. Conclusion: On multivariate analysis including TNM stage and performance status, SPF was the significant and independent prognostic factor in the primary squamous lung cancer patients group.

• Tuberculosis and Respiratory Diseases
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• v.44 no.6
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• pp.1225-1233
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• 1997

Background : Cervical tuberculous lymphadenitis(CTL) is one of the most common extra-pulmonary tuberculosis. Recently overall incidence of pulmonary tuberculosis has decreased, but the incidence of tuberculous lymphadenitis has not decreased. Its duration of treatment is still controversial and the pathogenesis, prognosis and relationship with other site tuberculous are poorly published. So we did a retrograde study of 120 cases of confirmed CTL about its clinical manifestations. Method : All patients were applied fine needle aspiration(FNA) of palpable enlarged cervical lymph nodes and 114 patients were examined for AFB smear and 34 patients for TB culture with aspirated fluid. 57 patients were examined Mantoux test(5TU with PPD-S). With above methods, a total of 120 patients was diagnosed as having CTL. Results : 1) CTL is most prevalent in young women between the age of 20~30 years and the incidence of CTL in female is 2.5 times higher than that of male. It is located most commonly in the posterior cervical area. The most common presenting symptom is painless palpable enlarged cervical lymph nodes. 2) With FNA of enlarged cervical lymph nodes, the percentage of histopathological positivity is 82.3%. The percentage of AFB smear positivity is 38.6%, and that of TB culture positivity is 17.6%(p<0.001). 3) Pulmonary tuberculosis is noted in 79 cases(65.8%). And 42 cases(53.5%) of them had minimal pulmonary tuberculosis. In 14 cases(11.7%), other extrapulmonary tuberculosis coexsisted and pleural tuberculosis was most Common in the order. 4) CTL was treated with anti-tuberculous medication(first line drug) and median treatment duration was 18.5months. During treatment, the size of involved lymph nodes decreased gradually in 62 cases(75.8%), newly developed lymph nodes were found in 25 cases(30.4%), fluctuation formation in 22 cases(26.8%) and fistula formation in 14 cases(17.0%). Conclusion : CTL is prevalent in women between the age of 20~40 years and it involves posterior cervical area most commonly. CTL is treated with long-term anti-tuberculous chemotherapy. We think it is one manifestation of systemic disease and frequently coexisting with pulmonary tuberculosis. Despite anti-tuberculous chemotherapy, the size of involved lymph nodes was increased, new lymph nodes were developed or fluctuation and fistula formed in involved lymph nodes. After sufficient medication, when the patient felt pressure discomfort from enlarged lymph node or fistula was formed, we recommended total excision of involved lymph nodes.

• Tuberculosis and Respiratory Diseases
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• v.45 no.5
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• pp.953-961
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• 1998

Background : In recent years, lung cancer has been one of most common cause of death in Korea. Despite many physician's high degree of pessimism about the gains made in treatment, progressive improvement in the survival of lung cancer by treatment has occurred, particulary in the early stages of the disease. However, a lot of patients refuse treatment or give up in the fight against the disease. This study was done to evaluate factors influencing the compliance to therapy and to lead in the establishment of special programs to enhance compliance in patients with lung cancer. Methods: The medical records of 903 patients, whose ECOG(Eastern Cooperative Oncology Group) performance status was 3 or less and whose medical record was relatively satisfactory, among 1141 patients diagnosed with lung cancer between January 1989 and December 1996 were reviewed retrospectively. Compliance was classified into three groups based on the degree of compliance with physicians practice guideline: (a) compliants; (b) patients who initially complied but gave up of themselves midway during the course of treatment; (c) noncompliants who refused the treatment. Results: The overall compliance rate was 63.9%, which was progressively increased from 57.3-61.3% in 1989 and 1990 to 64.2-67.5% in 1995 and 1996. Age, education level and occupation of patients bore statistically significant relationship with the compliance but sex, marital status and smoking history did not. The compliance was significantly higher in patients without symptoms than with, and was also significantly higher in patients with good performance status. The compliance was significantly high in patients with NSCLC(non-small cell lung cancer) compared to SCLC(small cell lung cancer), but after exclusion of stage I and II, among NSCLC, which had higher compliance to surgery there was no significant difference of compliance by histology. The compliance was significantly lower in advanced stage. Conclusion: To enhance the compliance, special care including education programs about therapy including complication and prognosis are necessary, especially for educationally and economically disadvantaged patients.

• Tuberculosis and Respiratory Diseases
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• v.49 no.6
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• pp.733-739
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• 2000

Background : Pleural eosinophilia is rare and commonly considered to be an indicator of good prognosis. The diagnostic significance of eosinophilic pleural effusions remains controversial despite a century of observation and discussion. This study was conducted to assess the prevalence of eosinophilia in 446 consecutive samples of pleural fluid, to review the cause of eosinophilic pleural effusion and to determine whether the presence of eosinophils increases the likehood of benign conditions. Method : A retrospective analysis was performed upon patients that underwent first thoracentesis due to pleural effusion between January 1999 and December 1999. Results : Eosinophilic pleural effusions were identified in 24 of the 446 patients (5.4%). Malignancy, parapneumonic effusion and tuberculosis were determined the major causes of pleural effusion (80.6%). Malignancy was diagnosed as frequently in eosinophilic effusions as in non-eosinophilic effusions (54.2% vs 50.5%, p=0.725). No difference was found in the prevalence of eosinophilic and non-eosinophilic effusion according to the etiology. The mean blood eosinophil ratio in patients with eosinophilic pleural effusion was 5.4% and no significant correlation existed between the blood and pleural eosinophilic count. Conclusion : Pleural eosinophilia is not helpful for differentiating benign and malignant etiology and is not related with bood eosinophilia or repeated tapping.

• Tuberculosis and Respiratory Diseases
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• v.55 no.3
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• pp.287-296
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• 2003

Background : Drowning represents the third most common cause of all accidental deaths worldwide. Although few studies of submersion injury were done in Korea, the subjects were mainly pediatric patients. The purpose of this study is to describe the clinical feature of submersion injury in adults. Methods : The medical records of 31 patients with submersion injury who were >15 years of age and admitted to Kyungpook National University Hospital from July 1990 to March 2003 were retrospectively examined. Results : The most common age-group, cause, and site of submersion accidents in adults were 15-24 years of age, inability to swim, and river followed by more than 65 years of age, drinking, and public bath respectively. The initial chest radiographics showed bilaterally and centrally predominant distribution of pulmonary edema at lung base in about 90% of patients with pulmonary edema represented by submersion injury but at only upper lung zone in 10%. Eventually, 25 patients (80.6%) survived without any neurologic deficit and 2 patients (6.5%) with significant neurologic deficit, and 4 patients (12.9%) died. Age, arterial gas oxygenation, and mental status among baseline variables showed significant difference for prognosis. Conclusions : More than 65 year of age, drinking, and occurrence in public bath were relatively important in submersion injury of adults, and the successful survival of 80.6% of patients suggests that cardiopulmonary resuscitation should be intensively done in even adults.

• Tuberculosis and Respiratory Diseases
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• v.61 no.1
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• pp.34-40
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• 2006

Background: Extubation failure was associated with poor prognosis and high hospital mortality. Cuff leak test (CLT) has been proposed as a relatively simple method for detecting laryngeal obstruction that predispose toward postextubation stridor (PES) and reintubation. We examined the risk factors of extubation failure and evaluated the usefulness and limitation of CLT for predicting PES and reintubation. Methods: Thirty-four consecutive patients intubated more than 24 hours were examined. The subjects were evaluated daily for extubation readiness, and CLT was performed prior to extubation. Several parameters in the extubation success and failure group were compared. The accuracy and limitation of CLT were evaluated after choosing the thresholds values of the cuff leak volume (CLV) and percentage (CLP). Results: Of the 34 patients studied, 6 (17.6%) developed extubation failure and 3 (8.8%) were accompanied by PES. The patients who had extubation failure were more likely to have a longer duration of intubation and more severe illness. The patients who developed PES had a smaller cuff leak than the others: according to the CLV ($22.5{\pm}23.8$ vs $233.3{\pm}147.1ml$, p=0.020) or CLP ($6.2{\pm}7.3$ vs $44.3{\pm}24.7%$, p=0.013). The best cut off values for the CLV and CLP were 50ml and 14.7%, respectively. The sensitivity, negative predictive value, and specificity of CLT were relatively high, but the positive predictive value was low. Conclusion: The likelihood of developing extubation failure increases with increasing severity of illness and duration of intubation. A low CLV or CLP (<50ml or 14.7%) is useful in identifying patients at risk of PES, but the CLT is not an absolute predictor and should not be used an indicator for delaying extubation.

• Tuberculosis and Respiratory Diseases
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• v.61 no.1
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• pp.13-19
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• 2006

Background: Acinetobacter baumannii has emerged as an important nosocomial pathogen worldwide. The incidence of these infections has recently begun to increase. The mortality rate associated with these infections is high (bacteremia; 52%, pneumonia: 23%~73%) and multidrug resistance has been reported. For the effective control of multidrug-resistant Acinetobacter baumannii(MDR-AB), the impact of these organisms in clinical practice should be determined. This study compared the clinical characteristics, mortality and morbidity of Acinetobacter nosocomial pneumonia between MDR strain and non-MDR strain. Methods: From Jan. 1, 2002 to Nov. 1. 2004, 47 adult patients with Acinetobacter nosocomial pneumonia in Chuncheon Sacred Heart Hospital were recruited and analyzed retrospectively. MDR-AB was defined as showing in vitro resistance to all commercially available antibiotics against A. baumannii. Results: There were 47 patients with Acinetobacter nosocomial pneumonia. MDR-AB and non MDR-AB was the cause of the pneumonia in 17 and 30 patients, respectively. Mean age of the former was $69{\pm}11$ years old and the latter was $70{\pm}13$ years old. The mean APCHE II score, ICU days and mortality were not different between the two groups ($16.1{\pm}5.4$ vs. $14.9{\pm}4.8$, P=0.43, $25.1{\pm}13.6$ vs. $39.1{\pm}31.0$, P=0.2, 58.8% vs. 40%, P=0.21). Conclusion: There are no significant differences in mortality and morbidity between MDR and non-MDR Acinetobacter baumannii. The mortality of the two groups is surprisingly high, therefore proper infection control practices are essential.

• Tuberculosis and Respiratory Diseases
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• v.58 no.6
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• pp.582-589
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• 2005

Background : The incidence of lung adenocarcinoma, which is more prevalent in women and nonsmokers, is increasing. The aim of this study was to determine the prognostic factors of an adenocarcinoma of the lung. Material and method : The clinical information of patients diagnosed with an adenocarcinoma of the lung at the Kosin University Gospel Hospital from January 1994 to July 2004 was reviewed retrospectively. The survival time of these patients was analyzed by the patient's age, gender, performance status, weight loss, smoking history, location of the primary tumor, clinical stage, serologic tumor markers, and treatment modality. Results : For all 422 patients with an adenocarcinoma of the lung, 247 (58.5%) were male, and their mean age was 59.8 years the. The majority of patients were smokers (58.3%), and the tumors were located in the periphery (59.7%). In the smokers, the tumor was located more in the central airway compared to the non-smokers (42.8% vs. 31.9%, p=0.12). The overall median survival time was 390 days (95% CI;304-436 days). Univariate survival analysis revealed that an older age (${\geq}65$ years old), male, weight loss, smoker, central type, advanced clinical stage, elevated serum carcinoembryonic antigen (CEA, >5 ng/ml) and neuron specific enolase (NSE, >15 ng/ml), and the supportive care only were significantly poor prognostic factors. The median survival time was shorter in the smokers than nonsmokers (289 days vs. 533 days, p<0.001). In addition, it was also shorter in the elevated NSE group than in the normal range group (207 days vs. 469 days, p<0.001). Multivariate analysis showed that age, clinical stage, serum NSE, smoking status, and treatment modality were independent predictors of survival (hazard ratios: 1.68, 1.94, 1.92, 2.39 and 1.57, respectively). Conclusions : Smoking is an important prognostic factor in an adenocarcinoma of the lung, but not gender. This suggests that the better prognosis of women is more related with the lower rate of smoking. In addition, the elevated serum NSE is also an important prognostic in an adenocarcinoma of the lung.