• Journal of Hospice and Palliative Care
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• 제8권2호
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• pp.200-208
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• 2005

목적: 악성 위장관 폐색 환자에서 완화적 시술이나 수술은 폐색의 다양한 증상을 조절할 뿐만 아니라 삶의 질을 향상시킨다. 본 연구는 완화적인 시술을 받았던 악성 위장관 폐색 말기암 환자의 임상적 특징과 예후인자를 알아보고자 하였다. 방법: 2002년 5월부터 2005년 5월까지 본원에서 악성 위장관 폐색으로 진단받아 완화적인 시술을 받았던 48명의 말기암 환자를 대상으로 후향적으로 조사하였다. 완화적인 암절제 환자는 제외하였다. 임상적 특성과 시술내용을 조사하였고 예후인자는 log-rank test를 이용한 단변량 분석을 하고 통계적으로 의미 있는 인자는 Cox's proportional hazard model을 사용하여 다변량 분석을 하였다. 결과: 연령의 중앙값은 65세이고 남자가 25명(52%), 여자가 23명(48%)이었다. 가장 많은 암은 대장직장암으로 26명(55%)이고 다음으로 10명(21%)의 위암이었다. 치료를 전혀 받지 않았던 환자는 25명(58%)이었고 20명(42%)은 치료를 받았으며 이 중 18명은 항암 치료를 받은 과거력이 있었다. 가장 흔한 증상은 통증으로 15명(31%)이었다. 활동도 1점 혹은 2점이 23명(48%), 3점 혹은 4점이 25명(52%)이었다. 가장 많은 완화적인 시술은 대장루술로 19명이 받았다. 완화적 시술로 인한 사망은 없었다. 단변량과 다변량 분석에 의해서 전체 생존기간과 무증상 생존기간에 대하여 활동도 만이 의미있는 독립 예후인자였다. 전체 중간 생존기간은 150일이었으며 무증상 중간 생존기간은 90일이었다. 결론: 완화적 시술을 받은 악성 위장관 폐색 환자의 전체 중간 생존기간과 무증상 중간 생존기간에 대하여 활동도만이 유일한 독립 예후인자였다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권23호
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• pp.10217-10223
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• 2015

Hyperactivated ${\alpha}2$-6-sialylation on N-glycans due to overexpression of the Golgi enzyme ${\beta}$-galactoside: ${\alpha}2$-6-sialyltransferase (ST6Gal-I) often correlates with cancer progression, metastasis, and poor prognosis. This study was aimed to determine the association between ST6Gal-I expression and the risk of recurrence and survival of patients with localized clear-cell renal cell carcinoma (ccRCC) following surgery. We retrospectively enrolled 391 patients (265 in training cohort and 126 in validation cohort) with localized ccRCC underwent nephrectomy at a single center. Tissue microarrays were constructed for immunostaining of ST6Gal-I. Prognostic value and clinical outcomes were evaluated. High ST6Gal-I expression was associated with Fuhrman grade (p<0.001 and p=0.016, respectively) and the University of California Los-Angeles Integrated Staging System (UISS) score (p=0.004 and p=0.017, respectively) in both cohorts. Patients with high ST6Gal-I expression had significantly worse overall survival (OS) (p<0.001 and p<0.001, respectively) and recurrence free survival (RFS) (p<0.001 and p=0.002, respectively) than those with low expression in both cohorts. On multivariate analysis, ST6Gal-I expression remained associated with OS and RFS even after adjusting for the UISS score. Stratified analysis suggested that the association is more pronounced among patients with low and intermediate-risk disease defined by the UISS score. High ST6Gal-I expression is a potential independent adverse predictor of survival and recurrence in ccRCC patients, and the prognostic value is most prominent in those with low and intermediate-risk disease defined by the UISS score.

• Journal of Trauma and Injury
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• 제25권4호
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• pp.247-253
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• 2012

Purpose: Hemorrhage is a main cause of death in trauma patients. The goal of this study is to describe the characteristics of trauma patients with massive bleeding and to evaluate the prognostic factors concerning their survival. Methods: This study was performed retrospectively and included trauma patients with massive bleeding who had been treated from March 2007 to August 2012. The inclusion criterion was patients who received more than 10 U of packed red blood cells within the first 24 hours after visiting the emergency department. Based on their medical records, we collected data in terms of demographic findings, mechanisms of injury, initial clinical and laboratory findings, methods for hemostasis (emergency surgery and/or angioembolization), transfusion, injury severity score (ISS), revised trauma score (RTS) and trauma and injury severity score (TRISS). We used the Mann-Whitney U test and Fisher's exact test to compare the variables between the patients that survived and those that did not. We performed a logistic regression analysis with the significant variables from the univariate test. Results: Thirty-two(32) patients were enrolled. The main mechanisms of injury were falls and motor vehicle accidents. The mean transfusion amount of packed red blood cells (PRBC) was 17.4 U. The mean elapsed time for the first hemostasis (surgery or embolization) was 3.5 hours. The initial technical success rates were 83.3%(15/18) in angioembolization and 66.7%(8/12) in surgery. The overall mortality rate was 34.4%(11/32). The causes of death were bleeding, brain swelling and multiple organ failure. The ISS(25.5 vs 46.3, p=0.000), TRISS(73.6 vs 45.1, p=0.034) and base excess(<-12 mmol/L, p=0.020) were significantly different between the patients who survived and those who did not. Conclusion: The ISS was a prognostic factor for trauma patients with massive bleeding.

• 대한임상독성학회지
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• 제2권2호
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• pp.72-76
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• 2004

Purpose: Dealing patients with organophosphate poisoning, cholinesterase level has been used as a diagnostic and prognostic value. But there are some controversies that the cholinesterase level is significantly related to the severity or prognosis of acute organophosphate poisoning. We evaluated the correlation between initial serum level of cholinesterase and APACHE II score as an index for severity, and we assessed cholinesterase levels for predicting value of weaning from mechanical ventilation. Method: From August 1996 to March 2003, 23 patients with organophosphate poisoning who needed ventilatory care were enrolled. Retrospective review was done for the serum level of cholinesterase, APACHE II score, and the duration of ventilatory care. The percentage of measured serum cholinesterase to median normal value was used to standardize cholinesterase levels from different laboratories. Result: There were tendencies that the lower initial serum of cholinesterase, the higher the APACHE II score (r=0.297) and the longer the duration of mechanical ventilation (r=-0.204), but they were not significant (p=0.264 and p=0.351 respectively). In 9 patients whose serum cholinesterase level were checked at the time of weaning, mean of measured cholinesterase level was $10.3\pm7.60\%$ of normal value. Conclusion: There was no significant relationship between initial level of serum cholinesterase and severity or duration of mechanical ventilation. General health status of patient, amount of ingestion, toxicity of agent should be considered as important factors for severity of poisoning. And the decision of weaning should be based not solely on the cholinesterase level but on the consideration of general and respiratory state of individual patients.

• Journal of Trauma and Injury
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• 제21권2호
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• pp.100-107
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• 2008

Purpose: A traumatic lung cyst (TLC) is a rare complication and is usually detected with a pulmonary contusion. This study attempted to identify the prognostic factors and the clinical characteristics for pulmonary contusion with TLCs. Methods: We retrospectively reviewed the medical records and chest CT findings of 71 TLC patients who visited our hospital from January 2006 to December 2007. Patients were assessed for any clinical characteristics. We evaluated significant differences between the survival and the death groups for patients with a traumatic lung cyst. Results: The male-to-female ratio of patients with TLCs was 54:17, and the mean age of the patients was $37.70{\pm}19.78years$ with 36.6% of the patients being under 30 years fo age. The cause of blunt thoracic trauma was mainly pedestrian traffic accidents (26.8%) and falls (25.4%). Associated conditions included pulmonary contusion in 68 patients (95.7%), hemopneumothorax in 63 patients (88.7%), and rib fracture in 52 patitents (73.2%). There was no consistent relationship between the number of TLCs and the pulmonary contusion score. The overall mortality rate of TLC patients was 26.8%. Death correlated with a need for ventilatory assistance, mean arterial pressure, worst mean arterial pressure in 24 hours, initial pH and base excess, worst pH and base excess in 24 hours, refractory shock, initial GCS score, and pulmonary contusion score. Conclusion: The presence of the aforementioned predictors indicate serious injury, which is the main determinant of the outcome for thoracic injuries with TLCs.

• Journal of Gastric Cancer
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• 제22권1호
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• pp.56-66
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• 2022

Purpose: Nutritional problems after gastrectomy affect continuation of postoperative chemotherapy. There have been no studies limited to total gastrectomy, which is particularly prone to nutritional problems. In this study, we aimed to investigate the factors that predict the continuation of postoperative chemotherapy. Materials and Methods: We included 101 patients who underwent curative total gastrectomy and postoperative chemotherapy at Hiroshima Memorial Hospital. The effects of 37 factors, including perioperative inflammatory, nutritional, and tumor status, on the persistence of postoperative chemotherapy were analyzed. Results: In univariate analysis of preoperative factors, age, carbohydrate antigen 19-9, platelet-to-neutrophil ratio, Onodera's prognostic nutritional index (PNI), controlling nutritional status score, and nutritional risk screening (NRS-2002) score were significantly associated with the duration of postoperative chemotherapy. In multivariate analysis of preoperative factors, age (≥74 years) was an independent factor for a shorter duration of postoperative chemotherapy (hazard ratio [HR], 5.24; 95% confidence interval [CI], 2.19-12.96; P<0.01). In univariate analysis of factors before postoperative chemotherapy, intraoperative blood loss, perioperative weight loss rate, postoperative performance status, PNI, albumin-to-bilirubin index, and NRS-2002 score were significantly associated with the duration of postoperative chemotherapy. In multivariate analysis of factors before postoperative therapy, age (≥74 years) (HR, 5.75; 95% CI, 1.90-19.49; P<0.01) and PNI (<39) (HR, 3.29; 95% CI, 1.26-8.56; P=0.02) were independent factors for a shorter duration of postoperative chemotherapy. Conclusions: Age and PNI are useful predictors of postoperative chemotherapy intolerance after total gastrectomy and may determine the treatment strategy and timing of chemotherapy initiation.

• Journal of Korean Neurosurgical Society
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• 제67권2호
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• pp.209-216
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• 2024

Objective : Some patients with disc herniation who underwent discectomy complain of back pain after surgery and are unsatisfied with the surgical results. This study aimed to evaluate the relationship between preoperative disc height (DH), postoperative DH, and pain score 12 months after surgery in patients who underwent microdiscectomy for herniated lumbar disc. Methods : This study enrolled patients who underwent microdiscectomy at a medical center between January 2012 and December 2020. Patients with X-ray or computed tomography and pain score assessment (visual analog scale score) prior to surgery, immediately post-op, and at 1, 6, and 12 months after surgery were included. The DH index was defined as DH/overlying vertebral width. The DH ratio was defined as the postoperative DH/preoperative DH. Simple linear regression and multivariate linear regression analyses were applied to assess the correlation between DHs and leg pain scores 12 months after surgery. Results : A total of 118 patients who underwent microdiscectomy were included. DH decreased up to 12 months after surgery. The DH ratio at 1, 6, and 12 months after discectomy showed a significant positive correlation with the pain scores at 12 months after discectomy (1 month : p=0.045, B=0.52; 6 months : p=0.008, B=0.78; 12 months : p=0.005, B=0.69). Multivariate linear regression analysis revealed that the level of surgery, sex, age, and body mass index had no significant relationship with back pain scores after 12 months. Conclusion : In patients who underwent microdiscectomy, the DH ratios at 1, 6, and 12 months after surgery were prognostic factors for back pain scores at 12 months after surgery. Aggressive discectomy is recommended for lower postoperative DH ratios and Visual analog scale scores, leading to improved patient satisfaction.

• 대한관절경학회지
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• 제7권1호
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• pp.81-86
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• 2003

목적 : 재발성 전방 견관절 탈구 환자에서 비흡수성 봉합사를 사용하여 suture-anchor 방식을 이용한 관절경적 Bankart 술식의 임상적 결과와 병변의 예후에 영향을 미칠것으로 사료되는 여러 인자들을 술 전, 술 후 Rowe 점수를 통해 평가, 비교하였다. 대상 및 방법 : 1997년 6월부터 2001년 5월까지 외상으로 인한 재발성 견관절 탈구로 인해 관절경적 Bankart 병변 봉합술을 시행 후 최소 1년 6개월 이상 추시가 가능했던 29예를 대상으로 하였다. 28명 모두 남자였으며 수상 당시의 평균나이는 21.3세다. 술 전, 술 후 견관절의 기능평가는 Rowe점수를 사용하였으며 예후에 영향을 미칠 것으로 사료되는 9개의 인자를 설정한 후 술 전, 술 후 Rowe 점수를 이용하여 공변량 분석을 이용한 통계학적 검증을 실시하였다. 결과 : 술전 Rowe 점수는 평균 28.4점(보통 11예, 불량 17예)이었는데 반해 술 후 Rowe점수는 87.1점(우수 12예, 양호 15예, 보통 1예)이었고 통계학적으로 유의한 점수의 증가를 나타냈다(p=0.000). 추시상 나타난 합병증으로는 재탈구 1례, 경미한 견관절 운동범위 장애를 나타내는 2례가 있었다. 술 전, 술 후 Rowe점수를 통한 예후 인자 분석에 있어서는 수상 당시의 나이가 20세 미만인 군에서 20세 이상인 군보다 통계학적으로 유의하게 (p=0.023) 예후가 좋은 것으로 나타났다. 결론 : 관절경을 이용한 Bankart 술식은 재발성 견관절 탈구환자에 있어 유용한 치료방법중의 한가지로 사료된다. 또한 수상당시의 나이는 술 전, 술 후 Rowe점수를 비교한 결과 예후에 영향을 미치는 인자로 사료되었다.

• Tuberculosis and Respiratory Diseases
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• 제49권5호
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• pp.601-613
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• 2000

연구배경 : 통상성 간질성 폐섬유증(usual interstitial pneumonia : UIP)은 특발성 간질성 폐렴(Idiopathic interstitial pneumonia : I.I.P)의 한 형태로서 생존기간 중앙값이 약 3-5 년 정도로 보고되는 치명적인 질환으로 알려져 있으나, 최근 분류된 BOOP이나 NSIP등을 제외한 순수한 UIP환자들만을 대상으로 임상경과나 예후에 대한 연구는 외국에서도 극소수아고, 국내에서는 보고된 바가 없다. 이에 연구자들은 수술적 폐생검 검사로 확진된 UIP 환자들의 임상경과와 예후의 예측 지표를 찾고자 본 연구를 시행하였다. 방법 : 1989년 3월부터 1999년 8월까지 서울중앙병원에서 개흉 또는 흉강경을 통한 폐생검검사로 UIP로 진단된 72명(연령 $58.2{\pm}11.6$세, 남 : 여=45:27, 관찰기간 중앙값 : 18.1개월 (0.7-103.6개월))을 대상으로 하였다. 진단시의 임상증상과 흉부고해상도단층촬영, 폐기능검사, 동맥혈 가스검사 등을 증상점수(C) (1-20점), 방사선학점수(R)(봉와양 소견 : 0-5점, 젖빛유리야 소견 : 0-5점) 및 생리적검사점수(P) (FVC 1-12점, $FEV_1$ 0-3점, TLC 1-10점, $D_{LCO)$ 0-5점, $AaDO_2$ 0-10점)로 수치화하여 CRP 접수를 계산하였다. 임상경과와 진단시의 CRP점수, 기관지 폐포세척액검사 등을 비교 분석하여 예후의 예측지표를 검색하였다. 결과 : 1) 대상 UIP환자들의 1년 누적생존률은 78.3%, 3년 누적생존률은 58.1% 였고, 생존기간 중앙값은 42.5개월이었다. 2) 단기(1년)예후 : 단기 사망군(14명)은 생존군(46명)에 비하여 전체CRP점수($28.6{\pm}8.3$ vs. $16.6{\pm}9.7$)가 높았으며, 이는 주로 증상점수($8.4{\pm}2.1$ vs. $5.7{\pm}3.9$)와 FVC, $D_{LCO)$, $AaDO_2$를 포함하는 생리적검사점수 $v{\pm}7.5$ vs. $8.1{\pm}7.3$)의 차이에 기인하였다. 또한 호전 혹은 안정군(61.7%)과 악화군 및 사망군(38.3%) 사이에는 연령과 흡연률, 진단당시의 CRP점수(증상점수, FVC, $AaDO_2$, $D_{LCO)$)가 유의한 차이가 있었다. 그러나 방사선학점수, TLC 및 기관지폐포세척액소견 등은 유의한 차이가 없었다. 2) 장기(3년) 예후 : 장기생존군(14명)은 사망군(22명)에 비하여 역시 진단시 총CRP점수($12.2{\pm}6.7$ vs. $28.7{\pm}7.9$)와 증상점수, FVC, $D_{LCO)$, $AaDO_2$)가 차이가 있었다. 3) 생존기간분석에서도 총 CRP 점수와 증상점수, $AaDO_2$ FVC, $D_{LCO)$가생존기간과 유의한 상관관계를 보였다. 4) Cox 회기분석을 이용한 다변수 분석에서는 $D_{LCO)$ (${\geq}$60% : Hazard ratio : 4.56, 95% CI : 2.30-16.04)만이 UIP환자 사망의 독립적인 예측인자로 나타났다. 결론 : 이상의 결과는 UIP 진단시의 $D_{LCO)$는 UIP환자의 예후를 예측할 수 있는 임상적 지표임을 시사하였다.

• Annals of Clinical Neurophysiology
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• 제6권2호
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• pp.92-97
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• 2004

Background: There were several studies comparing prognostic factors in Guillain-Barre syndrome treated with intravenous immunoglobulin and plasmapheresis. However, there were controversies in what were significant factors and there were few studies so far comparing the therapeutic outcomes in patients treated with immunoglobulin. This study was aimed to determine the prognostic factors which affected the therapeutic outcome of Guillain-Barre syndrome treated with intravenous immunoglobulin. Method: We retrospectively reviewed the medical records of patients with Guillain-Barre syndrome admitted to our hospital between January 1999 and March 2004. All patients were treated with intravenous immunoglobulin. Outcome and prognosis were followed up after four weeks using the overall disability sum score. Results: Thirty-six patients were enrolled in this study. According to the clinical and electrophysiological findings, 17 patients were AIDP, 10 were axonal forms, two were mixed and seven had electrophysiologically no evidence of abnormalities. At a follow-up of four weeks, disabilities at the nadir (p<0.001) and admission (P<0.012), initial manifestations of bulbar symptom (P<0.024) and electrodiagnostic features (P<0.013) were significantly correlated with outcome in patients treated with intravenous immunoglobulin. But only disabilities at the nadir (P<0.033) and electrodiagnostic features (P<0.018) were significant in the multivariate logistic regression analysis. Conclusion: Among the patient treated with intravenous immunoglobulin, the outcomes were significantly different according to the neurological status at the nadir. Therefore early diagnosis, administration of intravenous immunoglobulin and preventing complications during acute stages are essential to minimize neurological deficit and shorten the periods of recovery.