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Pulmonary Complications after Surgery for Esophageal Cancer (식도암 수술 후 발생한 호흡기 합병증)

  • Lee, Jang-Hoon;Lee, Jung-Cheul
    • Journal of Chest Surgery
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    • v.39 no.2 s.259
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    • pp.134-139
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    • 2006
  • Background: Complications after surgery for esophageal cancer are various and not rare. Among them, pulmonary complication is well known as one of the most important insults which has negative influence on the postoperative course and results in mortality. So we attempted to analyze the factors which may have relation to postoperative pulmonary complication. Material and Method: The retrospective study was undertaken in 87 patients who underwent curative surgery for esophageal cancer from Jan. 1996 to Aug. 2005. We divided them into two groups, patients with pulmonary complication (group A, n=28), without pulmonary complication (group B, n=59). Statistical analysis was performed with Fisher's exact test. Result: The postoperative pulmonary complication developed in 28 patients ($32\%$). There was no difference between two groups in past medical history, preoperative pulmonary function, surgery time, anastomosis method, pathologic stage, and trial of neoadjuvant therapy. Age and incidence of cervical anastomosis were significantly higher in group A (p=0.001, p=0.023). The rate of routine postoperative ventilator care was significantly higher in group S (p=0.007). Chest tube indwelling time and hospital stay were significantly longer in group A (p=0.011, p=0.001). There were 6 postoperative deaths ($6.8\%$) and 5 deaths were related to pulmonary complication. Pneumonia was the most common cause of death and MRSA (methicillin resistant staphylococcus aureus) was the most common organism in sputum culture. Conclusion: Pulmonary complication after esophageal cancer surgery was the most important cause of death. Pulmonary complication was closely related to patient's age and cervical anastomosis. We think postoperative routine ventilator care is helpful for prevention of pulmonary complications, especially MRSA pneumonia, and reducing mortality.

Analysis of the Causes of and Risk Factors for Mortality in the Surgical Repair of Interrupted Aortic Arch (대동맥궁 단절증 수술 사망 원인과 위험인자 분석)

  • Kwak Jae Gun;Ban Ji Eun;Kim Woong-Han;Jin Sung Hoon;Kim Yong Jin;Rho Joon Ryang;Bae Eun Jung;Noh Chung Il;Yun Yong Soo;Lee Jeong Ryul
    • Journal of Chest Surgery
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    • v.39 no.2 s.259
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    • pp.99-105
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    • 2006
  • Background: Interrupted aortic arch is a rare congenital heart anomaly which still shows high surgical mortality. In this study, we investigated the causes of and the risk factors for mortality to improve the surgical outcomes for this difficult disease entity. Material and Method: From 1984 to 2004, 42 patients diagnosed as IAA were reviewed retrospectively. Age, body weight at operation, preoperative diagnosis, preoperative PGE1 requirement, type of interrupted aortic arch, degree of left ventricular outflow stenosis, CPB time, and ACC time were the possible risk factors for mortality. Result: There were .14 hospital deaths. Preoperative use of PGE1, need for circulartory assist and aortic cross clamp time proved to be positive risk factors for mortality on univariate analysis. Preoperative left ventricular outflow stenosis was considered a risk factor for mortality but it did not show statistical significance (p-value=0.61). Causes of death included hypoxia due to pulmonary banding, left ventricular outtract stenosis, infection, mitral valve regurgitation, long cardiopulmonary bypass time and failure of coronary transfer failure in TGA patients. Conclusion: In this study, we demonstrated that surgical mortality is still high due to the risk factors including preoperative status and long operative time. However preoperative subaortic dimension was not related statistically to operative death statistically. Adequate preoperative management and short operation time are mandatory for better survival outcome.

The Usefulness of a Percutaneous Cardiopulmonary Support Device for the Treatment of Fulminant Myocarditis (전격성 심근염의 치료에 있어 경피적 순환 보조 장치의 유용성)

  • Lim, Juyoug;Jung, Sung Ho;Je, Hyoung-Gon;Lee, Taek Yeon;Choo, Suk Jung;Lee, Jae Won;Chung, Cheol Hyun
    • Journal of Chest Surgery
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    • v.43 no.1
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    • pp.20-24
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    • 2010
  • Background: Fulminant myocarditis is a rare, but life threatening condition. Its prognosis is related with proper management in the acute phase. A cardiopulmonary support device can be very useful in this phase. We report on our experiences with managing acute fulminant myocarditis with a cardiopulmonary support (CPS) device. Material and Method: We reviewed retrospectively 9 patients who had a CPS device used for their fulminant myocarditis between September, 2006 and October, 2008. A Capiox emergency bypass system (Terumo Inc, Tokyo, Japan) was percutaneously inserted in all the patients. Upon implantation, all the patients were in cardiogenic shock because of ventricular arrhythmia or severe left ventricular dysfunction. The mean left ventricular ejection fraction (EF) was $20{\pm}6%$ according to transthoracic echocardiography. Result: 3 patients died despite CPS. The CPS was bridged to a transplanted heart in one patient. The rest were successfully explanted after a mean time of $107{\pm}70$ hours of running. The mean EF after discharge was $56{\pm}7%$ without dilated cardiomyopathy. Conclusion: Fulminant myocarditis can be fatal, but its prognosis is excellent if these patients receive proper, timely treatment. A cardiopulmonary support device can be very useful in this acute period. However, the implantation and management protocol of cardiopulmonary support are not yet settled. Further study is necessary to lower the complications of cardiopulmonary support for patients with fulminant myocarditis.

Blood Picture of the Korean Native Goats from Birth to Maturity (한국 재래 염소의 성장에 따르는 혈액상의 변동)

  • Choi, Hi In
    • Korean Journal of Veterinary Research
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    • v.14 no.1
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    • pp.115-133
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    • 1974
  • Although considerable research has been done on the changes associated with age in the blood picture of domestic and laboratory animals, little work has been made of the changes occurring at different age in the blood picture of goats. And a comprehensive survey of the bood picture of Korean native goats has not been made. The object of the present investigation was to suggest standards for the blood picture of Korean native goats at frequent intervals from birth to maturity. The goats were kept under average farming conditions in this country. Observations were made at the following ages: at birth; 2,4 and 7 days; 2, 3, 4, 5, 6, 7, 8 and 9 weeks; 2.5, 3,6 and 12 months. Blood samples were drawn from the jugular vein. It was taken between 8 and 9 a.m. except those for the at-birth period. Erythrocyte and leukocyte enumerations and, determinations of hemoglobin in blood and hematocrit value were made in the usual manner. Reticulocytes were enumerated per 1,000 erythrocytes in blood smears stained with briIliant cresyl blue and counterstained with Wright's stain. Erythrocytes counts declined from $8.7{\times}10^8/mm^3$ at birth to a low of 7.0 at 4 days of age. These values increased to 11.5 at 5 weeks and reached a maximum of 14.0 at 3 months of age; it then fell to 11.5 at 12 months of age. Concentrations of hemoglobin in blood and hematocrit values were not related to the changes of erythrocyte counts. The values at birth were higher than at any other period during the first year of life. These fell from highs of 12.3 g/100 ml and 38.0 ml/100 ml to lows of 9.2 and 29 at 4 weeks for concentration of hemoglobin in blood and hematocrit value, respectively. There was a common pattern for the hematocrit value and hemoglobin in blood which showed three phases-a fall during the first month, a rise to the third month, and a fall to the mature level at 12 months of age. Mean corpuscular volume and mean corpuscular hemoglobin showed a common pattern. The values were $44.2{\mu}m^3$ and 14.2 pg at birth and fell, at first slowly and then rapidly, to reach adult levels of 24.1 and 7.9 at 6 weeks of age for mean corpuscular volume and mean corpuscular hemoglobin, respectively. Mean corpuscular hemoglobin concentration was little affected by age. Reticulocyte was observed from birth to 4 weeks of age. Percentage of reticulocyte decreased from 0.85% at birth to 0.06% at 4 weeks of age. Total leucocyte counts increased from $5.64{\times}10^3/mm^3$ at birth to a maximum of 13.4 at 3 months; it then fell to 11.5 at 12 months of age. In differential counts myelocyte, juvenile and band form decreased with advancing age. No myelocyte and juvenile were seen after the age of 7 and 9 weeks, respectively, and band forms were rare after the age of 3 months. Percentage of mature neutrophil showed a quick decline from 52.5% at birth to reach a minimum level (34.5%) at 3 months of age; it then rose to 38% at 12 months of age. Percentage of lymphocyte increased from 39.2% at birth to maximum of 59% at 3 month of age; it then fell to 54.9% at 12 months of age. Percentage of monocyte was not affected with advance of age. Percentage of eosinophil and basophil were increased with advance of age to reach a maximum at 2 to 3 month of age. It then fell to adult level at 12 month of age.

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Prognostic Factors and Clinical Characteristics of Terminally Ill Patients with Gastric Cancer (말기 위암 환자의 임상적 특성과 예후 인자)

  • Kim, Soo-Jae;Moon, Do-Ho;Lee, Choon-Sub;Lee, Jung-Ho;Kim, Tae-Gyun;Park, Jung-Chul;Lee, Ji-Eun
    • Journal of Hospice and Palliative Care
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    • v.10 no.4
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    • pp.178-183
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    • 2007
  • Purpose: The prevalence and mortality of gastric lancer is high. We studied clinical characteristics and prognostic factors of the advanced gastric canter patients who had died in the hospice care unit. and our study is the basic report for efficient hospice and palliative care for the terminally ill patients with gastric cancer. Methods: We retrospectively reviewed the medical records of 99 advanced gastric cancer patients who had died in a hospice rare unit from May 2004 to August 2007. The survival days during the hospice and palliative care were analyzed using Kaplan-Meier method of SPSS version 13.0. Results: There were 62 males (63%) and 37 females (37%). Median age of patients was 60.9 years and liver metastasis was as high as 38 patients (38%) of all. The most prevalent symptom of admission was general weakness (97%) and poor or intake (86%). There were also bypoalbuminemia (88%), anemia (73%), and hyponatremia (61%). Palliative procedure was performed on 17 (63%) out of 27 patients with intestinal obstruction. Of these stents were inserted to 11 patients. The stores of ECOGPS and dyspnea were significantly correlated with the length of survival. The duration of median survival and hospitalization in the hospice and palliative care was 22 days and was 20 days respectively. Conclusion: We need to study more about clinical characteristics of advanced gastric rancor patients to predict the length of survival for an effective hospice and palliative care.

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Geochemistry of the Kwanaksan alkali feldspar granite: A-type granite\ulcorner (관악산 알칼리 장석 화강암의 지구화학 : A-형 화강암\ulcorner)

  • S-T.Kwon;K.B. Shin;H.K. Park;S.A. Mertzman
    • The Journal of the Petrological Society of Korea
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    • v.4 no.1
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    • pp.31-48
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    • 1995
  • The Jurassic Kwanaksan stock, so far known to be composed of biotite granite only, has the mineral assemblage of quartz+K-feldspar+plagioclase+biotite${\pm}$gernet. The lithology of the stock is classified as alkali feldspar granite by their mode and plagioclase compositions (An<5). Subsolvus feldspars, rather early crystallization of biotite, and shallow emplacement depth estimated from Q-Ab-Or diagram suggest hydrous nature of the magma, which contrasts with anhydrous A-type like geochemistry described below. Major and trace element compositions of the Kwanaksan stock are distinct from those of the adjacent Seoul batholith, suggesting a genetic difference between the two, The Kwanaksan stock shows geochemical characteristics similar to A-type granite in contrast to most other Mesozoic granites in Korea, in that it has high $SiO_2$(73~78wt%), $Na_2O+K_2O$, Ga(27~47 ppm). Nb(22~40 ppm), Y(48~95 ppm), Fe/Mg and Ga/Al, and low CaO(<0.51 wt%). Ba (8~75 ppm) and Sr(2~23 ppm). However, it has lower Zr and LREE and higher Rb(384~796 ppm) than typical A-type granite. LREE-depleted rare earth element pattern with strong negative Eu anomaly of previous studies is reinterpreted as representing source magma characteristics. The residual material during partial melting is not compatible with pyroxenes, amphibole or garnet, while significant amount of plagioclase is required. Similarity of geochemistry of the Kwanaksan stock to A-type granite suggests the origin of the stock has a chose relationship with that of A-type granite. These observations lead us to propose that the Kwanaksan stock was formed by partial melting of felsic source rock.

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Efficacy of Pamidronate in Nephropathic Children with Ongoing Long Term Corticosteroid Therapy (장기 스테로이드 치료요법 중인 신질환 환자에서 Pamidronate의 효과)

  • Hong Hyun-Kee;Kim Eun-Seong;Kim Sung-Do;Cho Byoung-Soo
    • Childhood Kidney Diseases
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    • v.8 no.1
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    • pp.43-50
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    • 2004
  • Background : Steroid-induced osteoporosis(SIO) is one of the serious complications of long-term steroid therapy, especially in growing children. Recently bisphosphonates have been used to treat or prevent SIO in adult, which is rare in children with glomerular diseases. We studied the effect of pamidronate on SIO using dual energy X-ray absorptiometry and biochemical markers of bone turnover. Methods : Forty four children receiving moderate-to-high doses of steroids were enrolled. They had no history of bone, liver, or endocrine disease. Patients were stratified by their baseline bone mineral density(BMD) findings. All patients received corticosteroids for 3 month and oral calcium supplementation(500 mg/day) daily. Among them, 28 patients were treated with placebo and 16 were treated with pamidronate(125 mg) for 3 months. Blood chemistry and bone mineral density(BMD) were measured at baseline, and 3months. In addition, parathyroid hormone(PTH), serum osteocalcin, and urinary dipyridinoline levels were evaluated. Results : In overall population, the mean lumbar spine BMD decreased from $0.754{\pm}0.211(g/cm^2)$ to $0.728{\pm}0.208(g/cm^2)$ in the placebo group(P<0.05) and increased from $0.652{\pm}0.194(g/cm^2)$ to $0.658{\pm}0.226(g/cm^2)$ in the pamidronate group(P>0.05). Conclusion : Pamidronate appears to be effective in preventing SIO in children with glomerular diseases requiring long-term steroids therapy. Further careful observation and follow-up might be needed for children receiving bisphosphonates such as pamidronate.

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Systemic Candida Infection in Very Low Birth Weight Infants : Epidemiological Features Over 5 Years (극소 저체중 출생아에서 전신성 칸디다 감염 : 5년간의 역학적 특성)

  • Lee, Seung-Woo;Lee, Jeong-Eun;Lee, Ju-Young;Lee, Hyun-Seung;Lee, Jung-Hyun;Sung, In-Kyung
    • Neonatal Medicine
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    • v.16 no.2
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    • pp.190-196
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    • 2009
  • Purpose: Candida infection has increased in neonatal intensive care units (NICU). However, recent reports on systemic candida infections in preterm newborns are rare in Korea. The aim of this study was to examine the epidemiological features of systemic candida infection in very low birth weight infants (VLBW) over the past five years. Methods: We retrospectively reviewed the medical records of 19 patients with systemic candida infections in VLBW that were admitted to the neonatal intensive care units of three hospitals affiliated with the College of Medicine, The Catholic University of Korea from January 2004 to December 2008. We analyzed the birth weight, gestational age, age at diagnosis, risk factors, co-morbidity, antifungal treatment, and mortality rates among the 19 patients. Results: Systemic candida infections occurred in 19 cases (4.7%) among the VLBW infants. The mean birth weight and gestational age were 959.0$\pm$255.9 g and 26.7$\pm$2.1 weeks. The isolated Candida species were C. albicans (4), C. parapsilosis (9), C. glabrata (2), C. famata (2), and unkown subspecies (2). Most patients had various associated risk factors, including a central venous catheter, broad spectrum antibiotics, parenteral nutrition, intravenous lipid emulsion, endotracheal intubation and $H_2$ blocker therapy. There was no significant difference in the risk factors between newborns that survived and those that died with regard to the systemic candida infection, except for gestational age. Nine (47.4%) out of 19 patients with a candida infection died and four cases (21.2%) were directly related to the candida infection. Conclusion: The prevalence of systemic candida infection is increasing in VLBW infants. The majority of Candida species has shifted to C. non-albicans, especially C. parapsilosis. Because of the high mortality associated with candida infection in the NICU, prophylaxis and early treatment based on epidemiological features is necessary.

Compositional Variation of Arsenopyrites in Arsenic and Polymetallic Ores from the Ulsan Mine, Republic of Korea, and their Application to a Geothermometer (울산광산산(蔚山鑛山産) 유비철석(硫砒鐵石)의 조성변화(組成變化) 및 지질온도계(地質溫度計)에 대(對)한 적용(適用))

  • Choi, Seon-Gyu;Chung, Jae-Ill;Imai, Naoya
    • Economic and Environmental Geology
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    • v.19 no.3
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    • pp.199-218
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    • 1986
  • Arsenopyrite in arsenic and polymetallic ores from calcic Fe-W skarn deposit of the Ulsan mine, Republic of Korea, has been investigated by means of electron microprobe analysis and X-ray diffractometry. As a result, it is revealed that the Ulsan arsenopyrite may be classified into the following three species with different generation on the basis of its mode of occurrence, chronological order during polymetallic mineralization and chemical composition; arsenopyrites I, II and III. 1) Arsenopyrite I-(Ni, Co)-bearing species belonging to the oldest generation, which has crystallized together with (Ni, Co)-arsenides and -sulpharsenides in the early stage of polymetallic mineralization. In rare cases, it contains a negligible amount of antimony. It occurs usually as discrete grains with irregular outline, showing rarely subhedral form, and is diffused in skarn zone. The maximum contents of nickel and cobalt are 10.04 Ni and 2.45 Co (in weight percent). Occasionally, it shows compositional zoning with narrow rim of lower (Ni+Co) content. 2) Arsenopyrite II-arsenian species, in which (Ni+Co) content is almost negligible, may occur widely in arsenic ores, and its crystallization has followed that of arsenopyrite I. It usually shows subhedral to euhedral form and is closely associated with $l{\ddot{o}}llingite$, bismuth, bismuthinite, chalcopyrite, sphalerite, bismuthian tennantite, etc. It is worthy of note that arsenopyrite II occasionally contains particles consisting of both bismuth and bismuthinite. 3) Arsenopyrite III-(Ni, Co)-free, S-excess and As-deficient species is close to the stoichiometric composition, FeAsS. It occurs in late hydrothermal veins, which cut clearly the Fe-W ore pipe and the surrounding skarn zone. It shows euhedral to subhedral form, being extremely coarse-grained, and is closely associated with pyrite, "primary" monoclinic pyrrhotite, galena, sphalerite, etc. Among three species of the Ulsan arsenopyrite, arsenopyrite I does not serve as a geothermometer, because (Ni+Co) content always exceeds 1 weight percent. In spite of the absence of Fe-S minerals as sulphur-buffer assemblage, the presence of $Bi(l)-Bi_2S_3$ sulphur-buffer enables arsenopyrite II to apply successfully to the estimation of either temperature and sulphur fugacity, the results are, $T=460{\sim}470^{\circ}C$, and log $f(S_2)=-7.4{\sim}7.0$. With reference to arsenopyrite III, only arsenopyrite coexisting with pyrite and "primary" monoclinic pyrrhotite may serve to restrict the range of both temperature and sulphur fugacity, $T=320{\sim}440^{\circ}C$, log $f(S_2)=-9.0{\sim}7.0$. These temperature data are consistent with those obtained by fluid inclusion geothermometry on late grandite garnet somewhat earlier than arsenopyrite II. At the beginning of this paper, the geological environments of the ore formation at Ulsan are considered from regional and local geologic settings, and physicochemical conditions are suspected, in particular the formation pressure (lithostatic pressure) is assumed to be 0.5kb (50MPa). The present study on arsenopyrite geothermometry, however, does not bring about any contradictions against the above premises. Thus, the following genetical view on the Ulsan ore deposit previously advocated by two of the present authors (Choi and Imai) becomes more evident; the ore deposit was formed at shallow depth and relatively high-temperature with steep geothermal gradient-xenothermal conditions.

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Mineralogical Characteristics of Carbonate Rock-Hosted Naturally Occurring Asbestos from Asan, Muju, Jangsu Areas (국내 탄산염암 지역(아산, 무주, 장수)에서 산출되는 자연발생석면의 광물학적 특성)

  • Shin, Eunhea;Jeong, Hyeonyi;Baek, Jiyeon;Jeong, Hyewon;Park, Jaebong;Roh, Yul
    • Economic and Environmental Geology
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    • v.51 no.4
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    • pp.309-322
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    • 2018
  • Naturally occurring asbestos (NOA) occurs in rocks and soils as a result of natural weathering and human activities. It is proved that inhalation of asbestos fibers can lead to increase risk of developing several diseases such as lung cancer and malignant mesothelioma. The parent rocks of asbestos have been mainly associated with (ultra)mafic and carbonate rock. The previous studies on NOA were mainly limited to (ultra)mafic rock-hosted asbestos, but studies on carbonate rock-hosted asbestos are relatively rare in S. Korea. Therefore, this study was aimed to examine mineralogical characteristics of carbonate rock-hosted NOA at three sites including Muju and Jangsu, Jeonbuk province and Asan, Chungnam province. Types of rocks at the three sites mainly consisted of Precambrian metasedimentary rocks, carbonate rock, and Cretaceous and Jurassic granites. Asbestos-containing carbonate rock samples were obtained for mineralogical characterization. XRD, PLM, EPMA, SEM and EDS analyses were used to characterize mineralogical characteristics of the carbonate rock-hosted NOA. From the carbonate rock, fibrous minerals were occurred acicular and columnar forms in the three sites. Fibrous minerals were composed of mainly tremolite and associated minerals included possibly asbestos containing materials (ACM) such as talc, vermiculite, and sepiolite. The length and aspect ratios of tremolite were similar to the standard asbestiform (length >$5{\mu}m$, length:width = 3:1). These results indicate that both non-asbestiform and asbestiform tremolite with acicular forms occurred in carbonate rocks at three sites. Geological and geochemical characteristics and mineral assemblages indicate tremolite and associated minerals might be formed by hydrothermal alternation and/or hydrothermal veins of carbonate rocks due to intrusion of acidic igneous rocks.