• Journal of Korean Neurosurgical Society
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• v.56 no.2
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• pp.108-113
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• 2014

Objective : Ankylosing spondylitis is an inflammatory rheumatic disease mainly affecting the axial skeleton. The rigid spine may secondarily develop osteoporosis, further increasing the risk of spinal fracture. In this study, we reviewed fractures in patients with ankylosing spondylitis that had been clinically diagnosed to better define the mechanism of injury, associated neurological deficit, predisposing factors, and management strategies. Methods : Between January 2003 and December 2013, 12 patients with 13 fractures with neurological complications were treated. Neuroimaging evaluation was obtained in all patients by using plain radiography, CT scan, and MR imaging. The ASIA Impairment Scale was used in order to evaluate the neurologic status of the patients. Management was based on the presence or absence of spinal instability. Results : A total of 9 cervical and 4 thoracolumbar fractures were identified in a review of patients in whom ankylosing spondylitis had been diagnosed. Of these, 7 fractures were associated with a hyperextension mechanism. 10 cases resulted in a fracture by minor trauma. Posttraumatic neurological deficits were demonstrated in 11 cases and neurological improvement after surgery was observed in 5 of these cases. Conclusions : Patients with ankylosing spondylitis are highly susceptible to spinal fracture and spinal cord injury even after only mild trauma. Initial CT or MR imaging of the whole spine is recommended even if the patient's symptoms are mild. The patient should also have early surgical stabilization to correct spinal deformity and avoid worsening of the patient's neurological status.

• Journal of Chest Surgery
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• v.29 no.3
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• pp.311-314
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• 1996

Eighteen patients (13 female and ave male) aged from 15 to 62 years (mean age 42.6 years) underwent excision of cardiac myxoma(17 left atrial, one right atrial) between 1985 and 1994 at Pusan National University hospital. All patients complained of exertional dyspnea and most had a few additional symtoms including palpitation, chest pain, syncope, general weakness, weight loss, fever, cough and epigastric disconyort. The diagnosis was made by echocardiography alone in left atrial myxomas but a myxoma in right atrium was diagnosed incidentally during mitral valve replacement for rheumatic valvular heart disease. The tumor attachment sites were fossa ovalis in 13, other interatrial septum in 4, mitral valve annulus in one and free wall of left atrium in two cases. The tumor was excised successfully via right atriotomy in 8 and biatriotomy in 10 cases. There was no hospital nor late death, and no recurrent case during the follow up period. Curative surgical excision of cardiac myxoma can be performed with low morbidity and very low r currence rate.

• The Journal of the Korea Contents Association
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• v.14 no.10
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• pp.10-19
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• 2014

In recent, hospital information systems are widely used to electronically record, manage and share the data collected in hospitals. Such systems have contributed greatly to improving the work efficiency in modern hospitals, however, the collected data concerning the patients should be appropriately processed and reused to provide the healthcare service providers with decision supports. Especially, this paper proposes the patient flow monitoring system for the operations management of the outpatient department for patients with chronic diseases, and discusses the related issues. The proposed system visualizes the standard process model extracted from the patient history data and various performance measures, and this enables the managers to evaluate and enhance the operations of the outpatient clinic. In this paper, the patient flow monitoring system is applied to the rheumatology clinic, and the prototype system optimized for I-pad is illustrated.

• Journal of Korean Academy of Nursing
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• v.37 no.2
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• pp.249-256
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• 2007

Purpose. Tai Chi exercise, an ancient Chinese martial art, has drawn more and more attention for its health benefits. The purpose of the study was to identify the effects of a Sun-style Tai Chi exercise on arthritic symptoms (joint pain and stiffness), motivation for performing health behaviors, and the performance of health behaviors among older women with osteoarthritis. Methods. Total of 72 women with the mean age of 63 years old were recruited from outpatients clinic or public health centers according to the inclusion criteria and assigned randomly to either the Tai Chi exercise group or the control. A Sun-style Tai Chi exercise has been provided three times a week for the first two weeks, and then once a week for another 10 weeks. In 12 weeks of study period, 22 subjects in the Tai Chi exercise group and 21 subjects in the control group completed the posttest measure with the dropout rate of 41 %. Outcome variables included arthritic symptoms measured by K-WOMAC, motivation for health behavior, and health behaviors. Results. At the completion of the 12 week Tai Chi exercise, the Tai Chi group perceived significantly less joint pain (t = -2.19, P = 0.03) and stiffness (t = -2.24, P = 0.03), perceived more health benefits (t = 2.67, P = 0.01), and performed better health behaviors (t = 2.35, P = 0.02), specifically for diet behavior (t = 2.06, P = 0.04) and stress management (t = 2.97, P = 0.005). Conclusion. A Sun-style Tai Chi exercise was found as beneficial for women with osteoarthritis to reduce their perceived arthritic symptoms, improve their perception of health benefits to perform better health behaviors.

• Journal of Chest Surgery
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• v.28 no.12
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• pp.1107-1112
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• 1995

Between December 1993 and December 1994, fifty-eight percent of the mitral valve patients[33/57 had undergone mitral valve repair. Their mean age was 49[SD-16 years[range 11 - 75 and they were consisted with 15 males and 18 females. The causes of mitral disease in 33 patients were classified as follows: 19 cases[58% were degenerative, 9[27% were rheumatic, 3[9% were congenital and 2[6% were infectious. Carpentier`s functional classification was consisted with Class I 4 cases[12% , II 25 [76% and III 4 [12% . Surgical techniques included prosthetic annuloplasty in 32 cases[97% , leaflet resection in 16[48% , chorda shortening in 13[39% , chorda transfer in 9[27% , new chorda formation in 7[21% , commissurotomy in 7[21% , leaflet mobilization in 4[12% , chorda resection in 3[9% , papillary muscle splitting in 2[6% , cleft repair in 2[6% , leaflet patching in 1[3% and vegetation removal in 1[3% . Average number of mitral anatomical lesions per patient was 3.3 and We used average 3.0 procedures upon mitral valve apparatus per patient. Intraoperative transesophageal echocardiography was carried out in 27 patients[82% for providing an immediate and accurate assessment of the adequacy of the reconstruction before closure of the chest. Operative mortality was absent. The mean functional class[NYHA was 2.87 preoperative and improved to 1.03 postoperatively. Postoperative Doppler echocardiography showed much improvement from grade II MR[5 , grade III[5 , grade IV[21 to no MR[26 , only trace MR[3 , grade III MR[2 . Postoperative mean mitral valve area was 2.4$\pm$0.6cm2[range 1.5 - 4.0 . We conclude that cautiously evaluated mitral valve reconstruction is stable and predictable operation with minimal postoperative left ventricular dysfunction.

• The Korean Journal of Pain
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• v.24 no.1
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• pp.13-21
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• 2011

Background: This study aimed to evaluate processes from the mutual maintenance model in relation to daily functioning in patients with both chronic pain and a history of a traumatic experience. The mechanism illustrated the structural relations for daily functioning among pain intensity, hyperarousal, re-experiencing, trauma avoidance, and pain avoidance. Methods: Archival data (N = 214) was used for this study and data were analyzed for 142 chronic pain patients reporting a traumatic experience and seeking treatment at a tertiary pain clinic in Korea. Results: The results indicated that pain intensity, hyperarousal, and pain avoidance had significant direct effects on daily functioning. Also, pain intensity showed significant indirect effects on daily functioning through hyperarousal and pain avoidance; and hyperarousal through pain avoidance. Conclusions: Results suggest a direct contribution of high levels of pain, hyperarousal symptoms of PTSD, and pain avoidance behaviors to reduced daily functioning. Also, elevated pain as reminders of the trauma may trigger high levels of hyperarousal symptoms of PTSD. Subsequently, avoidant coping strategies may be used to minimize pain so that the trauma would not be re-experienced, thus inhibiting the activation of hyperarousal symptoms of PTSD. However, prolonged use of such strategies may contribute to decline in daily functioning.

• Reproductive and Developmental Biology
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• v.35 no.2
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• pp.151-157
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• 2011

Clinical arthritis is typically divided into rheumatoid arthritis (RA) and osteoarthritis (OA). Arthritis-induced muscle weakness is a major problem in aged people, leading to a disturbance of balance during the gait cycle and frequent falls. The purposes of the present study were to confirm fiber type-dependent expression of muscle atrophy markers induced by arthritis and to identify the relationship between clinical signs and expression of muscle atrophy markers. Mice were divided into four experimental groups as follows: (1) negative control (normal), (2) positive control (CFA+acetic acid), (3) RA group (CFA+acetic acid+type II collagen), and (4) aging-induced OA group. DBQA/1J mice (8 weeks of age) were injected with collagen (50 ${\mu}g/kg$), and physiological (body weight) and pathological (arthritis score and paw thickness) parameters were measured once per week. The gastrocnemius muscle from animals in each group was removed, and the expression of muscle atrophy markers (MAFbx and MuRF1) and myosin heavy chain isoforms were analyzed by reverse transcription-polymerase chain reaction. No significant change in body weight occurred between control groups and collagen-induced RA mice at week 10. However, bovine type II collagen induced a dramatic increase in clinical score or paw thickness at week 10 (p<0.01). Concomitantly, the expression of the muscle atrophy marker MAFbx was upregulated in the RA and OA groups (p<0.01). A dramatic reduction in myosin heavy chain (MHC)-$I{\beta}$ was seen in the gastrocnemius muscles from RA and OA mice, while only a slight decrease in MHC-IIb was seen. These results suggest that muscle atrophy gene expression occurred in a fiber type-specific manner in both RA- and OA-induced mice. The present study suggests evidence regarding why different therapeutic interventions are required between RA and OA.

• Pediatric Infection and Vaccine
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• v.22 no.3
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• pp.210-215
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• 2015

Macrophage activation syndrome (MAS) is a rare complication in systemic lupus erythematosus (SLE) that can be triggered by infections. Due to the fact that MAS may mimic clinical features of underlying rheumatic disease, or be confused with an infectious complication, its detection can prove challenging. This is particularly true when there is an unknown/undiagnosed disease; and could turn into an even greater challenge if MAS and SLE are combined with a viral infection. A-14-year-old female came to the hospital with an ongoing fever for 2 weeks and a painful facial skin rash. Hepatomegaly, pancytopenia, increased aspartate aminotransferase, elevated serum ferritin and lactate dehydrogenase were reported. No hemophagocytic infiltration of bone marrow was reported. The patient was suspected for hemophagocytic lymphohistiocytosis. Her skin rashes were eczema herpeticum, which is usually associated with immune compromised conditions. With the history of oral ulcers and malar rash, positive ANA and low C3, C4 and the evidence of hemolytic anemia, she was diagnosed as SLE. According to the diagnostic guideline for MAS in SLE, she was diagnosed MAS as well, activated by acute HSV infection. After administering steroids and antiviral agent, the fever and skin rash disappeared, and the abnormal laboratory findings normalized. Therefore, we are reporting a rare case of MAS triggered by acute HSV infection as the first manifestation of SLE.

• Journal of Chest Surgery
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• v.36 no.7
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• pp.463-471
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• 2003

The long-term results of combined mitral valve repair and aortic valve replacement (AVR) have not been well evaluated. This study was performed to investigate the early and long-term results of mitral valve repair with AVR. Material and Method: We retrospectively reviewed 45 patients who underwent mitral valve repair and AVR between September 1990 and April 2002. The average age was 47 years: 28 were men and 17 women. Twelve patients had atrial fibrillation and three had a previous cardiac operation. The mitral valve disease consisted of pure insufficiency (MR) in 34 patients, mitral stenosis (MS) in 3, and mixed lesion in 8. Mitral valve disease was due to rheumatic origin in 24 patients, degenerative in 11, annular dilatation in 8, and ischemia or endocarditis in 2. The functional anatomy of mitral valve was annular dilatation in 31 patients, chordal elongation in 19, leaflet thickening in 19, commissural fusion in 13, chordal fusion in 10, chordal rupture in 6, and so on. Aortic prostheses used included mechanical valve in 32 patients, tissue valve in 12, and pulmonary autograft in one. The techniques of mitral valve repair included annuloplasty in 32 patients and various valvuloplasty of 54 techniques in 29 patients. Total cardiopulmonary bypass and aortic cross clamp time were 204$\pm$62 minute and 153$\pm$57 minutes, respectively. Result: Early death was in one patient due to low output syndrome (2.2%). After follow up of 57$\pm$37 months, late death was in one patient and the actuarial survival at 10 years was 96$\pm$4%. Recurrent MR developed grade II or III in 11 patients and moderate MS in 3. Three patients required reoperation for valve-related complications. The actuarial freedom from recurrent MR, MS, and reoperation were 64$\pm$11%, 86$\pm$8%, and 89$\pm$7% respectively. Conclusion: Combined mitral valve repair with AVR offers good early and long-term survival, and adequate techniques and selection of indication of mitral valve repair, especially in rheumatic disease, are prerequisites for better long-term results.

• Journal of Chest Surgery
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• v.36 no.12
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• pp.929-936
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• 2003

We analysed the surgical outcomes of immediate reoperations after mitral valve repair. Material and Method: Eighteen patients who underwent immediate reoperation for failed mitral valve repair from April 1995 through July 2001 were reviewed retrospectively. There were 13 female patients. The mitral valve disease was regurgitation (MR) in 12 patients, stenosis (MS) in 3, and mixed lesion in 3. The etiologies of the valve disease were rheumatic in 9 patients, degenerative in 8, and endocarditis in 1. The causes of reoperation was residual MR in 13 patients, residual MS in 4, and rupture of left ventricle in 1. Fourteen patients had rerepair for residual mitral lesions (77.8%) and four underwent replacement. Result: There was no early death. After mean follow-vp of 33 months, there was one late death. Echocardiography revealed no or grade 1 of MR (64.3%) in 9 patients and no or mild MS in 11 patients (78,6%). Reoperation was done in one patient. The cumulative survival and freedom from valve-related reoperation at 6 years were 94% and 90%, respectively. The cumulative freedom from recurrent MR and MS at 4 years were 56% and 44%, respectively. Conclusion: This study suggests that immediate reoperation for failed mitral valve repair offers good early and intermediate survival, and mitral valve rerepair can be successfully performed in most of patients. However, because mitral rerepair have high failure rate, especially in rheumatic valve disease, adequate selections of valvuloplasty technique and indication are important to reduce the failure rate of mitral rerepair.