• Title/Summary/Keyword: Risk management

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Initial Experience of the Emergency Bypass System ($EBS^{(R)}$) for the Patients with Cardiogenic Shock due to an Acute Myocardial Infarction (급성 심근경색으로 인한 심인성 쇼크 환자에 대한 경피적 순환 보조장치($EBS^{(R)}$) 적용의 초기경험)

  • Ryu, Kyoung-Min;Kim, Sam-Hyun;Seo, Pil-Won;Ryu, Jae-Wook;Kim, Seok-Kon;Kim, Young-Hwa;Park, Seong-Sik
    • Journal of Chest Surgery
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    • v.41 no.3
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    • pp.329-334
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    • 2008
  • Background: Percutaneous cardiopulmonary support. (PCPS) has the potential to rescue patients in cardiogenic shock who might otherwise die. PCPS has been a therapeutic option in a variety of the clinical settings such as for patients with myocardial Infarction, high-risk coronary intervention and postcardiotomy cardiogenic shock, and the PCPS device is easy to install. We report our early experience with PCPS as a life saving procedure in cardiogenic shock patients due to acute myocardial infarction. Material and Method: From January 2005 to December 2006, eight patients in cardiogenic shock with acute myocardial infarction underwent PCPS using the CAPIOX emergency bypass system($EBS^{(R)}$, Terumo, Tokyo, Japan). Uptake cannulae were inserted deep into the femoral vein up to the right atrium and return cannulae were inserted into the femoral artery with Seldinger techniques using 20 and 16-French cannulae, respectively. Simultaneously, autopriming was performed at the $EBS^{(R)}$ circuit. The $EBS^{(R)}$ flow rate was maintained between $2.5{\sim}3.0L/min/m^2$ and anticoagulation was performed using intravenous heparin with an ACT level above 200 seconds. Result: The mean age of patients was $61.1{\pm}14.2$ years (range, 39 to 77 years). Three patients were under control of the $EBS^{(R)}$ before percutaneous coronary intervention (PCI), three patients were under control of the $EBS^{(R)}$ during PCI, one patient was under control of the $EBS^{(R)}$ after PCI, and one patient was under control of the $EBS^{(R)}$ after coronary bypass surgery. The mean support time was $47.5{\pm}27.9$ hours (range, 8 to 76 hours). Five patients (62.5%) could be weaned from the $EBS^{(R)}$ after $53.6{\pm}27.2$ hours. (range, 12 to 68 hours) of support. All of the patients who could successfully be weaned from support were discharged from the hospital. There were three complications: one case of gastrointestinal bleeding and two cases of acute renal failure. Two of the three mortality cases were under cardiac arrest before $EBS^{(R)}$ support, and one patient had an intractable ventricular arrhythmia during the support. All of the discharged patients are still surviving at $16.8{\pm}3.1$ months (range, 12 to 20 months) of follow-up. Conclusion: The use of $EBS^{(R)}$ for cardiogenic shock caused by an acute myocardial infarction could rescue patients who might otherwise have died. Successfully recovered patients after $EBS^{(R)}$ treatment have survived without severe complications. More experience and additional clinical investigations are necessary to elucidate the proper installation timing and management protocol of the $EBS^{(R)}$ in the future.

A Survey on the Status of Health Examination among Farmers in a Rural Area (일부 농촌지역 농업종사자들의 건강진단 수검 실태)

  • Park, Soon-Woo
    • Journal of agricultural medicine and community health
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    • v.22 no.1
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    • pp.1-18
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    • 1997
  • This study was carried out to reveal the status of health examination among farmers and to attract more attention to the health care system for farmers. Ten pre-trained medical students interviewed the rural residents 18 years of age and older in eight villages which were randomly selected from a county near Taegu city in Korea, in August 1996. Finally 751 persons were interviewed of whom the percentages of male and female were 41.8%, 58.2% respectively. Among the subjects, 361(48.3%) were fully engaged in farming, 184(24.4%) were partly engaged, and the remaining 206(27.3%) were not engaged in farming at all. The overall prevalence of farmer's disease was 23.0% and there was no significant difference between the group of fully engaged in farming(23.3%) and the group of not-fully engaged(22.9%). But the prevalence of farmer's disease in female subjects(27.8%) was significantly higher than that in male(16.2%)(p<0.01). Among the 288 farmer engaged in spraying pesticide, 113(39.2%) had experienced one or more pesticide related symptoms during last one year, but only 18(15.9%) of them had visited medical facilities due to their symptoms. The experience of receiving education about pesticide was significantly correlated with the degree of wearing protectors during pesticide spraying(p<0.001). Among the 736 persons excluding non-respondents, 281(38.2%) received health examination during last one year ; 176(62.6%) of them received free health examination, and 105(37.4%) received charged one. Among the 533 persons 40 years age and older, only 124(23.3%) had received the 'health examination for the elderly' during last one year, which is provided for the 40 years age and older by Korea medical insurance corporation and medical insurance societies. Most of all beneficiaries of self-employed medical insurance thought the imposed contributions as very expensive(77.4%) or moderately expensive(13.2%). The great majority of farmers are exposed to various health risk factors including pesticide, high temperature, overwork etc. comparable to industrial workers. But farmers are excluded from the regular yearly worker's health examination because of not belonging to a company despite they pay relatively more medical insurance contributions compared with the industrial workers and the urban self-employed medical insureds. It is necessary to develop special health management program for farmers such as the special health examination for the industrial workers exposed harmful agents.

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The Causes of Conflict and the Effect of Control Mechanisms on Conflict Resolution between Manufacturer and Supplier (제조-공급자간 갈등 원인과 거래조정 방식의 갈등관리 효과)

  • Rhee, Jin Hwa
    • Journal of Distribution Research
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    • v.17 no.4
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    • pp.55-80
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    • 2012
  • I. Introduction Developing the relationships between companies is very important issue to ensure a competitive advantage in today's business environment (Bleeke & Ernst 1991; Mohr & Spekman 1994; Powell 1990). Partnerships between companies are based on having same goals, pursuing mutual understanding, and having a professional level of interdependence. By having such a partnerships and cooperative efforts between companies, they will achieve efficiency and effectiveness of their business (Mohr and Spekman, 1994). However, it is difficult to expect these ideal results only in the B2B corporate transaction. According to agency theory which is the well-accepted theory in various fields of business strategy, organization, and marketing, the two independent companies have fundamentally different corporate purposes. Also there is a higher chance of developing opportunism and conflict due to natures of human(organization), such as self-interest, bounded rationality, risk aversion, and environment factor as imbalance of information (Eisenhardt 1989). That is, especially partnerships between principal(or buyer) and agent(or supplier) of companies within supply chain, the business contract itself will not provide competitive advantage. But managing partnership between companies is the key to success. Therefore, managing partnership between manufacturer and supplier, and finding causes of conflict are essential to improve B2B performance. In conclusion, based on prior researches and Agency theory, this study will clarify how business hazards cause conflicts on supply chain and then identify how developed conflicts have been managed by two control mechanisms. II. Research model III. Method In order to validate our research model, this study gathered questionnaires from small and medium sized enterprises(SMEs). In Korea, SMEs mean the firms whose employee is under 300 and capital is under 8 billion won(about 7.2 million dollar). We asked the manufacturer's perception about the relationship with the biggest supplier, and our key informants are denied to a person responsible for buying(ex)CEO, executives, managers of purchasing department, and so on). In detail, we contact by telephone to our initial sample(about 1,200 firms) and introduce our research motivation and send our questionnaires by e-mail, mail, and direct survey. Finally we received 361 data and eliminate 32 inappropriate questionnaires. We use 329 manufactures' data on analysis. The purpose of this study is to identify the anticipant role of business hazard (environmental dynamism, asset specificity) and investigate the moderating effect of control mechanism(formal control, social control) on conflict-performance relationship. To find out moderating effect of control methods, we need to compare the regression weight between low versus. high group(about level of exercised control methods). Therefore we choose the structural equation modeling method that is proper to do multi-group analysis. The data analysis is performed by AMOS 17.0 software, and model fits are good statically (CMIN/DF=1.982, p<.000, CFI=.936, IFI=.937, RMSEA=.056). IV. Result V. Discussion Results show that the higher environmental dynamism and asset specificity(on particular supplier) buyer(manufacturer) has, the more B2B conflict exists. And this conflict affect relationship quality and financial outcomes negatively. In addition, social control and formal control could weaken the negative effect of conflict on relationship quality significantly. However, unlikely to assure conflict resolution effect of control mechanisms on relationship quality, financial outcomes are changed by neither social control nor formal control. We could explain this results with the characteristics of our sample, SMEs(Small and Medium sized Enterprises). Financial outcomes of these SMEs(manufacturer or principal) are affected by their customer(usually major company) more easily than their supplier(or agent). And, in recent few years, most of companies have suffered from financial problems because of global economic recession. It means that it is hard to evaluate the contribution of supplier(agent). Therefore we also support the suggestion of Gladstein(1984), Poppo & Zenger(2002) that relational performance variable can capture the focal outcomes of relationship(exchange) better than financial performance variable. This study has some implications that it tests the sources of conflict and investigates the effect of resolution methods of B2B conflict empirically. And, especially, it finds out the significant moderating effect of formal control which past B2B management studies have ignored in Korea.

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The Roles of Service Failure and Recovery Satisfaction in Customer-Firm Relationship Restoration : Focusing on Carry-over effect and Dynamics among Customer Affection, Customer Trust and Loyalty Intention Before and After the Events (서비스실패의 심각성과 복구만족이 고객-기업 관계회복에 미치는 영향 : 실패이전과 복구이후 고객애정, 고객신뢰, 충성의도의 이월효과 및 역학관계 비교를 중심으로)

  • La, Sun-A
    • Journal of Distribution Research
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    • v.17 no.1
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    • pp.1-36
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    • 2012
  • Service failure is one of the major reasons for customer defection. As the business environment gets tougher and more competitive, a single service failure might bring about fatal consequences to a service provider or a firm. Sometimes a failure won't end up with an unsatisfied customer's simple complaining but with a wide-spread animosity against the service provider or the firm, leading to a threat to the firm's survival itself in the society. Therefore, we are in need of comprehensive understandings of complainants' attitudes and behaviors toward service failures and firm's recovery efforts. Even though a failure itself couldn't be fixed completely, marketers should repair the mind and heart of unsatisfied customers, which can be regarded as an successful recovery strategy in the end. As the outcome of recovery efforts exerted by service providers or firms, recovery of the relationship between customer and service provider need to put on the top in the recovery goal list. With these motivations, the study investigates how service failure and recovery makes the changes in dynamics of fundamental elements of customer-firm relationship, such as customer affection, customer trust and loyalty intention by comparing two time points, before the service failure and after the recovery, focusing on the effects of recovery satisfaction and the failure severity. We adopted La & Choi (2012)'s framework for development of the research model that was based on the previous research stream like Yim et al. (2008) and Thomson et al. (2005). The pivotal background theories of the model are mainly from relationship marketing and social relationships of social psychology. For example, Love, Emotional attachment, Intimacy, and Equity theories regarding human relationships were reviewed. As the results, when recovery satisfaction is high, customer affection and customer trust that were established before the service failure are carried over to the future after the recovery. However, when recovery satisfaction is low, customer-firm relationship that had already established in the past are not carried over but broken up. Regardless of the degree of recovery satisfaction, once a failure occurs loyalty intention is not carried over to the future and the impact of customer trust on loyalty intention becomes stronger. Such changes imply that customers become more prudent and more risk-aversive than the time prior to service failure. The impact of severity of failure on customer affection and customer trust matters only when recovery satisfaction is low. When recovery satisfaction is high, customer affection and customer trust become severity-proof. Interestingly, regardless of the degree of recovery satisfaction, failure severity has a significant negative influence on loyalty intention. Loyalty intention is the most fragile target when a service failure occurs no matter how severe the failure criticality is. Consequently, the ultimate goal of service recovery should be the restoration of customer-firm relationship and recovery of customer trust should be the primary objective to accomplish for a successful recovery performance. Especially when failure severity is high, service recovery should be perceived highly satisfied by the complainants because failure severity matters more when recovery satisfaction is low. Marketers can implement recovery strategies to enhance emotional appeals as well as fair treatments since the both impacts of affection and trust on loyalty intention are significant. In the case of high severity of failure, recovery efforts should be exerted to overreach customer expectation, designed to directly repair customer trust and elaborately designed in the focus of customer-firm communications during the interactional recovery process to affect customer trust rebuilding indirectly. Because it is a longer and harder way to rebuild customer-firm relationship for high severity cases, low recovery satisfaction cannot guarantee customer retention. To prevent customer defection due to service failure of high severity, unexpected rewards as a recovery will be likely to be useful since those will lead to customer delight or customer gratitude toward the service firm. Based on the results of analyses, theoretical and managerial implications are presented. Limitations and future research ideas are also discussed.

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Analysis of Foodborne Pathogens in Food and Environmental Samples from Foodservice Establishments at Schools in Gyeonggi Province (경기지역 학교 단체급식소 식품 및 환경 중 식중독균 분석)

  • Oh, Tae Young;Baek, Seung-Youb;Koo, Minseon;Lee, Jong-Kyung;Kim, Seung Min;Park, Kyung-Min;Hwang, Daekeun;Kim, Hyun Jung
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.44 no.12
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    • pp.1895-1904
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    • 2015
  • Foodborne illness associated with food service establishments is an important food safety issue in Korea. In this study, foodborne pathogens (Bacillus cereus, Clostridium perfringens, Escherichia coli, pathogenic Escherichia coli, Listeria monocytogenes, Salmonella spp., Staphylococcus aureus, and Vibrio parahaemolyticus) and hygiene indicator organisms [total viable cell counts (TVC), coliforms] were analyzed for food and environmental samples from foodservice establishments at schools in Gyeonggi province. Virulence factors and antimicrobial resistance of detected foodborne pathogens were also characterized. A total of 179 samples, including food (n=66), utensil (n=68), and environmental samples (n=45), were collected from eight food service establishments at schools in Gyeonggi province. Average contamination levels of TVC for foods (including raw materials) and environmental samples were 4.7 and 4.0 log CFU/g, respectively. Average contamination levels of coliforms were 2.7 and 4.0 log CFU/g for foods and environmental swab samples, respectively. B. cereus contamination was detected in food samples with an average of 2.1 log CFU/g. E. coli was detected only in raw materials, and S. aureus was positive in raw materials as well as environmental swab samples. Other foodborne pathogens were not detected in all samples. The entire B. cereus isolates possessed at least one of the diarrheal toxin genes (hblACD, nheABC, entFM, and cytK enterotoxin gene). However, ces gene encoding emetic toxin was not detected in B. cereus isolates. S. aureus isolates (n=16) contained at least one or more of the tested enterotoxin genes, except for tst gene. For E. coli and S. aureus, 92.7% and 37.5% of the isolates were susceptible against 16 and 19 antimicrobials, respectively. The analyzed microbial hazards could provide useful information for quantitative microbial risk assessment and food safety management system to control foodborne illness outbreaks in food service establishments.

Clinical Analysis of Acute Respiratory Tract Infections by Influenza Virus in Children (인플루엔자 바이러스에 의한 소아 급성 호흡기 감염증의 유행 및 임상 양상)

  • Kwon, Min Kyoung;Kim, Mi Ran;Park, Eun Young;Lee, Kon Hee;Yoon, Hae Sun;Kim, Kwang Nam;Lee, Kyu Man
    • Clinical and Experimental Pediatrics
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    • v.45 no.12
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    • pp.1519-1527
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    • 2002
  • Purpose : Although influenza virus is one of the most important causes of acute respiratory tract infections(ARTIs) in children, virus isolation is not popular and there are only a few clinical studies on influenza in Korea. We evaluated the epidemiologic and clinical features of ARTIs by influenza virus in children. Methods : From February 1995 to August 2001, nasopharyngeal aspirations were obtained and cultured for the isolation of influenza virus in children admitted with ARTIs. The medical records of patients with influenza virus infection were reviewed retrospectively. Results : Respiratory viruses were isolated in 997(22.0%) out of 4,533 patients examined, and influenza virus was isolated in 164 cases(3.6%). Influenza virus was isolated year after year mainly from December to April of next year. The ratio of male and female was 1.9 : 1 with a median age of 15 months. The most common clinical diagnosis of influenza virus infection was pneumonia, and fever and cough developed in most patients. There was no difference between influenza A and B infection in clinical diagnoses and symptoms. All patients recovered without receiving antiviral treatment except for one patient diagnosed with pneumonia who had underlying disease of Down syndrome with ventricular septal defect. Conclusion : ARTIs caused by influenza virus developed every winter and spring during the period of study. Because fatal complication can develop in the high risk group, prevention, early diagnosis and proper management of influenza should be emphasized.

Low Dose Cisplatin as a Radiation Sensitizer in Management of Locally Advanced Scluamous Cell Carcinoma of the Uterine Cervix : Evaluation of Acute Toxicity and Early Response (국소 진행된 자궁경부암의 방사선치료와 저용량 cisplatin 항암요법 동시치료시 급성독성 밀 초기반응 평가)

  • Kim Hunjung;Cho Young Kap;Kim Chulsu;Kim Woo Chul;Lee Sukho;Loh J K
    • Radiation Oncology Journal
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    • v.17 no.2
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    • pp.113-119
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    • 1999
  • Purpose : To evaluate possible acute toxicity and early response of concurrent radiation therapy and low dose daily cisplatin as a radiosensitizer in patients with locally advanced uterine cervical carcinomas. Materials and Method : From December 1996 to January 1999, 38 previously untreated Patients with locally advanced squamous cell carcinoma of the uterine cervix (from stage IIB to stage IIIB) were treated at Inha University Hospital. All patients underwent standard pretreatment staging Procedures after the initial evaluation by gynecologists and radiation oncologists. Sixteen Patients with huge cervical mass (>4 cm) were submitted to the group treated with concurrent radiation therapy and low dose daily cisplatin while the remainder was treated with radiation therapy alone. Radiation therapy consisted of 4500 cGy external beam irradiation to whole pelvis (midline block after 3000 cGy), 900$\~$1000 cGy boost to involved parametrium, and high dose-rate intracavitary brachytherapy (a total dose of 3000$\~$3500 cGy/500 cGy per fraction to point A, twice per week). In the group treated with low dose cisplatin concurrently, 10 mg of daily intravenous cisplatin was given from the 1st day of radiation therapy to the 20th day of radiation therapy. Acute toxicity was measured according to expanded common toxicity criteria of the NCI (C) Clinical Trials. Early response data were analyzed at minimum 4 weeks' follow-up after completion of the treatment protocol. Results: Hematolgic toxici쇼 was more prominent in patients treated with radiation therapy and cisplatin. Six of 16 patients (37.5$\~$) treated with radiation therapy and cisplatin and one of 22 patients (4.5$\~$) treated with radiation therapy alone experienced grade 3 leukopenia. In Fisher's exact test, there was statistically significant difference between two groups regarding leukopenia (P=0.030). There was no apparent difference in the frequency of gastrointestinal and genitourinary toxicity between two groups (P=0.066). Three of 16 patients (18.7$\~$) treated with radiation therapy and cisplatin and two of 22 patients (9.1$\~$) treated with radiation therapy alone experienced more than 5 kg weight loss during the treatment. There was no statistically significant difference on weight loss between two groups (P=0.63). Two patients on each group were not evaluable for the early response because of incomplete treatment. The complete response rate at four weeks' follow-up was 80$\~$(16/20) for the radiation therapy alone group and 78$\~$ (11/14) for the radiation therapy and cisplatin group. There was no statistically significant difference in early response between two treatment groups (P=0.126). Conclusion : This study led to the conclusion that the hematologic toxicity from the treatment with concurrent radiation therapy and low dose daily cisplatin seems to be more prominent than that from the treatment of radiation therapy alone. There was no grade 4 hematologic toxicity or mortality in both groups. The hematologic toxicity in both treatment groups seems to be well managable modically. Since the risk factors were not balanced between two treatment groups, the direct comparison of early response of both groups was not possible. However, preliminary results regarding early response for patients with bulky cervical tumor mass treated with radiation therapy and low dose daily cisplatin was encouraging. Longer follow-up is necessary to evaluate the survival data. A phase III study is needed to evaluate the efficacy of concurrent daily low dose cisplatin with radiation therapy in bulky cervical cancer.

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Breast Conservation Therapy Versus Mastectomy - Preliminary Results of Pattern of Failure and Survival Rate in Early Breast Cancer (조기유방암에서 유방보존치료와 유방전절제술의 치료결과 및 실패양상 비교)

  • Kim Yeon-Sil;Yoon Sei-Chul;Chung Su-Mi;Ryu Mi-Ryeong;Jung Sang-Sul;Choi Ihl-Bohng
    • Radiation Oncology Journal
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    • v.22 no.2
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    • pp.115-123
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    • 2004
  • Purpose : This retrospective study was conducted to compare early preliminary results of breast conservation therapy (BCT) with mastectomy In early breast cancer. Materials and Methods : We evaluated 171 women with AJCC stage I and II breast cancer who had been treated at Kangnam St. Mary's Hospital from March 1989 to August 1996. Eighty-eight patients underwent mastectomy and 85 patients did conservative surgery with breast irradiation. in the BCT group, all patients received whole breast irradiation to a total dose of 45$\~$50 Gy/5$\~$6 wks, followed by a boost to the original tumor site at least 60 Gy. Chemotherapy was administered to 29 (34.1$\%$) patients in BCT and 40 (45.5$\%$) in mastectomy, with various sequencing of surgery and/or radiation. We compared survival rate, patterns of failure in each treatment group and the prognostic factors that had a significant effect on treatment failure. The median follow-up time was 63 months (19$\~$111 months). Log rank test was used to estimate the prognostic factors for treatment failure. Results : Overall survival, disease free survival, locoregional recurrence and distant metastasis rates were not significantly different between the two treatment groups. During the follow-up period, 11 patients (12.5$\%$)in the mastectomy group and 10 patients (11.8%$\%$ in the BCT group were failed. Six local recurrences occurred after mastectomy and 5 after BCT Five patients fatted at distant site in mastectomy and 4 in BCT. Of the local recurrence cases, five of 6 mastectomy patients and 3 of S BCT patients were alive with no evidence of disease after salvage surgery and/or chemoirradiation. Our results indicated that the major influence on survival was distant metastasis. Unfortunately, control of distant metastasisis was not frequently achieved. Even with salvage systemic therapy or radiotherapy, most of distant metastasis patients died or had uncontrolled disease in both treatment groups: only one of 4 BCT patients and none of mastectomy patients were alive without disease. There was no apparent difference in the incidence rate of contralateral breast cancer and non-breast 2$^{nd}$ primary tumor between the two treatment groups. Univariate Log-rank test identified the N stage and the involved axillary LN number as distinct prognostic factors that were highly predictive of treatment failure in both treatment groups. Additionally, marginal status in BCT and histologic nuclear grade In the mastectomy group were risk factors for treatment fallure (p < 0.05). Concousion : Although further careful follow-up is necessary to confirm the trends evident In this serles, it would appear that patterns of failure and survival rate following conservative surgery and radiotherapy in early breast cancer are similar to those following mastectomy. The great majority of patients with local recurrence had an exellent salvage rate in both treatment groups. Therefore, these preliminary short term results support BCT as an equally effective management for early breast cancer as an alternative to mastectomy.

The Prognostic Value of the First Day and Daily Updated Scores of the APACHE III System in Sepsis (패혈증환자에서 APACHE III Scoring System의 예후적 가치)

  • Lim, Chae-Man;Lee, Jae-Kyun;Lee, Sung-Soon;Koh, Youn-Suck;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong;Park, Pyung-Hwan;Choi, Jong-Moo
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.6
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    • pp.871-877
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    • 1995
  • Background: The index which could predict the prognosis of critically ill patients is needed to find out high risk patients and to individualize their treatment. The APACHE III scoring system was established in 1991, but there has been only a few studies concerning its prognostic value. We wanted to know whether the APACHE III scores have prognostic value in discriminating survivors from nonsurvivors in sepsis. Methods: In 48 patients meeting the Bones criteria for sepsis, we retrospectively surveyed the day 1(D1), day 2(D2) and day 3(D3) scores of patients who were admitted to intensive care unit. The scores of the sepsis survivors and nonsurvivors were compared in respect to the D1 score, and also in respect to the changes of the updated D2 and D3 scores. Results: 1) Of the 48 sepsis patients, 21(43.5%) survived and 27(56.5%) died. The nonsurvivors were older($62.7{\pm}12.6$ vs $51.1{\pm}18.1$ yrs), presented with lower mean arterial pressure($56.9{\pm}26.2$ vs $67.7{\pm}14.2\;mmHg$) and showed greater number of multisystem organ failure($1.2{\pm}0.8$ vs $0.2{\pm}0.4$) than the survivors(p<0.05, respectively). There were no significant differences in sex and initial body temperature between the two groups. 2) The D1 score was lower in the survivors (n=21) than in the nonsurvivors ($44.1{\pm}14.6$, $78.5{\pm}18.6$, p=0.0001). The D2 and D3 scores significantly decreased in the survivors (D1 vs D2, $44.1{\pm}14.6$ : $37.9{\pm}15.0$, p=0.035; D2 vs D3, $37.9{\pm}15.0$ : $30.1{\pm}9.3$, p=0.0001) but showed a tendency to increase in the nonsurvivors (D1 vs D2 (n=21), $78.5{\pm}18.6$ : $81.3{\pm}23.0$, p=0.1337; D2 vs D3 (n=11), $68.2{\pm}19.3$ : $75.3{\pm}18.8$, p=0.0078). 3) The D1 scores of 12 survivors and 6 nonsurvivors were in the same range of 42~67 (mean D1 score, $53.8{\pm}10.0$ in the survivors, $55.3{\pm}10.3$ in the nonsurvivors). The age, sex, initial body temperature, and mean arterial pressure were not different between the two groups. In this group, however, D2 and D3 was significantly decreased in the survivors(D1 vs D2, $53.3{\pm}10.0$ : $43.6{\pm}16.4$, p=0.0278; D2 vs D3, $43.6{\pm}16.4$ : $31.2{\pm}10.3$, p=0.0005), but showed a tendency to increase in the nonsurvivors(D1 vs D2 (n=6), $55.3{\pm}10.3:66.7{\pm}13.9$, p=0.1562; D2 vs D3 (n=4), $64.0{\pm}16.4:74.3{\pm}18.6$, p=0.1250). Among the individual items of the first day APACHE III score, only the score of respiratory rate was capable of discriminating the nonsurvivors from the survivors ($5.5{\pm}2.9$ vs $1.9{\pm}3.7$, p=0.046) in this group. Conclusion: In sepsis, nonsurvivors had higher first day APACHE III score and their updated scores on the following days failed to decline but showed a tendency to increase. Survivors, on the other hand, had lower first day score and showed decline in the updated APACHE scores. These results suggest that the first day and daily updated APACHE III scores are useful in predicting the outcome and assessing the response to management in patients with sepsis.

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Clinical Indices Predicting Resorption of Pleural Effusion in Tuberculous Pleurisy (결핵성 늑막염에서 삼출액의 흡수에 영향을 미치는 임상적 지표)

  • Lee, Joe-Ho;Chung, Hee-Soon;Lee, Jeong-Sang;Cho, Sang-Rok;Yoon, Hae-Kyung;Song, Chee-Sung
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.5
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    • pp.660-668
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    • 1995
  • Background: It is said that tuberculous pleuritis responds well to anti-tuberculous drug in general, so no further aggressive therapeutic management is unnecesarry except in case of diagnostic thoracentesis. But in clinical practice, we often see some patients who need later decortication due to dyspnea caused by pleural loculation or thickening despite several months of anti-tuberculous drug therapy. Therefore, we want to know the clinical difference between a group who received decortication due to complication of tuberculous pleuritis despite of anti-tuberculous drug and a group who improved after 9 months of anti-tuberculous drug only. Methods: We reviewed 20 tuberculous pleuritis patients(group 1) who underwent decortication due to dyspnea caused by pleural loculation or severe pleural thickening despite of anti-tuberculous drug therapy for 9 or more months, and 20 other tuberculous pleuritis patients(group 2) who improved by anti-tuberculous drug only and had similar degrees of initial pleural effusion and similar age, sex distribution. Then we compared between the two groups the duration of symptoms before anti-tuberculous drug treatment and pleural fluid biochemistry like glucose, LDH, protein and pleural fluid cell count and WBC differential count, and we also wanted to know whether there was any difference in preoperative PFT value and postoperative PFT value in the patients who underwent decortication, and obtained following results. Results: 1) Group 1 patients had lower glucose level{$63.3{\pm}30.8$(mg/dl)} than that of the group 2{$98.5{\pm}34.2$(mg/dl), p<0.05}, and higher LDH level{$776.3{\pm}266.0$(IU/L)} than the group 2 patients{$376.3{\pm}123.1$(IU/L), p<0.05}, and also longer duration of symptom before treatment{$2.0{\pm}1.7$(month)} than the group 2{$1.1{\pm}1.2$(month), p<0.05}, respectively. 2) In group 1, FVC changed from preoperative $2.55{\pm}0.80$(L) to postoperative $2.99{\pm}0.78$(L)(p<0.05), and FEV1 changed from preoperative $2.19{\pm}0.70$(L/sec) to postoperative $2.50{\pm}0.69$(L/sec)(p<0.05). 3) There was no difference in pleural fluid protein level($5.05{\pm}1.01$(gm/dL) and $5.15{\pm}0.77$(gm/dl), p>0.05) and WBC differential count between group 1 and group 2. Conclusion: It is probable that in tuberculous pleuritis there is a risk of complication in the case of showing relatively low pleural fluid glucose or high LDH level, or in the case of having long duraton of symptom before treatment. We thought prospective study should be performed to confirm this.

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