• Journal of Chest Surgery
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• v.31 no.9
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• pp.867-872
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• 1998

Background: The fixed dose regimen with activated coagulation time(ACT) is the most commonly employed method for determining the required dosage of heparin and protamine during cardiopulmonary bypass(CPB). Material and Method: We performed a prospective study on a fixed dose regimen for analyzing adequate dosages of heparin and protamine, the incidence of heparin resistance and heparin-induced thrombocyt openia, factors affecting ACT during CPB, and changes of ACT during aprotinin usage. 300 units/kg of heparin were administered to patients, and ACTs were measured after 5 mins. ACTs were checked at 10 mins and 30 mins after the onset of CPB, and then at 30 min intervals thereafter. If the measured ACT was under 400 secs, we added 100 units/kg of heparin. The heparin was reversed with 1 mg of protamine for each 100 units administered. If the measured ACT was longer than 130 secs 30 mins after protamine administration or if there was definitive evidence of a coagulation defect, we administered a further 0.5 mg/kg of protamine. Result: We studied 80 patients(50 adults and 30 children) who underwent open heart surgery(OHS) at Seoul National University Hospital. Preoperative ACT was 114.3${\pm}$19.3 secs in adults, and 119.5${\pm}$18.2 secs in children. There were no differences in preoperative ACT due to age, body weight, body surface area, or sex. The preoperative ACT was not influenced by a positive past history of OHS. Ten adults(20%) and 3 pediatric patients(10%) needed additional doses of heparin to maintain the ACT above 400 secs. Additional protamine administration was needed in 9 adults(18%) and 10 children(33%). Heparin resistance was found in only two adults. Heparin-induced thrombocytopenia was detected in 2 adults and 1 child. During CPB, ACT was prolonged. 12 adult patients received a low dose of aprotinin and showed longer celite activated ACT compared to the control group.The kaolin activated ACT showed a lower tendency than the celite activated ACT in aprotinin users. Conclusion: In conclusion, fixed dose regimen of heparin and protamine can be used without significant problems, but the incidence of need of additional dosage remains unsatisfactory.

• Journal of Chest Surgery
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• v.42 no.6
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• pp.763-769
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• 2009

Background: In the majority of cases, sternal instability and wound infection concomitantly present after a cardiac operation following conventional median sternotomy, and these complications have a major influence on the postoperative course. The aim of this study is to compare the results of the different sternal wiring techniques of sternal infection. Material and Method: Between April 2004 and December 2008, 157 adult patients underwent cardiac in group A, whereas 71 patients who had undergone modified Robicsek sternal wiring were included in group B. The incidences of sternal wound complications in the two groups were assessed. Result: The mean age of the group B patients was older than that of the group A patients ($61{\pm}10$ years vs $57{\pm}13$ years). The incidence of preoperative left ventricular dysfunction (ejection fraction <30%), chronic obstructive pulmonary disease, renal failure requiring dialysis and diabetes mellitus were significantly higher in Group B, whereas the other perioperative risk factors for infection were not significantly different between the two groups. Two patients in group A experienced superficial wound infection, whereas 4 patients in group B displayed superficial wound infection, but the difference was not statistically significant (p=0.255). Yet poststernotomy deep sternal wound infection appeared in 6 patients of group A, whereas none of the patients in group B displayed this malady. Conclusion: The modified Robicsek sternal wiring technique showed greater sternal stability even for the patient with a high risk for infection, and the technique caused a lower incidence of deep sternal wound infection.

• Radiation Oncology Journal
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• v.22 no.4
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• pp.247-253
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• 2004

Purpose: Hypopharyngeal cancer is diagnosed at the advanced stage in most cases, which the prognosis known to be poor. Thus, the efficacy of induction chemotherapy followed by radiotherapy, with regards to the response and survival rate for stage IV hypopharyngeal cancer patients, was examined. Materials and Methods: From July 1998 to February 2000, 18 cases were diagnosedas AJCC stage IV hypopharyngeal cancer without distant metastasis. These patients were treated with induction chemotherapy followed by radiotherapy, and the results retrospectively analyzed. The regimen of the induction chemotherapy was the 5-FU and cisplatincombination, at 3-week intervals for, 2 cycles. The total radiation dose for the primary lesion and metastatic lymph nodes was $68.4\~72.0$Gy (median: 70.2 Gy). Results: The: The median follow up period was 28 months, ranging from 7 to 99 months. The 3-year overall survival and disease-free survival rate were 41.7 and $31.1\%$, respectively. In 6 cases ($33.3\%$), conservation of the larynx for over 3 years was possible. After the induction chemotherapy there were 16 partial responses ($88.8\%$), 1 complete response and 1 with no response ($5.6\%$ each), therefore, 17 of the 18 cases ($94.6\%$) showed responses. After the completion of the induction chemotherapy and radiotherapy, a complete response was noted in 13 cases ($72.2\%$), a partial response in 5 ($27.8\%$), with an overall response rate of $100\%$. In the analysis of the prognostic factors influencing the survival rate, the 3-year and disease-free survival rates for the complete and partial response groups were 43.1, and $20.0\%$, and 39.6, and $20.0\%$, respectively (p=0.0003, p=0.002). Only the final response after treatment completion was statistically significant. Conclusion: For stage IV hypopharyngeal cancer, induction chemotherapy followed by radiotherapy was an effective treatment, with no severe side effects.

• Radiation Oncology Journal
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• v.28 no.2
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• pp.79-84
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• 2010

Purpose: We retrospectively analyzed the long-term results of radical surgery and intraoperative radiation therapy (IORT) in patients with stomach cancer. Materials and Methods: From 1988 to 1994, 51 patients were treated with curative surgery and IORT. Postoperative external beam radiotherapy (EBRT) was administered to 30 patients, while adjuvant chemotherapy was administered to 35 patients. A dose of 15 Gy was irradiated with a 9 MeV electron beam as the IORT and a median dose of EBRT was 43.2 Gy (range, 7.2 to 45 Gy). The follow-up period ranged from 1~254 months, with a median follow-up period of 64 months. Results: The median age of all the patients was 58 years (range, 30 to 71 years). The distribution of pathologic stage (American Joint Committee on Cancer [AJCC] 2002 tumor-note-metastasis [TNM]) was as follows: 13 stage I (25.5%), 10 stage II (19.6%), 25 stage III (49.0%), and 3 stage IV (5.9%). Distant metastases occurred in 11 patients (10 in the peritoneum and 1 in bone), including one patient with concurrent local recurrence (anastomosis site). The 5-year locoregional control, disease free survival and overall survival rates were 94.7%, 66.5%, and 51.7%, respectively. For the multivariate analysis, age, TNM stage, and EBRT were significant prognostic factors for overall survival, and only TNM stage for disease free survival. Conclusion: We could have achieved a high loco-regional control rate in patients with locally advanced stomach cancer by adding IORT to radical surgery. However, the benefit of IORT on survival remains to be elucidated.

• Radiation Oncology Journal
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• v.16 no.1
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• pp.27-33
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• 1998

Purpose : To improve the therapeutic results of postoperative recurrent disease and inoperable disease of stomach cancer, we used the thermoradiotherapy. We conducted a retrospective analysis of the results and compared the results of hyperthermia before radiotherapy and those of hyperthermia after radiotherapy Materials and Methods : From July 1994 to November 1996, we treated twenty patients with locally advanced stomach cancer and recurrent stomach cancer with thermoradiotherapy. We divided those patients into two groups : hyperthermia before radiotherapy group (PreRT group : 13 Patients) and hyperthermia after radiotherapy group (PostRT group : 7 patients). We performed radiation therapy with the total tumor dose of 3000-5040cGy in a traction of 180-300cGy and 5 fractions per week. Hyperthermia was performed with 8 MHz radiofrequency apparatus. PreRT group patients were treated daily for 30 minutes before the radiation therapy within the interval of ten minutes. And PostRT group patients were treated with 1-2 sessions Per week for 40-60 minutes after the radiation therapy within the interval of 10 minutes. Results : Overall response rate was $33.3\%$. This response rate appeared the same in both groups. Mean survival and 1 rear survival rate were 10.3 months and $16.5\%$. In PreRT group, mean survival and 1 year survival rate were 6.8 months and $9.0\%$, and in PostRT group, mean survival and 1 year survival rate were 7.7 months and $34\%$. There were no statistically significant difference between the prognostic factors and therapeutic results. Conclusion : The thermoradiotherapy was a safe treatment method in advanced and recurrent gastric cancer when compared with other treatment. Because the number of patients we treated was small and the follow up period was short. we were not able to draw any conclusions about the therapeutic efficacy of the sequence of radiation therapy and hyperthermia. Therefore, further clinical trials of thermoradiotherauy for stomach cancer appear to be warranted.

• Journal of Society of Preventive Korean Medicine
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• v.5 no.1
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• pp.41-56
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• 2001

Overview: The purpose of this study was to evaluate the determinants on the correlation between constitution and health promoting lifestyle profile on the workers. Also, the questionnaire on the HPLP (health promoting lifestyle profile) of Walker(1987) and Sa-sang constitution of Lee(l894) were utilized Methods: Data from a representative sample of 652 workers were analyzed Pearson's chi-square test analysis was utilized to test the explanatory causal model and to determine the direct and indirect effects of independent variables on quality of life. Results: Constitutional distribution among exposed group, were Tae-eum In(43.7%), So-eum In(33.6%), and So-yang In(22.7%). The degree of the subjects practicing health promoting lifestyle, on a scale of 1 to 4, is an average of 2.62, personal relations 2.94, self-realization 2.86, stress management 2.71, nutrition 2.68, responsibility for health 2.37, and exercise 2.21, with personal relations earning the highest points and exercise the lowest As for factors influencing health promoting lifestyle, there is significant difference between sex and age. That is female and higher age. On the difference between constitution and health promoting lifestyle, Tae-eum In is the highest all area except personal relations. So-eum In is the lowest all area except responsibility for health. Conclusions: Tae-eum In totally do health promoting lifestyle well but So-eum In relatively not. On the Study we used the HPLP(health promoting lifestyle profile) on the premise that each person's daily life, the attitude and the practice level to the health have an influence on the health. So in the constitution there is a little differences in the consideration and the practice level and health condition will be different. On this study we finish up by knowing about the health promoting lifestyle. But on next time we will have to go on studying about the sign and the comparison with the result of western and oriental medical health examination to the each constitution on carrying out continuously oriental medical health examination.

• Journal of Preventive Medicine and Public Health
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• v.30 no.3 s.58
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• pp.609-622
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• 1997

Nitrogen dioxide $(NO_2)$ has been regarded as one of the main elements among air pollutants, and we measured $NO_2$ levels of near gas range, kitchen, living room and outdoor on 489 apartments in Pusan area. $NO_2$ were sampled by using Palmes tubes (diffusion tube sampler) during August 16-25, 1995 (summer) and January 15-29, 1996 (winter), respectively. Authors wanted to know comparison of $NO_2$ levels in summer and winter, $NO_2$ levels categorized by variables, and variables affected to $NO_2$ levels. According to this study, we conducted to establish the degree of indoor-outdoor air pollution of urban apartments in Korea and methods to reduce indoor air pollution. The results of this study were summarized as follows: 1) Mean $NO_2$ levels of near gas range, kitchen, living room, and outdoor were $25.9{\pm}10.0ppb,\;23.3{\pm}8.0ppb,\;19.9{\pm}6.1ppb,\;and\;19.0{\pm}6.0ppb$ in summer, and $34.5{\pm}16.8ppb,\;28.2{\pm}13.4ppb,\;25.3{\pm}12.5ppb,\;21.8{\pm}9.8ppb$ in winter, respectively. 2) Mean $NO_2$ levels according to the floor levels were not significantly different in summer, and in winter, $NO_2$ levels were decreased as the floor levels were increasing, but those were increased above 16th floor. 3) Variables showing significant correlation(p<0.05) with $NO_2$ levels were as follows; Summer: floor level, family size, number of family during a meal, number using gas range during rice cooking per day, and natural ventilation. Winter: floor level, family size, number of person who have been respiratory disease in a house, number of family during a meal, total number of meals, and number using gas range during rice or side-dish cooking per day. 4) We suggest that the methods of reducing indoor $NO_2$ levels are ventilation during cooking, complete combustion, decreasing number and time of cooking, and substitution of fuels.

• Journal of Preventive Medicine and Public Health
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• v.29 no.4 s.55
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• pp.733-746
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• 1996

To evaluate the follow-up management state and related factor of lead battery workers in periodic health examination as part of program of group occupational health service, author studied 293 workers with questionnaire on knowledge of results and follow-up management state and related factors, and compared the responses to their periodic health examination result charts. The results were as follows: 1. 252(86%) workers responsed that they had received the health examination result chart, but only 116(39.6%) workers responsed that they had been educated or explained about the results of health examination, and 11(57.9%) workers among 19 workers with non-occupational disease D, 101(44.3%) workers among 228 workers with non-occupational disease C, and 19(28.4%) workers among 67 workers with occupational disease C knew accurately their health examination results. 2. 78(24.8%) of the workers responsed that they had follow-up management, and contents of follow-up management were follow-up(36.6%), out-patient treatment (31%), change worksite(8.5%), temporary retirement(7.0%) and others(16.9%). 3. Most of the workers responsed that the health examination were necessary, but three-fourths of the workers responsed that the health examination had been superficial or that they didn't know. 4. In this study, follow-up management show significant association with only explanation or education about health examination result chart.

• Journal of Preventive Medicine and Public Health
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• v.29 no.4 s.55
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• pp.801-814
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• 1996

Background: Korean people could abuse healthy foods as well as medications, which might cause serious side effects. The aim of this study was elucidating liver dysfunction due to the self-medications of hepatotonics, healthy foods and herb medications by nested case-control study. Methods: Study subjects were drawn from male members of Seoul Cohort Study who were recruited by self-administered structured questionnaire survey through mailing to the healthy men between the age of 40 and 59 years through the program of biennial health check-up offered by Korea Medical Insurance Corporation(KMIC). The liver dysfunction was defined as the level of serum AST and ALT above 40 IU/L and increased in more than one hunderd per-cent during the 2 year follow-up period. To estimate the odds ratio between self-medication and liver dysfunction after controlling for potential confounders, logistic regression was performed. Results: During the follow-up period, 30 members were identified to fit into case criteria and 2,625 members were selected as control. In logistic regression analyses, history of healthy foods intake, age under 45 years, obesity, and habit of regular exercise were significantly associated with liver dysfunction. The following factors exhibited no statistical significance: intake of hepatotonics, of herb medicine; history of disease in family, of operation, and of radiologic examination; smoking habits and drinking amounts. Conclusion: The significant association between the intake of healthy foods and the liver dysfunction illustrates that chronically optional overuse of healthy foods might bring to hazards to health. As the increasing trend of the size of purchasing healthy foods in Korea, pharmacoepidemiologic studies evaluating the safety and efficacy of the widely used healthy foods should be performed in the near future.

• Journal of Preventive Medicine and Public Health
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• v.29 no.4 s.55
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• pp.765-783
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• 1996

This study surveyed and measured the level and structure of cancer deaths and their trends over time for offering the fundamental data of e cancer prevention and control in Pusan city in the future. Authors conducted the study of descriptive epidemiology using materials derived from the computerized data of total 3,722 certified cancer deaths in Pusan city from January 1 to December 31, 1993 registered on the National Statistical Once, the Republic of Korea. The obtained results were as follows: 1. According to the total registered cases of deaths(16,331 cases) in Pusan city during 1993, cancer(3,722 cases) and cerebrovascular disease(2,118 cases) were the first and second cause of deaths as 23.1% and 16.9%, respectively. These pattern showed the change between cancer (14.7%) and cerebrovascular disease(18.5%) in order of frequency in comparison to 1982. Also, the total number of cancer deaths was increased in comparison to 1982. The rate of death certification by physicians was 87.1% of all registered deaths, which was increased to 6.8% in comparison to 1982(80.3%). 2. Crude death rate and cancer specific death rate was 4.06 per 1,000 populations and 93.8 per 100,000 populations(male:117.8, female:70.0), respectively. The former was similar to that of 1982, but the latter was increased to 1.6 times as that of 1982. 3. Age-adjusted cancer specific death rate by standardization with whole country population was 111.9(male:141.5, female:106.7) per 100,000 populations, higher than not age-adjusted cancer specific death rate(93.8), and the sex difference was statistically significant with male predominance (p<0.05). 4. Cancer specific death rate by age was generally increased with age and most of cancer deaths(male:91.8%, female:88.5%) occurred since 40 years old. 5. The major cancer(cancer specific death rate per 100,000 populations) in male was liver(30.6) followed by stomach(25.6), lung(21.9), and GB and EHBD(5.7), in female stomach(15.7), liver(9.9), lung(7.3), and uterus(6.9). The relative frequency of the leading three cancer among total cancer deaths marked 66.3% in male and 47.l% in female, and decreased in comparison to 1982(male:72.2%, female:54.5%). 6. The total ratio of male to female cancer specific death rate showed 1.68 to 1 with male predominance. And the ratio was above 2.0 in larynx, oral cavity & pharynx, esophagus, liver, lung, bladder cancer and the ratio was $1.0\sim1.9$ in stomach, pancreas, gall bladder and EHBD, brain, rectum and anus cancer, leukemia, but the ratio was reversed in thyroid and colon cancer. In conclusion, cancer was the first cause of deaths. The proportion of lung cancer was increased, that of stomach & uterine cancer was decreased relatively, and liver cancer was constantly higher proportion. In the future, it is necessary to conduct the further investigations on the cancer risk factors considering areal specificity.