• Tuberculosis and Respiratory Diseases
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• v.40 no.5
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• pp.468-473
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• 1993

Background: Recent advance in video technology, endoscopic equipments, and surgical techniques have expanded the use of thoracoscopy from diagnosis of the pleural diseases to treatment of the various intrathoracic diseases. Video Assisted Thoracoscopic Surgery(VATS) is a pretty new and fascinating thoracic surgical modality, and so we present our early VATS resuls. Methods: Using Video Thoracoscopic techniques in 30 patients for 10 months from July 1992 to April 1993, we had performed a variety of procedures. These incuded (1) bleb resections in 18 patients (19 cases), (2) mediastinal tumor excision in 4, (3) lung biopsies for parenchymal pulmonary disease in 3, (4) pleural biopasies in 3, (5) pleural tumor excision in 1, (6) and pleuropericardial window in 1. Results: There were no mortality associated with the procedures. We had minor 8 complications; prolonged air leak in 3 patients, prolonged serous drainage in 2, recurrence of pneumothorax in 1, Honer's syndrome in 1, and hoarseness in 1 patient. None of the 30 patients had reverted to the conventional full thoracotomies. Mean postoperative hospital stay of non-complicated pneumothoraces was about 5 days, which was a little shorter than conventional thoracotomy group. Conclusion: Though we had somewhat higher postoperative complication rate due to lack of experiences in the begining, we were able to convince that VATS had benifical value for patients; lesser postoperative pain, shorter hospitalization, quicker recovery time, and cosmetically superior scar. The role of VATS can be expanded to the diagnosis and treatment of various thoracic diseases, even to the cardiovascular diseases, with satisfactory outcome and less postoperative morbidity.

• Tuberculosis and Respiratory Diseases
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• v.72 no.5
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• pp.441-447
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• 2012

Background: Chest tube drainage (CTD) is an indication for the treatment of pneumothorax, hemothroax and is used after a thoracic surgery. But, in the case of incomplete lung expansion, and/or persistent air leak from CTD, medical or surgical thoracoscopy or, if that is unavailable, limited thoracotomy, should be considered. We evaluate the efficacy of bronchoscopic injection of ethanolamine to control the persistent air leak in patients with CTD. Methods: Patients who had persistent or prolonged air leak from CTD were included, consecutively. We directly injected 1.0 mL solution of 5% ethanolamine oleate into a subsegmental or its distal bronchus, where it is a probable air leakage site, 1 to 21 times using an injection needle through a fiberoptic bronchoscope. Results: A total of 15 patients were enrolled; 14 cases of spontaneous pneumothorax [idiopathic 9, chronic obstructive pulmonary disease (COPD) 3, post-tuberculosis 2] and one case of empyema associated with broncho-pleural fistula. Of these, five were patients with persistent air leak from CTD, just after a surgical therapy, wedge resection with plication for blebs or bullae. With an ethanolamine injection therapy, 12 were successful but three (idiopathic, COPD and post-tuberculosis) failed, and were followed by a surgery (2 cases) or pleurodesis (1 case). Some adverse reactions, such as fever, chest pain and increased radiographic opacities occurred transiently, but resolved without any further events. With success, the time from the procedure to discharge was about 3 days (median). Conclusion: Bronchoscopic ethanolamine injection therapy may be partially useful in controlling air leakage, and reducing the hospital stay in patients with persistent air leak from CTD.

• Tuberculosis and Respiratory Diseases
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• v.63 no.5
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• pp.449-453
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• 2007

Totally implanted central venous access devices for chemotherapy (chemoport) are being used increasingly in lung cancer patients. Vascular catheters are associated with various complications including infection, thrombosis as well as spontaneous fractures and embolization of the catheter, which is known as 'pinch-off syndrome'. 'Pinch-off syndrome' refers to the compression of a subclavian central venous catheter between the clavicle and first rib resulting in an intermittent or permanent obstruction, which can lead to tears, transection, or embolization. We report two cases of fractured and embolized implanted subclavian venous catheters in which the fragments were removed percutaneously. A 62-year-old man presented with back pain with a duration of a few weeks. The chest radiograph revealed complete transsection and embolization of the catheter into the right atrium. In addition, a 47-year-old woman with a chemoport had a grade 3 pinch-off sign in a chest radiograph demonstrating complete transsection and embolization of the catheter into the pulmonary artery. Both cases were managed by retrieving the embolized distal fragment percutaneously and removing the proximal section of the catheter.

• Journal of Yeungnam Medical Science
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• v.2 no.1
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• pp.229-235
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• 1985

This study was undertaken for the clinical evaluation and statistical analysis on the 88 women with histopathologically confirmed ectopic pregnancies who were admitted and treated from grand opening on May-28, 1983 to Sept.-30, 1985. Incidence of ectopic pregnancy was 1 in 22.2 deliveries and the most common age group was in 30~34 years of age. There was tendency of decreasing incidencies as the gravidity, panty or artificial abortion were over 3. The most common etiologic factor was pelvic inflammatory disease and procedures for family planning were the next common. Common symptoms were lower abdominal pain (85.2%) and vaginal spotting (56.8%). At the admission, hemoglobin level under 10gm% were 44.3%, 69.5% of urine HCG tests were positive. Culdocentesis was positive only in 75.9%. Termination was frequent at 6 ~ 7 weeks of gestation mostly with rupture or abortion. Free blood in the abdominal cavity was averaged 1,224 ml. 4 cases of clinicobiochemically suspected ectopic pregnancies with spontaneous regression were excluded, and there was no fatal case treated in hospital.

• Journal of Preventive Medicine and Public Health
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• v.27 no.4 s.48
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• pp.711-734
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• 1994

Among chemical agents in herbicides, dioxin (2, 3, 7, 8-tetrachloro dibenzo-$\rho$-dioxin : TCDD), a chemical contaminant in herbicides sprayed during the Vietnam War has been known to be the major agent causing toxic effects. Approximately 320,000 korean soldiers participated the Vietnam War from 1964 to 1974. Although the potential hazards of the herbicides among Korean veterans exposed were implicated, the problem had not been a public issue until 1991 when Korean veterans were informed U.S. companies, the herbicides manufacturer payed fund, from which a trust fund for New Zealand and Australian Class members were established in 1985. After a series of appeals and demonstration by the Korean Veterans demanding medical care and compensation for their serious health damages, a bill of medical care and compensation for herbicides victims was promulgated in March 1993 and become effective from May 1993, This study was carried out with two major objectives : the first to understand the health problems caused from the herbicides by reviewing literatures published, and the second to examine the nature and extent of health impacts among Korean veterans exposed and to develop valid study methods for the major study by interviewing and reviewing records on a part of veterans (638 persons) registered and completed medical examination in Seoul Veterans Administration Hospital from June to October 1993. The results obtained are as followings: 1. The literature review of 107 papers revealed that 1) Dioxin is teratogenic, carcinogenic and affects almost all organs including nervous, endocrine, and reproductive systems in animal experiments. 2) The diseases showing evidence of causal association were Hodgkin's disease, non-Hodgkin's disease, lung cancer, lymphoma, soft tissue sarcoma, chloroacne and polyneuropathy when judged on the basis of consistency in study results and biological plausibility. 2. Interview and medical record review study on 638 veterans, though limited validity owing to lack of control group, crude estimates of dioxin exposure levels (no biomarkers measurable), and uncertainty of diagnosis, showed that: 1) Most of the study subject's were in their 40's of age and had been dispatched to Vietnam during the period from $1965{\sim}1970$ around one year. 2) Most frequently complained symptoms in medical examination were motor weakness (32%), sensory abnormalities in extremities (23%), skin diseases (22%), and pain in extremities (20%) whereas in Interview they were more frequent in order of skin problem (44%), motor weakness (38%), sensory abnormalities and pain in extremities(17% and 19% each). Kappa indices on the same category of complaints between two sources of information were variable and relatively low. 3) On medical examination, only a part of the 638 subjects had initial impression (442 pts) and final diagnosis (218 pts) suggesting decision making on diagnosis appeared to be difficult even with all available modern medical technologies: in initial impression disorders from peripheral and central neuropathy were predominant whereas in final diagnosis various types of skin disorder were most frequent 4) When dose-response relationship between several conditions (from questionnaire) and arbitrary exposure scores were examined by CMH linear trend test, spontaneous abortion, sexual problems and health problem of offsprings showed statistically significant linear trends. However, pregnancy, accident and suicidal attempts did not show any relationship in this study capacity. 5) Among complaints, psychosis and neurosis (anxiety, phobia) in interview study, and memory disorder and psychosis in medical record study revealed linear trend. 6) Skin disorder was the only condition showing linear trend in initial impression and none in final diagnosis on medical examination. Even though objective to select out dioxin-related disease or group of diseases from this study was not achieved the research experiences provided firm basis for developing various methodological approaches. 3. From this preliminary study we concluded that a larger scale major epidemiologic study on health impacts of herbicides among Korean veterans exposed is not only Indispensible but also well designed study with more valid exposure information and diagnosis may be able to establish causal relationship between certain groups of diseases and exposure to the herbicides among Korean veterans.

• Journal of agricultural medicine and community health
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• v.12 no.1
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• pp.5-27
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• 1987

It is widely recognized that primary health care in the community is one of the most important and effective health measures in these days. However, it is reality that unsatisfactory health care system, ineffective utilization of health care by the community people in the rural area are hampering better understanding for primary health care. Therefore promoting health for the rural people and increasing understanding about primary health care, the baseline survey in the community focused in examination for safe community water supply was carried out. The survey was conducted through August 25-31, 1986 in order to find out health problems and relevant factors and to define the demographic characteristics of $^*$Sanpuk village, Kumsa-Myun, Yuju-Gun, Kyunggi-Do, Korea. Household survey was carried out for every home by trained interviewers. The major results are found out as follows : 1) 84.2%(400 houses) of total households were surveyed because 15.8%(75 houses) were unable to survey due to either refusal against interview or absence of family. These 400 households were composed of 1,697 residents(male:830, female 867). Educational level of respondents showed 34.1% as elementary school graduated. Religion distribution showed Buddism(23.8%) as the most dominant. 50.7% of respondents married in the area. 2) Most households(91.5%) have lived in their own house in Sanpuk area. Average family size showed 4.3. More than half of residents(64.2%) have used public supplied water tap. Only 1.5% of the households had a flush toliet. The rest of households have still used primitive insanitary latrines. 3) 32.5% of residents have used gas burner for cooking and for heating in the house, and the coal briquet were used for boiler. Lack of convenient public transportation was the chief complaint for their day life. 4) Each household occupied 1,990 pyungs of rice paddy and 1,170 pyungs of ordinary field in average. Beside farming products, mushroom was the highest product. 5) Sixth percent of households in the survey area regularly participated in community meeting one hand and on the other hand 39.5% never participated. Most of respondents closely contacted with their neighbours and they seemed very friendly each other. 6) The prevalence rate of illness and injury during recent 15 days showed 48.3 per 1,000. The prevalence rate of chronic illnesses during the past one year showed 74 per 1,000. Injury and accident lead the higher portion(22.0%) in the former and in the latter pain(arthritis, back-pain) showed 27.0% as the dominant sickness. 87.8% of the ill residents in the former received medical treatment. As the most frequently utilized medical facility, the clinic or hospital were counted. Among the residents suffering from chronic illnesses, 77.3% in Sanpuk area get some kind of medical treatments and they rarely utilized the clinic or hospital. The reason why the patient did not receive any medical care was found out the fact that symptoms of illness was light or mild and economic problems was serious. 7) Average age of marriage showed 21.6 years old in the women and the average duration of marital period was shown for 15.1 years. The married woman in reproductive age in Sanpuk area had experienced pregnancies 4 times in the aver-age including 0.7 time of pregnancy in average were interrupted by induced abortion and 0.3 time by spontaneous abortion respectively. The practicing rate of the family planning of the married woman during reproductive ages showed 70.7% and the tuballigation was found out as the most frequently used contraceptives. 8) Among woman who has children under 2 years old, 70.0% had received the prenatal care for the last pregnancy. However, the average number of prenatal care visitis per woman showed 3.3 times. Fifty-two % of woman who received the postnatal care for the last delivery showed only 37.5%. 9) Immunization rate of the children under 2 years old showed relatively high and looked successful. The breast feeding for these children showed dominantly in the most. Most of the mothers in Sanpuk area had started the supplementary diet during weaning period of their infants of 6th and 7th month after birth. * : Sanpuk area is a demstration area for community development which has been supported by the Community Development Foundation during the part 10 years. The village is relatively closer to urban area such as Seoul, However, it has a similar characteristics shown as a remote village because of geographical location and inconvenient transportation at present.

• Pediatric Infection and Vaccine
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• v.8 no.2
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• pp.150-159
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• 2001

Purpose : We need to reconsider booster vaccination schedule of Japanese encephalitis vaccination. To do that we evaluate the long-term immunogenicity and the incidence of adverse events with inactivated mouse brain derived Nakayama Japanese encephalitis vaccine. Methods : We tested neutalizing antibody for 311 elementary school students by plaque reduction neutralizing test(PRNT) at USAMC-AFRIMS(United States Armed Forces Research Institute of Medical Science/Department of Virology). We evaluated vaccine related adverse events by spontaneous reporting prospectively among 15,487 vaccinees who were vaccinated at public health center and 2,277 elementary school students who were immunized previously by a questionnaire and school health record. Results : According to the time interval from the last booster injection of 311 children, PRNT antibody titers gradually decreased as the interval increased; 239 mIU/mL, 188 mIU/mL, 134 mIU/mL, 49 mIU/mL each at 6, 18, 30, 42 months after the last booster injection. The seropositivity rates were 98%, 99%, 95.6%, 71.4% each at 6, 18, 30, 42 months after the last booster injection. There were 21(0.13%) cases with systemic reactions among 15,487 vaccinees who had visited the hospital by prospective passive reporting system at public health center. According to the questionnaires and school health records in elementary school students, local induration and pain were 17.4% and 14.8%, respectively. Systemic reactions including fever, vomiting, rash were reported in few cases. Conclusion : Biannual booster vaccination that has been recommended so far should not be necessary. Surveillance for adverse events with inactivated mouse brain derived Nakayama vaccine should be strengthened to better assess the number of cases and reactions associated with immunization.

• Journal of Chest Surgery
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• v.30 no.10
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• pp.991-1000
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• 1997

Closed thoracostomy with UWSD* which is the most utilized procedure in chest surgery applies general thoracic disorders, trauma and after-thoracic surgery. The University hospital was involved on operating 2341 cases of closed thoracostomy with UWSD except chest tubing after-thoracic surgery for a full six years from January, 1991 to December, 1996. The rate of men and women out of the total 2341 cases was 3.5 : 1, the distribution by age showed that men were 36.6 $\pm21.0$ years old, women were $47.0\pm20.2$ years old and so that the total were 40.0 $\pm$ 20.5 years old. As for indication, spontaneous, secondary and traumatic pneumothorax were the most common, in addition to hemothorax hemopneumothorax, hydrothorax, hydropneumothorax, empyema, chylothorax. The most indwelling period of chest tubing is between eight and fourteen days for 974 cases and the average is 13.7 $\pm$ 6.3 days, The average drainage amount immediately after thoracostomy was 537 $\pm$ 88m1, and in 694 cases(46.0%), the drain amount was 201 ~ 500 ml. The rate of right and left tubing was 52.4 47.6, in 2071 cases(88.5%), the thoracostomy was the first chance and 2210 cases(94.4%) were treated with a single tube drainage. Almost all the patients complained of tube site pain, besides tube site infection, intercostal neuralgia, loss of tube function by the pleural adhesion, intrathoracic infection, incomplete reexpansion of defective lung, hemorrhage caused by the rupture of a blood vessel, subcutaneous emphysema, lung parenchymal rupture, diaphragmatic and intraabdominal trauma, reexpansionary pulmonary edema of one side lung and cellulitis were relapsed. 84.6% of all patients recovered with only clo ed thoracostomy and the rest of patient needed additional some necessary managements and so on to have successful results. There were two deaths(0.1%), caused by reexpansionary pulmonary edema, the cellulitis were complicated by thoracostomy with UWSD on an empyema patients to come to death(due to sepsis). t UWSD = under water seal drainage

• Advances in pediatric surgery
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• v.9 no.1
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• pp.45-51
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• 2003

A nationwide survey on choledochal cyst was undertaken among 39 members of the Korean Association of Pediatric Surgeons. The members were required to complete a questionnaire and the case registration form for each patient during the five year period of 1997 to 2001. Three hundred and forty eight patients were registered from 32 institutions. The average number of patients per surgeon was one to two every year. The male to female ratio was 1:3.4. The age of patients on diagnosis was $49.0{\pm}44.4$ months. The geographic distribution was 34.8% in Seoul and Kyoungki-do, 33.3% in Kyoungsang-do, 17.9% in Cholla-do, and 8.5% in Choongchung-do, in order of frequency. The three common clinical presentations were abdominal pain (63.8%), vomiting (35.3%), and jaundice (29.1%). Only seven patients (2%) presented with classic triad, and 25 patients were diagnosed by antenatal ultrasonographic examination. According to the Todani Classification, 238 patients (7l.3%) were type 1, 3 (0.9%) type 11, and 93 (27.8%) type IV. At the time of the operation, three important associated conditions were choledocholithiasis in 45 patients (15.1%), liver fibrosis (Grade 1-4) in 35, and previous operative procedure for biliary diseases in 10. Associated anomalies were observed in 13 patients (3.8%). Three hundred thirty nine (98.8%) of 343 lesions were treated by Cyst excision and Roux-Y hepaticoiejunostomy. One hundred seventy-six patients had an anomalous arrangement of the pancreatobiliary ductal system (APBD): APBD was not in 92 patients, biliary duct joined to the pancreatic duct in 51, and pancreatic duct joined to the biliary duct in 26. There were 8.5% early, and 7.7% late phase operative complications. The major complications were bleeding, anastomotic leakage, and acute pancreatitis. The combination of acute abdomen and choledochal cyst may suggest spontaneous rupture. Because of the development of late intrahepatic bile duct stones, long term follow up after cyst excision and hepaticojejunostomy is required. The optimal time of surgical intervention should also be considered in the situation of routine use of antenatal ultrasonographic examination. This is the first review of the choledochal cyst in Korea and provides baseline data for future comparisons.

• Journal of Yeungnam Medical Science
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• v.18 no.1
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• pp.75-84
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• 2001

Background: The accidental swallowing of foreign body is a common problem in the children. Ingested foreign bodies may be managed by endoscopy, observation, or surgery. So we analyzed the methods of removal, type, location and complications of foreign bodies. Materials and Methods: This report reviewed 37 cases of ingested foreign body in the gastrointestinal tract at the Department of Pediatrics, Yeungnam University Hospital between January 1997 and April 2001. Results: The age ranged from 8 months to 8 years. The most prevalent age group was between 1 year and 2 years of age(19%). The male to female ratio was 2.1:1 with 25 male and 12 female patients. The type of foreign bodies were coins in 20 cases(54%), nail in 4 cases(11%), key in 4 cases(11%), pin in 2 cases(5.5%), necklace in 2 cases(5.5%) and others. The locations of foreign bodies were upper esophagus in 12 cases(32.5%), lower esophagus in 4 cases(10.8%), stomach in 16 cases(43.2%), small bowel in 5 cases(13.5%). 4. Presenting symptoms were variable with asymptomatic(59.4%), vomiting(19.0%), epigastric pain(8.1%), dysphagia(5.4%) and others. The methods for removal of foreign bodies included 20 cases of endoscopic removal(54.0%). 3 cases of spontaneous removal(8.1%) and there was no surgical removal. 14 cases(37.9%) did not confirmed removal of foreign body because of no revisit of our hospital. Endoscopic finding of patients were normal(15 cases), ulceration(2 cases), erosion(1 case), inflammation(1 case), mucosal scratch(1 case). Conclusion: It appears that the endoscopic approach is the preferable method for the removal of upper gastrointestinal foreign bodies in the children.