• Journal of Korean Neurosurgical Society
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• v.29 no.6
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• pp.754-762
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• 2000

Objectives : The surgical results of 80 patients with growth hormone(GH)-producing pituitary adenoma were analyzed retrospectively to evaluate the clinical manifestations and to determine which preoperative factors significantly influenced the surgical outcome. Patients and Methods : The patients consisted of 39 men and 41 women and the age of patients at the time of initial operation ranged from 17 to 67 years(mean age, 40.5 years) Between January 1990 and June 1996, 77 patients underwent transsphenoidal surgery and 3 patients underwent craniotomy for GH-producing pituitary adenoma at our institution. Preoperative administration of octreotide was performed in 18 patients. Surgical control was defined as a postoperative serum basal level of GH less than 5ng/ml. A logistic regression model was used for univariate and multivariate analysis. Probability value of less than 0.05 was considered as statistically significant. Results : The most common presenting symptom was acromegaly, followed by headache, visual disturbance, and fatigability. Visual symptoms were present in 39% of the patients. Diabetes mellitus was associated in 24 patients and hypertension in 12. Preoperative mean basal level of GH was 93.2ng/ml(range 72-500ng/ml) which was closely related with tumor size(p<0.05). Grade II by Hardy's classification was the most common radiological type. Preoperative octreotide treatment significantly reduced the level of GH(p<0.05), but not enough to induce endocrinological remission. One patient died of cerebral infarction after craniotomy. The most common surgical complication was transient diabetes insipidus. The symptom of the earliest improvement after surgery was paresthesia and tightness of the hand and foot, followed by headache and easy fatigability. The preoperative visual symptom was improved in all patients. The patients who had hypertension or DM experienced alleviated symptoms in 67% and 92%, respectively. The overall rate of endocrinological remission was 44%. By multivariate logistic regression analysis, the size of tumor, extrasellar extension, and extent of removal were significant prognostic factors for endocrinologial remission. Conclusion : Early detection of a small tumor without extrasellar extension followed by a complete resection is highly recommended in order to achieve endocrinological cure of GH-producing pituitary adenomas.

• Journal of Korean Neurosurgical Society
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• v.60 no.6
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• pp.654-660
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• 2017

Objective : Mechanical thrombectomy is increasingly being used for the treatment of acute ischemic stroke. The population over 80 years of age is growing, and many of these patients have acute infarction; however, these patients are often excluded from clinical trials, so the aim of this study was to compare the functional outcomes and complication rates in very elderly patients (age ${\geq}80$ years) and aged patients (60-79 years) treated with mechanical thrombectomy. Methods : Between January 2010 and June 2015, we retrospectively reviewed 113 senior patients (over 60 years old) treated at our institution for acute ischemic stroke with mechanical thrombectomy. They were divided into a very elderly (${\geq}80$ years) and aged (60-79 years) group, with comparisons in recanalization rates, complications, death and disability on discharge be reported. Results : The mean age was 70.3 years in the aged group and 83.4 years in the very elderly group. Elderly patients had higher rates of mechanical thrombectomy failure than the younger group (40% vs. 14%; odds ratio [OR] 4.1; 95% confidence interval [CI] 1.4-11.9; p=0.012). Results from thrombolysis in cerebral ischemia and modified Rankin scale at discharge were worse in the older group (p=0.005 and 0.023 respectively). There were no differences in mortality rate or other complications, but infarction progression rates were significantly higher in the very elderly group. (15% vs. 2.2%; OR 8.0; 95% CI 1.2-51.7; p=0.038). The majority (92.3%) of the patients who failed in aged group were not successful after several trials. However, in half (4 of 8) of the very elderly group, the occlusion site could not be accessed. Conclusion : Patients older than 80 years of age undergoing mechanical thrombectomy for acute infarction were more difficult to recanalize due to inaccessible occlusion sites and had a higher rate of infarction progression, However, mortality and other complications were similar to those in younger patients.

• Journal of Chest Surgery
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• v.45 no.1
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• pp.40-44
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• 2012

Background: The experience of a single-institution regarding surgery for small cell lung cancer (SCLC) was reviewed to evaluate the surgical outcomes and prognoses. Materials and Methods: From July 1990 to December 2009, thirty-four patients (28 male) underwent major pulmonary resection and lymph node dissection for SCLC. Lobectomy was performed in 24 patients, pneumonectomy in eight, bilobectomy in one, and segmentectomy in one. Surgical complications, mortality, the disease-free survival (DFS) rate, and the overall survival rate were analyzed retrospectively. Results: The median follow-up period was 26 months (range, 4 to 241 months), and there was one surgical mortality (2.9%). Six patients (17.6%) experienced recurrence, all of which were systemic. Eight patients died during follow-up; four died of disease progression and the other four died of pneumonia or of another non-cancerous cause. The three-year DFS rate was $79.2{\pm}2.6%$ and the overall survival rate was $66.4{\pm}10.5%$. Recurrence or death was significantly prevalent in the patients with lymph node metastasis (p=0.001) as well as in those who did not undergo adjuvant chemotherapy (p=0.008). The three-year survival rate was significantly greater in the patients with pathologic stage I/II cancer than in those with stage III cancer (84% vs. 13%, p=0.001). Conclusion: Major pulmonary resection for small cell lung cancer is feasible in selected patients. Patients with pathologic stage I or II disease showed an excellent survival rate after surgery and adjuvant treatment. Prospective randomized studies will be needed to define the role of surgery in early-stage small cell lung cancer.

• Radiation Oncology Journal
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• v.17 no.4
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• pp.275-280
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• 1999

Purpose : To assess the feasibility and the toxicity of the neoadjuvant chemotherapy on the treatment of patients with locoregionally advanced nasopharyngeal carcinoma. Methods and Materials : We analyzed 77 previously untreated and histologically confirmed advanced stage nasopharyngeal carcinoma patients treated with neoadjuvant chemotherapy followed by radiation therapy at the Seoul National University Hospital between 1984 and 1996. The stage distribution was as follows : AJCC stage III-2, stage IV-75. Sixty-six patients received infusion of 5-FU (1000 mg/m$^2$, on Day 1$\~$5) and cisplatin (100 mg/m$^2$, on Day 1), eleven patients received infusion of 5-FU (1000 mg/m$^2$, on Day 1 $\~$5) and carboplatin (300 mg/m$^2$, on Day 1) as neoadjuvant chemotherapy Prior to radiation therapy. The median follow-up for surviving patients was 44 months. Results : The overall chemotherapy response rates were 87$\%$. The toxicities of chemotherapy were mild. Only 3 patients experienced Grade 3 toxicities (1 for cytopenia, 2 for nause/vomiting). The degree of radiation induced mucositis was not severe, and ten patients developed Grade 2 mucositis. The 5-year overall survival rates were 68$\%$ and the 5-year disease free survival rates were 65$\%$. The 5-year freedom from distant metastasis rates were 82$\%$ and 5-year locoregional control rates were 75$\%$. Conclusion : This single institution experience suggests that neoadjuvant chemotherapy improves overall survival and disease free survival for patients with advanced stage nasopharyngeal carcinoma without increase of toxicity.

• Journal of Acupuncture Research
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• v.33 no.1
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• pp.1-7
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• 2016

Objectives : This study was conducted to analyze the single dose toxicity of Mecasin (Gami-Jakyak Gamcho buja Decoction) herbal acupuncture administered in the vein of Sprague-Dawley rats. Methods : All experiments were performed at the Medvill, an institution licensed to conduct nonclinical studies, under the Good Laboratory Practice (GLP) regulations. Sprague-Dawley rats were chosen in this pilot study. In the experiment, Sprague-Dawley rats were divided into four groups of five male and five female animals per group. Doses of Mecasin herbal acupuncture, at 0, 500, 1,000, and 2,000 mg/kg, were given to the experimental groups, and a dose of normal saline solution, at 2 ml/kg, was administered to the control group. Mecasin herb acupuncture and normal saline were injected into the vein at once, and we observed mortality, clinical signs, weights, and gross findings for 14 days after injection. This study was conducted under the approval of the Institutional Animal Ethics Committee. Results : There is no death or abnormality in any of the four groups. All groups put on weights favorably. There are no significant gross findings in necropsy examinations. Conclusions : The above results showed that intravenous injection of 500-2,000 mg/kg of Mecasin herb acupuncture did not cause any changes in weight or, in the results of necropsy examinations, in mortalities. Therefore, the toxicity of Mecasin herb acupuncture was not confirmed, and the presumptive lethal dose of Mecasin herb acupuncture was higher than 2,000 mg/kg. The outcomes suggest that treatment with Mecasin herbal acupuncture is relatively safe. Further evaluations on this subject are needed to yield more concrete evidence.

• Korean Journal of Social Welfare
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• v.68 no.4
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• pp.199-224
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• 2016

This study is a research that investigated organization of case management practice at a mental health center. For organization research of case management practice, this study applied the research method of Institutional Ethnography, and analyzed 'work knowledge' and 'texts' data which were obtained through field work that lasted 3 months with 11 study participants. The analysis is not interpretation of the researcher, but it is work that assembles 'work knowledge' of field workers until they reach discovering institutions that organize case management practice. As a result of this study, case management practice of the mental health center was being standardized as 'a service that is biased towards symptom management without comprehensive and continual resources links' by new public management theory, bio-medicine discussion, 'standardization policy', 'treatment rate improvement policy', 'performance-based budget system', 'performance evaluation system' and 'continual linkage policy', mediating texts. This is a different outcome from usefulness of case management that is claimed to support politically.

• Journal of the Korean Society of Radiology
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• v.11 no.6
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• pp.475-481
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• 2017

As the research about supplementary education of radiological technologist who works in Gyoungsangnam province, this study was conducted to draw the improvements by analyzing the satisfaction level and problems of the supplementary education. During November 01, 2016 to December 15, 2016, after we sent out a total of 250 questionnaires for the survey to radiological technologists working at medical institution located in Gyoungsangnam province, 200 questionnaires suitable for research were analysis by using SPSS 18.0 statistical analysis software. As the satisfaction factors, 21 items such as system, subject, help, appropriateness of lecturer selection, professionalism were used. And as the problem factors, 18 items such as place, transportation, diversity, administrative treatment, education promotion, proceed method were used. Consequentially, the satisfaction level(3.12 point) and problems(3.01 point) of the supplementary education were confirmed as normal level. The supplementary education is an essential education that any health and medical service personnel must complete. In order to improve the effectiveness and efficaciousness of the education, the diverse opinions and efforts to improve the education levels must be supported. Futhermore, through the realistic educational program, the continuous education for radiological technologist with excellent qualities and competence should be done.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.3
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• pp.1187-1191
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• 2016

Background: The prevalence of prostate cancer (PCa) has been increasing in recent years. Treatment strategies are largely based on the results of bone scan screening. Therefore, our aim was to investigate predictors of positive bone metastasis in newly diagnosed PCa patients. Materials and Methods: After extensive review, 336 consecutive patients newly diagnosed with PCa between April 2010 and November 2013 at our institution were enlisted in the study. Patients were divided into two groups according to bone scan results. Univariate analyses (Chi-square test for discrete variables and independent t-test for continuous variables) were applied to determine the potentially significant risk factors associated with distant bone metastasis. Binary logistic regression analyses were used to further investigate the influence of these factors on bone metastasis. Results: The patient mean age was $71.9{\pm}8.6years$ (range: 48 to 94 years). The mean prostate specific antigen (PSA) level and biopsy Gleason score were $260.2{\pm}1107.8ng/mL$ and $7.4{\pm}1.5$, respectively. The body mass index (BMI) for the series was $24.5{\pm}3.4kg/m^2$. Sixty-four patients (19.0%) had a positive bone scan result. Patients with positive bone scan results had a significantly lower BMI ($23.3{\pm}3.5$ vs. $24.8{\pm}3.3$; p=0.003), a higher Gleason score ($8.5{\pm}1.1$ vs. $7.1{\pm}1.5$; p < 0.001), and a higher PSA level ($1071.3{\pm}2337.1$ vs. $69.4{\pm}235.5$; p < 0.001) than those without bone metastasis. Multivariate logistic regression analysis employing the above independent predictors demonstrated that a Gleason score of ${\geq}7$, clinical stage ${\geq}T3$, $BMI{\leq}22kg/m^2$, and an initial PSA level of ${\geq}20ng/mL$ were all independent predictors of bone metastasis. Conclusions: A bone scan might be necessary in newly diagnosed PCa patients with any of the following criteria: clinical stage T3 or higher, a Gleason score of 7 or higher, BMI equal to or less than 22, and a PSA level of 20 or higher.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.17
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• pp.8009-8013
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• 2015

Background: Orthotopic organ transplantation, a treatment option for irreversible organ dysfunction according to organ failure, severe damaged organ or malignancy in situ, was usually accompanied with massive blood loss thus transfusion was required. We aimed to evaluate the adverse impact of blood transfusion on solid organ transplantation. Materials and Methods: From January, 2009 to December, 2014, patients who received orthotopic organ transplantation at Far Eastern Memorial Hospital medical center were enrolled. Clinical data regarding anemia status and red blood cell (RBC) transfusion before, during and after operation, as well as patient outcomes were collected for further univariate analysis. Results: A total of 105 patients who underwent orthotopic transplantation, including liver, kidney and small intestine were registered. The mean hemoglobin (Hb) level upon admission and before operation were $11.6{\pm}1.8g/dL$ and $11.7{\pm}1.7g/dL$, respectively; and the nadir Hb level post operation and the final Hb level before discharge were $8.3{\pm}1.6g/dL$ and $10.2{\pm}1.6g/dL$, respectively. The median units (interquartile range) of RBC transfusion in pre-operative, peri-operative and post-operative periods were 0 (0-0), 2 (0-12), and 2 (0-6) units, respectively. Furthermore, the median (interquartile range) length of hospital stay (LHS) from admission to discharge and from operation to discharge were 28 (17-44) and 24 (16-37) days, respectively. Both peri-operative and post-operative RBC transfusion were associated with longer LHS from admission to discharge and from operation to discharge. Furthermore, it increased the risk of post-operative septicemia. While peri-operative RBC transfusion elevated the risk of acute graft rejection in patients who received orthotopic transplantation. Conclusions: Worse outcome could be anticipated in those who had received massive RBC transfusion in transplantation operation. Hence, peri-operative RBC transfusion should be avoided as much as possible.

• Journal of environmental and Sanitary engineering
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• v.24 no.1
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• pp.1-12
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• 2009

The various environmental problems that we face on today are basically about environmental quality. Since early 1960s affluent material was produced because of remarkable economic growth by many cooperations. However, for the lack of environmental policy, environmental pollutions has been serious. The central government should transfer the producing and consuming structure to environmental affinity through the regulations for developing Korea as a model of environmental nation which takes an active part in global environmental programme and in which the environment and economy are well harmonized. Moreover, the central government should take the lead in prevention of environmental pollution through the direct policies such as strengthening the discharge limit or setting up environmental basic institutions by securing budget for conserving environment. This thesis emphasize on the public institution among many environmental basic institutions for environmental anti-pollution project. It will find the problems with running those institutions, and will suggest the preview of improvement. Also, it is necessary to investigate of variation trend for inflow and pollutant loading to environmental infrastructure as increased of the diffusion rate as established and maintenance of sewer system. The purpose of this study is to investigate for inflow and pollutant loading to environmental infrastructure, and also to provide the method of efficiently maintenance and management. The results obtained were summarized as follows; 1. Survey of actual condition on operation and management of environmental infrastructure was evaluated the propriety of treatment process and problem of plant management. 2. Analysis of pollutant loading contribution for river system of environmental infrastructure with data analysis of water quality measuring network. 3. To investigate on case study for efficiently maintenance and management of environmental infrastructure. The result on this study was provide the method of efficiently maintenance and management with survey for establish and repair of sewer system and survey of actual condition on operation and management of environmental infrastructure in the water area of discharge to Geum River System. Application as guideline for establish and management of environmental infrastructure, and management of Geum River System. Also, application for preliminary data for fulfill-assess of total effluent regulation of water pollution.