• Clinical and Experimental Pediatrics
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• v.48 no.5
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• pp.488-494
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• 2005

Purpose : To outline the aspects of extubation by birth weight and find the predictors for success/failure at the first extubation in extremely low birth weight infants. Methods : One hundred thirteen extremely low birth weight infants(<1,000 g) who were admitted to NICU at Samsung Seoul Hospital between Jan. 2000 and Jun. 2004 were enrolled. Clinical characteristics that are thought to be related with extubation success or failure were compared with the success and the failure of the first extubation. Results : As the birth weight decreased, extubation success day was significantly delayed : $16{\pm}3day(d)$ in 900-999 g; $20{\pm}3d$ in 800-899 g; $35{\pm}4d$ in 700-799 g; $37{\pm}9d$ in 600-699 g; $49{\pm}12d$ in ${\leq}599g$. 25 out of 113 infants(22%) failed the first extubation. Preterm premature rupture of membrane was associated with extubation success, and air leak was associated with extubation failure, with a borderline significance. Postnatal and corrected age and body weight at the first extubation, nutritional status, and ventilator settings were not associated with extubation success or failure. Extubation success day was significantly delayed, and the incidence of late-onset sepsis and mortality was significant higher in the failure of the first extubation. Conclusion : We could not find significant predictors for success/failure at the first extubation. The failure of the first extubation had an increased risk of late-onset sepsis and death. Further studies are needed to find the predictors for extubation success/failure.

• Journal of Chest Surgery
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• v.42 no.5
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• pp.597-603
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• 2009

Background: Atrioventricular valve regurgitation in pediatric patients with a functional single ventricles (FSV) - has been known as one of the important risk factors for death and unfavorable long-term results after a Fontan operation. We evaluated early and mid-term results of bivalvation valvuloplasty in FSV patients. Material and Method: We retrospectively evaluated 11 patients with a functional single ventricle who underwent bivalvationvalvuloplasty between 1999 and 2007. The degree of common atrioventricular valve regurgitation (CAVVR) was determined by color Doppler echocardiography (regurgitation grade scoring, trivial; 1, mild; 2, moderate; 3, severe; 4). Mean age at valve surgery was $6.9{\pm}7.0$ months (median 4 months, 24 days$\sim$21 months)and mean body weight was $6.2{\pm}2.8\;kg$ ($3.1{\sim}11.3\;kg$). Nine patients had isomerism heart and two of them had TAPVC. The concomitant procedures were performed in all but one patient. Additional commissural closure was performed in 3 patients and commissural annuloplasty in another 3 patients. Result: There was one hospital death after. surgery. A 32-day old patient who had been preoperatively dependent on a ventilator died of air way and lung problems 4.3 months after pulmonary artery banding and bivalvation valvuloplasty. Mean follow-up duration was 40 months ($4.3{\sim}114$ months). Mean preoperative CAVVR score was $3.3{\pm}0.6$, which decreased to $1.9{\pm}0.7$ postoperatively (p<0.0001). This residual regurgitation slightly increased to $2.2{\pm}0.4$ (no statistical significance) after a mean follow-up of 1.4.3 months. Six patients (60%) required re-operations for residual regurgitation at a subsequent bidirectionalcavopulmonary shunt or Fontan operation. One patient with Ebsteinoid malformation of the right sided atrioventricular valve required valve replacement due to stenoinsufficiency. Another patient required edge-to-edge repair at the right sided AV valve (between the right mural leaflet and the bridging leaflets). The remaining 4 patients required additional suture placements between bridging leaflets with or without commissural annuloplasty. All survivor had trivial or mild CAVVR at the latest follow-up. Conclusion: Bivalvation valvuloplasty for CAVVR in FSV patients is. an effective and safe procedure. However, significant numbers of the patients have small residual regurgitation and require additional valve procedures at subsequent operations. Long-term observations to monitor progression of the CAVVR is mandatory.

• Journal of Preventive Medicine and Public Health
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• v.35 no.3
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• pp.205-213
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• 2002

Objective : Whether exposure to chronic noise induces an increase in blood pressure, or the development of hypertension, has not been established. A cohort study was performed to identify the effects of chronic noise exposure on blood pressure. Methods : 530 males working at a metal manufacturing factory in Busan, Korea were enrolled for the study. They were monitored for 9 consecutive years, from 1991 to 1999, with an annual health check-up. The subjects were divided into 4 groups, which were determines by noise level categories(NLC) according to noise intensity ; NLC-I: office workers, exposed to noise a level below 60dB(A) ; NLC-II: field technical supporters or supervisors, frequently exposed to workplace noise, wearing no hearing protection device; NLC-III: workers, exposed to workplace noise below 85dB(A), wearing ear plugs or muffs; NLC-IV: workers, exposed to workplace noise over 85 dB(A), wearing both ear plugs and muffs. Results : After controlling possible confoundens, such as baseline age, smoking, alcohol intake, exercise, family history of hypertension, systolic(SBP) of diastolic blood pressure(DBP) and changes in BMI (body mass index), the pooled mean for the systolic blood pressures, over the duration of the study period, were 3.8mmHg, 2.0mmHg and 1.7mmHg higher in NLC-IV, NLC-III NLC-II groups, respectively, than in the NLC-I group. There were no significant differences in the diastolic blood pressures between the groups. Conclusion : This study suggests that chronic noise exposure increases systolic blood pressure independently, among male workers.

• Journal of Chest Surgery
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• v.41 no.3
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• pp.335-342
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• 2008

Background: Congenital cystic diseases of the lung are uncommon, and they share similar embryogenic and clinical characteristics. But they are sometimes vary widely in their presentation and severity. Therefore they are often difficult to make different diagnosis each other, and all require surgical treatment. Material and Method: From 1993 to 2006, 38 patients underwent surgical procedures under these diagnostic categories in the Depart. of Thoracic and. Cardiovascular Surgery, Busan-Paik Hospital, College of Medicine, Inje University. And we retrospectively reviewed these patients' charts for clinical presentations, surgical procedures, pathologic findings and postoperative morbidity and mortality. Result: There were 22 males and 16 females, ages ranged from 1 month after birth to 51 years and mean age was 20.8 years. The main symptoms were 19 fever, cough, sputum production due to recurrent infection, 7 dyspnea, 8 chest discomfort, 4 hemoptysis, but eight patients were asymptomatic. Computed tomography was chosen as diagnostic modalities and available for operation plan for all of patients. For all the cases, surgical resection were performed. Lobectomy was performed in 28 patients, simple excision (resection) in 8 patients, segmentectomy or wedge resection in 2 patients. There were 10 pulmonary sequestrations, 15 congenital cystic adenomatoid malformations (CCAM), 11 bronchogenic cysts, and 2 congenital lobar emphysemas. They all were confirmed by pathologic exams. The complications were 6 wound disruption or infection, 2 chylothorax, 1 ulnar neuropathy, but all of them were resolved uneventful. There was no persistent air leakage, respiratory failure, operative mortality and recurrence. Conclusion: We performed immediate surgical removal of congenital cystic lung lesions after diagnosis and obtained good results, so reported them with literature review.

• Journal of Chest Surgery
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• v.34 no.8
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• pp.621-625
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• 2001

For many years, 10mm videothoracoscope has been widely used in bullectomy of primary spontaneous pneumothorax. However we used a 2mm videothoracoscope to minimize operative wound. Thus, we compared the clinical results of bulllectomy using 2mm videothoracoscope with bullectomy using 10mm videothoracoscope. Material and method: We analyzed 118 patients who underwent VATS for primary spontaneous pneumothorax from April, 1998 to December, 2000. 2mm videothoracoscope was used in 53 patients(Group A) and 10mm videothoracoscope was used in 65 patients(Group B). The mean age was 20.2$\pm$6.9 years old in group A and 20.1$\pm$6.1 years old in group B. The mean follow up was 10.9$\pm$3.8 months in group A and 11.4$\pm$4.3 months in group B. Result: The operation time was shorter in group A than group B(55.7$\pm$22.9 minutes, 71.2$\pm$21.4 minutes, p<0.05). The duration of postoperative hospital stay was shorter in group A than group B(7.2$\pm$3.2 days, 9.2$\pm$3.6 days, p<0.05). The duration of postoperative chest tube indwelling was shorter in group A than group B(4.7$\pm$3.1 days, 6.3$\pm$2.8 days, p<0.05). The duration of postoperative air leakage(0.6$\pm$2.1 days, 1.0$\pm$2.4 days, p>0.05), the amount of analgesics(1.38$\pm$1.0 ampules, 1.7$\pm$1.4 ampules, p>0.05), the amount of analgesics(1.38$\pm$1.0 ampules, 1.7$\pm$1.4 ampules, p>0.05), postperative complications(2 cases, 7cases, p>0.05) and recurrences(1 case, 1 case, p>0.05) were not statistically different between two groups. Operative wound was smaller in group A than B. Conclusion: There were non adverse results in group A than group B. Furthermore, bullectomy using 2mm videothoracoscope brought us minimized operative wound and good cosmetic results. Thus, we could recommend bullectomy using 2mm videothoracoscope in primary spontaneous penumothorax.

• Korea and Global Affairs
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• v.1 no.2
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• pp.209-242
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• 2017

The purpose of this study is to contribute to enhancing spiritual combat power as the core of intangible combat power in Korean armed forces through analyses and suggestions on Admiral Yi Sun-sin's leadership for four major sweeping victories based upon jointness which effectively integrates tangible and intangible combat power in armed forces to maximize the synergy of fighting power. As our armed forces has improved their military structure in the dimension of hardwares so as to enhance their efficiency, according to the results of analyzing the process to promote the jointness between our armed forces and our allied powers in the dimension of softwares supporting such hardware dimensions, it was necessary to innovate the system for reinforcing future-oriented spiritual combat power as well as all the tasks related to leadership as the core of intangible combat power jointly and harmoniously. In order to derive tasks about the leadership of Korean armed forces in the dimension of softwares which should be combined with military structural reform for strengthening spiritual combat power for national defense, this study selected research questions linked with jointness. That is, (1) what is the core of military leadership in Western advanced countries in the age of jointness? (2) What are the contemporary illuminations or implications of Korean leaderships through Admiral Yi Sun-sin's war history? Then, this study analyzed literature reviews, this author's field interviews in the time of war participation, and leadership war history focusing on Admiral Yi Sun-sin's leadership for four major sweeping victories. According to the results of these analyses, this study extracted (1) the strategic leadership to predict and prepare the future, (2) the leadership of integration to create synergy effects, and (3) the leadership of knowledge to be practiced focusing on combats. In addition, in order to reinforce spiritual combat power based upon jointness, (1) it is necessary to precede in-depth and substantial leadership diagnosis for enhancing jointness. (2) It is necessary to embody national defense reform as well as integration for jointness improvement after scientifically comparing and analyzing the differentiation and integration between the Ministry of National Defense, army-navy-air force leadership centers, and PKO centers. (3) It is necessary to promote the merger and abolition between institutions related to intangibale combat power under the Ministry of National Defense.

• Tuberculosis and Respiratory Diseases
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• v.59 no.6
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• pp.613-618
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• 2005

Background : Recently, medical treatment of multi-drug resistant pulmonary tuberculosis has been unsuccessful. Through analyzing the cases with surgical treatment, we hope to provide some help in treating multi-drug resistant pulmonary tuberculosis in the future. Material and Method : A retrospective review was performed with 138cases of surgical treatment of multi-drug resistant tuberculosis during 10years from January 1994 to December 2003 at National Masan Hospital. Results : The ratio of men to women, 5.1:1 indicates that there were more incidences in men. The number of the resistant drugs was 5.3 with a mean age of 42.6 years. Cavitary lesions on the plain chest X-rays were seen in 94cases (68.1%). 128cases had positive sputum culture preoperatively. Types of operations were 24 pnemonectomies, 83 lobectomies, 10 bilobectomies, 19 lobectomies with segmentectomies or wedge resections, 1 wedge resection, and 1 carvenoplasty. There was no death after operation. There were 6cases of air leakage over a week, 6cases of postoperative bleeding, 8cases of bronchopleural fistula and empyema, 16cases of dead space, 1case of atelectasis, 1case of wound infection, 1case of cyst as postoperative complication. Postoperative complication showed higher long-term negative conversion rate of 92.8%. Conclusion : There has been many discussions about operative indications, postoperative drug regimens, length of postoperative chemotherapy. In our study, we showed higher long-term success rate of postoperative chemotherapy with pulmonary resection on multi-drug resistant pulmonary tuberculosis.

• Research in Community and Public Health Nursing
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• v.14 no.2
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• pp.190-199
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• 2003

This study was conducted to determine the factors affecting job satisfaction in workers by using the Job Stress Model proposed by the National Institute for Occupational Safety and Health (NIOSH). Data were collected from December 1 to December 30, 1999. The subjects were 2,133 workers employed at 155 work sites, who were examined using NIOSH Job Stress questionnaire translated by the Korea Occupational Safety ${\pounds}|$ Health Academy and Occupational Safety ${\pounds}|$ Health Research Institute. SAS/PC program was used for statistical analysis using descriptive analysis. Pearson's correlation coefficient, ANOVA, and Stepwise multiple regression analysis. The results of this study were as follows. 1. According to general characteristics of the subjects, job satisfaction was high in those with less number of children. 2. By work condition, job satisfaction was higher in those who were working in a permanent job position, were working with regular time basis than with shift basis, were working in regular shift hours than in changing shift hours, were working for a short period, and were working less hours and overtime works per week. 3. In terms of physical work environment, job satisfaction was significantly related to 10 physical environmental factors. In other words, job satisfaction was high in workers who were working in an environment with no noise, bright light, temperature adjusted to an appropriate level during summer and winter, humidity adjusted to an appropriate level. well ventilation, clean air, no exposure to hazardous substance during work hour, overall pleasant work environment and not crowded work space. 4. By work-related factors, job satisfaction was high in those with less ambiguity about future job and role, high job control/autonomy, and less workload. On the other hand, job satisfaction was low in those with little utilization of competencies, and much role conflict at work and workload. 5. As for the relationships between job satisfaction and the non-work related factors, job satisfaction was high in workers who were volunteering at different organizations or active in religious activities for 5-10 hours per week. 6. In the relationships between job satisfaction and buffering factors, significantly positive correlations were found between job satisfaction and factors such as support by direct superior, support by peers, and support by spouse, friend and family. 7. There were nine factors that affected job satisfaction in the workers: age, number of children, work hours per week, noise, temperature at the work site during summer, uncomfortable physical environment, role ambiguity, role conflict, ambiguity in job future, work load, no utilization of competencies and social support from direct supervisor. These nine factors accounted for 26% of the total variance in the multiple regression analysis. In conclusion. the following are proposed based on the results of this study. 1. The most important physical environmental factors affecting job satisfaction in workers were noise, role ambiguity, and work load, suggesting a need to develop strategies or programs to manage these factors at work sites. 2. A support system that could promote job satisfaction is needed by emphasizing the roles of occupational health nurses who may be stationed at work sites and manage the factors that could generate job stress. 3. Job satisfaction is one of the three acute responses to stress proposed in NIOSH job stress model (job satisfaction. physical discomfort and industrial accidents). Therefore, further studies need to be conducted on the other two issues.

• Journal of Chest Surgery
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• v.37 no.2
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• pp.166-172
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• 2004

When compare with blebectomy or bullaectomy simply and pleurodesis together in treatment of primary spontaneous pnevmthorax, the later has been realized as the method that can reduce the recurrent rate after surgical operation. Therefore, in this study, we compared the merits and demerits of the clinical result of chemical pleurodesis that use Talcum powder in pleurodesis and mechanical pleurodesis that use apical pleurectomy and analyzed the reappearance rate etc. Material and Method: The Pleurodesis through the apical pleurectomy and talc powder insufflation had been used as secondary procedure after blebectomy of spontaneous pneumothorax from January 1, 2000 to June 30, 2002. This study consisted of a retrospective review of 68 patients who were treated with apical pleurectomy, and 84 patients treated with talc powder insufflation. We compaired the apical pleurectomy and talc powder insufflation in terms of age, sex, cause of operation, number of used autosuture staple, tine duration of procedure after blebectomy, severity of pain and complication after operation, postoperative air leakage period, duration of chest tube insertion, hospitalization, and recurrence rate of pneumothorax. Result: Time required for secondary procedure was longer in apical pleurectomy than talc powder insufflation. Postoperative pain was more severe in talc powder insufflation than apical pleurectomy. Otherwise there was no significant difference between two methods. Conclusion: Although Talc powder insufflation is more convenient than apical pleurectomy, the difference is not large and, the severity of postoperative pain is worse in talc powder insufflation. Therefore apical pleurectomy can be recommended for the secondary surgical procedure after blebectomy of primary spontaneous pneumothorax can be recommended.

• Nuclear Medicine and Molecular Imaging
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• v.43 no.6
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• pp.565-571
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• 2009

Purpose: The aim of this study was to evaluate the clinical value of rectal gas distension F-18 FDG PET/CT imaging for the differentiation of the rectal focal uptake lesions. Materials and Methods: Twenty four patients (M:F=11:13, Age $62.8{\pm}12.4$ years) underwent rectal gas distension F-18 FDG PET/CT, prospectively: initial image at 50-60 min after the intravenous injection of F-18 FDG and rectal distension image after the infusion of air through the anus. Focally increased uptake lesions on initial images but disappeared on rectal distension images defined a physiological uptake. For the differential evaluation of persistent focal uptake lesions on rectal distension images, colonoscopy and histopathologic examination were performed. Results: Among the 24 patients, 27 lesions of focal rectal uptake were detected on initial images of F-18 FDG PET/CT. Of these, 7 lesions were able to judge with physiological uptake because the focal increased uptake disappeared from rectal distension image. Remaining 3 lesions were non-rectal lesions (2 lesions: rectovesical space, 1 lesion: uterine myoma). Among 17 lesions which was showed persistent increased uptake in rectal distension image, 15 lesions were confirmed as the malignant tumor (SUVmax=$15.9{\pm}6.8$) and 2 lesions were confirmed as the benign lesions including adenoma and inflammatory disease. Conclusion: The rectal distension F-18 FDG PET/CT imaging could be an important noninvasive method for the differentiation of malignant and benign focal rectal uptake lesions including physiologic uptake.