• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.8 no.2
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• pp.232-241
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• 1997

The psychological problems following the experiences of school-violence could be more important than the physical problems. Victims could suffer from fear, depression, anger, lowered self-esteem, suicidal thought, and personality changes. To study the risk factors for school violence and the psychiatric problems after the experiences to school-violence provide us important informations to prevent and solve the problems of school violence. We examined clinical characteristics and psychosocial backgrounds of 13 adolescents who visited the psychiatric clinic after exposures to school violence from September, 1996 to May, 1997. The clinical data included intensity, motivations, durations, and methods of violence, psychiatric symptoms following exposure, findings of psychological test, and treatment course. The socioeconomic data included developmental characteristics of subjects, family characteristics, school life, and peer relationships. Of the 13 adolescents who experienced exposure to violence, 8 have experienced chronic psychiatric disturbances, 5 experienced transient psychiatric symptoms such as anxiety, depression, suicidal attempt who eventually returned to home and school life. Of the 8 adolescents who experienced chronic psychiatric disturbances, 4 experienced PTSD and depression lasting 3-6 months more, otherwise 4 showed converted features, such as aggressive behavioral disorder or perpetrator by strong compensatory effects after psychological shock. The subjects who have experienced chronic psychiatric disturbance have clinical characteristics such as physical or emotional abuse, physical illness or handicap, defects of ego functionings, and lack of family support. In summary, victims by school-violence manifested serious psychiatric disturbances, and they had clinically significant risk factors and some of them became perpetrators of school-violence.

• Journal of Gastric Cancer
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• v.6 no.2
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• pp.109-113
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• 2006

Purpose: Various minimally invasive surgical techniques, such as an endoscopic mucosal resection and a laparoscopic gastrectomy, are becoming common practice for some cases of early gastric cancer (EGC) defined in terms of the depth of invasion being limited to the mucosa or submucosa. However, there are rare cases of early gastric cancer with massive lymph-node metastasis. Materials and Methods: From 6 university hospitals of Korea, 2,772 EGC cases were resected during the various period of analysis (1,432 cases of mucosal cancer and 1,340 of submucosal cancer). Results: As control data, we used the data from a single institute, CHA University Hospital. There were nine cases of early gastric cancer (9/2,772, 0.32%) with N3 lymph node metastasis defined by more than 15 lymph nodes being metastasized according to the UICC-TNM classification (pT1N3, stage IV). Two cases were mucosal cancer (2/1,432, 0.1 4%), and seven cases were submucosal cancer (7/1,340, 0.52%). Metastasized lymph nodes varied in number from 18 to 52. There were three male and six female patients with a mean age of 57. This is a totally reversed sex ratio compared to the usual gastric cancer or EGC. Among the total of 9 EGC patients, there were 5 who had superficial spreading carcinomas with surface areas larger than $25\;cm^2$. This is a significantly higher proportion compared to the general EGC population. When we compared the tumor size according to the LN status, the N3 group was definitely larger than the other groups. 78% of the pT1N3 cases showed lymphatic invasion, which is very high compared to the 4.7% in general EGC cases. Among the 9 cases, 6 patients had too short a follow-up period to evaluate the correct prognosis, but there was one patient with a non-curative resection and two patients with early recurrence. Although the sample size is small and the follow-up period is short, we can expect a very poor prognosis when we consider the common prognosis of EGC that is widely known and accepted. Conclusion: From these results, we can a conclude that the risk factors for pT1N3 gastric cancer are female patients, submucosal invasion, larger tumor size, and lymphatic invasion. However rare, the existence of pT1N3 gastric cancer needs to be taken into consideration, especially during the diagnosis. Furthermore, minimally invasive treatment for EGC needs to be chosen with great precaution. Since the prognosis of pT1N3 gastric cancer is expected to be poor, aggressive adjuvant chemotherapy may be necessary. (J Korean Gastric Cancer Assoc 2006;6:109-113)

• Journal of Gastric Cancer
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• v.6 no.2
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• pp.97-102
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• 2006

Purpose: The prognosis for patients with a Borrmann type IV gastric cancer is extremely poor despite an aggressive surgical approach. We evaluated the clinicopathological features for Borrmann type IV cancers to find treatment strategy. Materials and Methods: The 1098 patients with advanced gastric cancer who underwent surgical resection between 1990 and 2001 were analyzed. These patients were divided into two groups: 81 patients with a Borrmann type IV carcinoma, and 1017 patients with all other types of gastric carcinomas. Results: Patients with a Borrmann type IV carcinoma were younger than those with other types, and female was prevalent (p=0.000). Of the patients with a Borrmann type IV gastric carcinoma, 68 patients (84%) were classified as stage III or IV at the initial diagnosis. The histologic type was commonly undifferentiated and serosal infiltration; nodal involvement and lymphatic invasion were more frequent in patients with a Borrmann type IV than in those with other types of cancer. Multivariate analysis confirmed that the extent of lymph node metastasis was a negative prognostic factor for Borrmann type IV gastric carcinomas. The curability for a Borrmann type IV carcinoma was only 53.1%, and peritoneal dissemination rate was 25.9%. The predominant pattern of recurrence for a Borrmann type IV gastric carcinoma was peritoneal dissemination, and it was significantly different with other types (93.1% vs 55.8%, P<0.05). The 5-year survival rate of patients with a Borrmann type IV gastric carcinoma was significantly lower than those of patients with other types of cancer, even though a curative resection had been accomplished (26% vs 63%, p<0.005). The 5-year survival rates of patients with a Borrmann type IV carcinoma following a curative resection were 44.9%, 24%, and 0% for stages II, III and IV, respectively (p<0.05). Conclusion: Because the prognosis for patients of a Borrmann type IV gastric cancer is extremely poor despite a curative resection, preoperative and/or intraperitoneal chemotherapy should be considered. And diagnostic laparoscopy and peritoneal cytology may be used to play an important role in accurate staging workup. (J Korean Gastric Cancer Assoc 2006;6:97-102)

• Tuberculosis and Respiratory Diseases
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• v.41 no.5
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• pp.537-545
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• 1994

Background: In 1987, the British Thoracic Society (BTS) subjected an extensive list of patient variables to statistical analysis in a prospective study of prognosis in 453 adults with community-acquired pneumonia and, subsequently published guidelines for management of severe community acquired pneumonia. It was hoped that those at risk of dying from community acquired pneumonia could be easily identified and treated appropriately, thereby reducing mortality. To date, severe community acquired pneumonia has not been well studied in Korea. Therefore, we studied retrospectively 10 patients dying of severe community acquired pneumonia in Dongsan Hospital to see clinical manifestations of dying of severe community-acquired pneumonia. Methods: Between July 1987 and july 1993, 498 patients were admitted to Keimyung University Dongsan Hospital with community acquired pneumonia, and 77 of them received intensive care. Of the 77 patients, 10 patients died. We reviewed medical records of these patients. Results: 1) The mean age of the patients was 56.2 years(range, 25 to 75 years). There were 7 men and 3 women. Seven patients(70%) were older than 60years of age. 2) The clinical features on admission were as follows: tachypnca, hypoxemia, mental change, cyanosis, leukopenia, leukocytosis, azotemia, hypotension, hypoalbuminemia in order of frequency. Three patients had one abnormal physical finding, 3 patients had 2, 2 patients had 3, and 2 patients had none of these abnormal physical findings. All patients had at least one of the abnormal laboratory findings. 3) A potential bacterial pathogen was isolated in sputum culture from 2 patients. One was E.coli, the other Enterobacter species. Sputum stain were positive in eight cases (G(+)cocci in six, G(+) cocci and G(-)bacilli in two). 4) Features of respiratory failure were the main reasons for ICU transfer, but two patients were transferred only following a cardiac or respiratory arrest in the general ward. 5) The mean of 2.7 different antibiotics were given to the patients. The aminoglycoside and first generation cephalosporin were the most frequently prescribed antibiotics, followed by the third generation cephalosporin and vancomycin. The most frequently prescribed antibiotics combination was a 1st generation cephalosporin plus an aminoglycoside. 6) Seven patients death(70%) occured after admission within the first five days, and a mean duration of hospitaliztion was 11.2 days. Conclusion: As the results show most death occured within the first five days after admission and aged patients; consequently, an aggressive intensive treatment should be provided early to the patients with severe community acquired pneumonia, and we should pay more attention to the aged patients.

• Journal of Chest Surgery
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• v.35 no.7
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• pp.542-547
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• 2002

Background: Postpneumonectomy empyema(PPE) is an infrequent but potentially life-threatening complication. To date, various surgical efforts have been made to manage this complication. We reviewed our 20-year surgical experience of PPE and long-term follow-up data. Material and Method: Total of 37 patients who were treated for PPE between fan, 1980 and Jun, 2000 were included. Various clinical factors such as micro-organism, operative method and timing, presence of bronchopleural fistula(BPF), underlying disease and fate of empyema cavity were retrospectively reviewed and analyzed. Result: Majority of patients(34) underwent Eloesser operation for effective drainage. There was only one operative mortality. The causative organisms were Staphylococcus species and Pseudomonas species in 46% BPF was found in 20 cases, among which spontaneous closures took place in 4 cases. The chest wall was closed in 40%(8/20) of patients with BPF, compared to 59%(10/17) without BPF. The closure rate was statistically better in patients without BPF(p=0.006). Even though the patients with benign disease showed higher closure rate(50%) than those with lung cancer (31%), the difference was not significant(p=0.25). Conclusion: Eloesser procedure was an effective method for initial drainage of PPE cavity with low operative mortality. Given the findings of low spontaneous closure rate of BPF, aggressive approach to close the BPF is mandatory to achieve the final goal of chest wall closure. It was found that majority of patients still left their chest cavity opened, even after controlling the active inflammation of the empyema cavity. More aggnessive approach for chest wall closure is recommended in all patents with benign disease and in selective patients with lung cancer if there is no evidence of recurrence at several years after the initial operation.

• Childhood Kidney Diseases
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• v.4 no.2
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• pp.111-119
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• 2000

Purpose : Henoch-$Sch{\ddot{o}}nlein$ purpura(HSP) is a common pediatric discase presenting most frequently with skin, gastrointestinal, joint and renal manifestations. The prognosis of HSP is mainly determined by the involvement of the kidney, but prognostic markers have not been established. We evaluated the patients who have HSP nephritis with nephrotic syndrome. Method : Clinical manifestations and laboratory findings were observed and analyzed in 34 cases with HSP which were manifested by nephrotic syndrome hospitalized at Kyung Hee university Hospital during the period from Jan. 1990 to Dec. 1998. Results : 1) Male to female ratio was 1.3:1, and mean age at onset was 8.3 year. 2) Mean duration from symptom onset to renal biopsy was 10.5 weeks. 3) Proportion of patients presenting with acute nephritis was 32.4$\%$, gross hematuria 17.6$\%$, microscopic hematuria 50$\%$. 4) The findings of renal biopsy were 20 cases of grade II, 11 cases of grade III, 2 cases of grade I, 1 case of grade IV according to classification by ISKDC. 5) Patients with grade I were recovered with no residual defect, but patients with grade IV shows active renal disease(states C). Conclusion : Among the 디le patients with Henoch-$Sch{\ddot{o}}nlein$ purpura accompanying nephrotic syndrome, more aggressive treatment might be needed in patients showing crescents formation on renal biopsy. A prospective study will be needed to explore the progression of this disease.

• Journal of Chest Surgery
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• v.39 no.2 s.259
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• pp.127-133
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• 2006

Background: In the studies of the distribution of time to death in trauma patients, the early deaths within several hours after injury were a large component of total trauma deaths. Due to the development of trauma system, overall mortality of trauma was decreased, but trauma is still the major cause of deaths. Material and Method: From January 1994 to December 2003, trauma patients who had been admitted and had expired at tertiary hospital were enrolled. There was a total of 400 cases, a retrospective study was done to determine the distribution of trauma mortality according to the part of the body that were severely injured part and compared the difference between early deaths within 6 hours and late deaths after 6 hours. We also analysed the risk factors of early deaths due to trauma. Result: In severe injury to the head and abdomen, the distribution of mortality was bimodal. But, in severe chest injuries, the distribution was log-shape and most early deaths were almost of trauma related. The average of GCS were 5.86$\pm$4.15 for the early deaths and 8.24$\pm$5.02 for the late deaths (p < 0.05). The AIS of thorax were 2.66$\pm$1.87 for the early deaths and 1.55$\pm$1.76 for late deaths. The risk factors for early mortality were non-EMS transportation (odds ratio 3.474), high AIS (odds ratio 1.491) and GCS (odds ratio 0.859). Conclusion: In trauma patients, the causes of early mortality were severe brain injury and massive hemorrhage. Also severe chest injuries were the major cause of the early deaths in truama. Early diagnosis of chest injury can frequently be missed in the acute trauma setting. Therefore, high index of suspicion, a careful examination, and aggressive surgical treatment are important in multiple trauma patients.

• Journal of Trauma and Injury
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• v.23 no.2
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• pp.107-112
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• 2010

Purpose: Recently, the change to a more complex social structure has led to an increased frequency of traumas due to violence, accident and so on. In addition, the severity of the traumas and the frequency of penetrating injuries have also increased. Traumas to cervical and abdominal areas, what are commonly seen by general surgeons, can have mild to fatal consequences because in these areas, various organs that are vital to sustaining life are located. The exact location and characteristics of the injury are vital to treating patients with the trauma to these areas. Thus, with this background in mind, we studied, compared, and analyzed clinical manifestations of patients who were admitted to Wonju Christian hospital for penetrating injuries inflicted by themselves or others. Methods: We selected and performed a retrospective study of 64 patients who had been admitted to Wonju Christian Hospital from January 2005 to December 2009 and who had cervical or abdominal penetrating injuries clearly inflicted by themselves or others. Results: There were 51 male (79.7%) and 13 female (20.3%) patients, and the number of male patients was more dominant in this study, having a sex ratio of 3.9 to 1. The range of ages was between 20 and 86 years, and mean age was 43.2 years. There were 5 self-inflicted cervical injuries, and 19 self-inflicted abdominal injuries, making the total number of self-inflicted injury 24. Cervical and abdominal injuries caused by others were found in 11 and 29 patients, respectively. The most common area involved in self-inflicted injuries to the abdomen was the epigastric area, nine cases, and the right-side zone II was the most commonly involved area. On the other hand, in injuries inflicted by others, the left upper quadrant of the abdomen was the most common site of the injury, 14 cases. In the neck, the left-side zone II was the most injured site. In cases of self-inflicted neck injury, jugular vein damage and cervical muscle damage without deep organ injury were observed in two cases each, making them the most common. In cases with abdominal injuries, seven cases had limited abdominal wall injury, making it the most common injury. The most common deep organ injury was small bowel wounds, five cases. In patients with injuries caused by others, six had cervical muscle damage, making it the most common injury found in that area. In the abdomen, small bowel injury was found to be the most common injury, being evidenced in 13 cases. In self-inflicted injuries, a statistical analysis discovered that the total duration of admission and the number of patients admitted to the intensive care unit were significantly shorter and smaller, retrospectively, than in the patient group that had injuries caused by others. No statistically significant difference was found when the injury sequels were compared between the self-inflicted-injury and the injury-inflicted-by-others groups. Conclusion: This study revealed that, in self-inflicted abdominal injuries, injuries limited to the abdominal wall were found to be the most common, and in injuries to the cervical area inflicted by others, injuries restricted to the cervical muscle were found to be the most common. As a whole, the total duration of admission and the ICU admission time were significantly shorter in cases of self-inflicted injury. Especially, in cases of self inflicted injuries, abdominal injuries generally had a limited degree of injury. Thus, in our consideration, accurate injury assessment and an ideal treatment plan are necessary to treat these patients, and minimally invasive equipment, such as laparoscope, should be used. Also, further studies that persistently utilize aggressive surgical observations, such as abdominal ultrasound and computed tomography, for patients with penetrating injuries are needed.

• Radiation Oncology Journal
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• v.21 no.2
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• pp.149-157
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• 2003

Purpose: The purpose of this study was to determine if there were prognostic differences between BRCA related and BRCA non-related Korean patients with early-onset breast carcinomas. Materials and Methods: Sixty women who had developed breast cancers before the age of 40, and who were treated at the Soonchunhyang University Hospital, were studied independently of their family histories. The age range was 18 to 40 with a median of 34.5 years. Lymphocyte specimens from peripheral blood were studied for the heterozygous mutations of BRCA1 and BRCA2 using direct sequencing methods. Immunohistochemistry was peformed on the paraffin-embedded tissue blocks that were available. Results: Eleven deleterious mutations (18.3%, 6 in BRCA1 and 5 in BRCA2) and 7 missense mutations of unknown significance (11.7%), were found among the 60 patients. More than half of the mutation were novel, and were not reported in the database. Most of the BRCA-associated patients had no history of breast cancer. No treatment related failures were observed in the BRCA carriers, with the exception of one patient that had experienced a new primary tumor of the contralateral breast. The seven year relapse free survival rate were 50 and 79% In the BRCA carrier and BRCA negative patients, respectively. Although the expression of estrogen and progesterone receptors were less common, and histological features more aggressive, in the BRCA associated tumors, the outcome of the patients with BRCA mutations was not poorer than that on the patients without deleterious mutations. Conclusion.: Despite the BRCA mutation carriers having adverse prognostic features, the recurrence rate was relatively lower than that in the BRCA non-carrying Korean patients wi4h early-onset breast carcinomas. In addition, although the prevalence of the BRCA mutation in Korean patients was higher than that in white patients, the penetrance of the cancer seemed to be relatively low in Korean women carrying BRCA mutations. A large population based study of the BRCA mutation, with a long-term follow-up of the study patients will be required to confirm these results.

• The Journal of the Korean bone and joint tumor society
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• v.13 no.2
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• pp.81-87
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• 2007

Purpose: Chondroblastoma of bone is rare with the potential for local recurrence and metastasis. A retrospective review of 30 patients with chondroblastoma of bone treated at a single institution during a 24-year period was conducted to determine the clinical outcome and relevant prognostic factors. Materials and Methods: Thirty patients with biopsy-proven chondroblastoma of bone, treated between September of 1981 and September of 2005, were retrospectively reviewed. There were 16 men and 14 women with an average follow-up period of 7.2 years (range, 1.6~21.2). The most common sites were the distal femur (n=7), proximal humerus (n=6), proximal tibia (n=6) and proximal femur (n=4). The average age of the patients was 20 years (range, 12~47) with closed physes in 20 patients(67%.) Twenty-seven patients(90%) were treated by curettage of the tumor with or without bone grafting or cementing. Three patients(10%) were treated with en bloc resection. Clinical and pathological factors reported to be associated with poor outcome were analyzed. Results: Four local recurrences(13%) developed in postoperative 4, 6, 7 and 16 months. These patients underwent further curettage (once in 2 patients and twice 2) and had no further recurrence. All patients showed no evidence of disease at the final follow-up. Local recurrence developed in the two cases which removal of the tumor was incomplete. Curettage and bone-grafting (1) and cementing (1) were performed in the two other cases with local recurrences. In contrast, no local recurrences were observed in the 3 cases treated with en-bloc resection. The status of physes or the histologic presence of aneurysmal bone cyst, the anatomic location of the tumor did not affect local recurrence. Conclusion: Adequate removal of the tumor with aggressive curettage or en bloc resection seems to be necessary to prevent local recurrence in chondroblastoma. The status of physes, the histologic presence of aneurysmal bone cyst or the anatomic location of the tumor was not related with local recurrence.