• Journal of Chest Surgery
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• 제57권3호
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• pp.242-251
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• 2024

Background: This study compared the outcomes of surgical aortic valve replacement (AVR) in patients aged 50 to 70 years based on the type of prosthetic valve used. Methods: We compared patients who underwent mechanical AVR to those who underwent bioprosthetic AVR at our institution between January 2000 and March 2019. Competing risk analysis and the inverse probability of treatment weighting (IPTW) method based on propensity score were employed for comparisons. Results: A total of 1,580 patients (984 patients with mechanical AVR; 596 patients with bioprosthetic AVR) were enrolled. There was no significant difference in early mortality between the mechanical AVR and bioprosthetic AVR groups (0.9% vs. 1.7%, p=0.177). After IPTW adjustment, the risk of all-cause mortality was significantly higher in the bioprosthetic AVR group than in the mechanical AVR group (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.07-1.80; p=0.014). Competing risk analysis revealed lower risks of stroke (sub-distributional hazard ratio [sHR], 0.44; 95% CI, 0.28-0.67; p<0.001) and anticoagulation-related bleeding (sHR, 0.35; 95% CI, 0.23-0.53; p<0.001) in the bioprosthetic AVR group. Conversely, the risk of aortic valve (AV) reintervention was higher in the bioprosthetic AVR group (sHR, 6.14; 95% CI, 3.17-11.93; p<0.001). Conclusion: Among patients aged 50 to 70 years who underwent surgical AVR, those receiving mechanical valves showed better survival than those with bioprosthetic valves. The mechanical AVR group exhibited a higher risk of stroke and anticoagulation-related bleeding, while the bioprosthetic AVR group showed a higher risk of AV reintervention.

• Archives of Pharmacal Research
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• 제26권11호
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• pp.967-973
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• 2003

Cytochrome P4502C9(CYP2C9) is largely responsible for terminating anticoagulant effect by hydroxylation of S-warfarin to inactive metabolites. Mutations in the CYP2C9 gene result in the expression of allelic variants, CYP2C9*2 and CYP2C9*3 with reduced enzyme activity compared to wild type CYP2C9 *1. The aim of this study was to assess relationship between requirement of warfarin dose and polymorphism in CYP2C9 in Korean population. Patients on warfarin therapy for longer than 1 year were included from July 1999 to December 2000 and categorized as one of four groups; regular dose non-bleeding, regular dose bleeding, low dose non-bleeding and low dose bleeding. Low dose was defined as less than 10 mg/week for 3 consecutive monthly follow-ups. Bleeding complications included minor and major bleedings. Blood samples were processed for DNA extraction, genotyping and sequencing to detect polymorphism in CYP2C9. Demographic data, warfarin dose per week, prothrombin time (INR), indications and co-morbid diseases were assessed for each group. Total 90 patients on warfarin were evaluated; The low dose group has taken warfarin 7.6$\pm$1.7 mg/week, which was significantly lower than 31.4$\pm$0.9 mg/week in the regular dose group (p<0.0001). The measured INR in the low dose group was similar to that of the regular dose group (2.3$\pm$0.7 vs. 2.3$\pm$0.6, p=0.9). Even though there was a higher possibility of CYP2C9 variation in the low dose group, no polymorphism in CYP2C9 was detected. All patients were homozygous C416 in exon 3 for CYP2C9*2 and A1061 in exon 7 for CYP2C9*3. The DNA sequencing data confirmed the homozygous C416 and A 1061 alleles. In conclusion, polymorphism in CYP2C9 is not a critical factor for assessing warfarin dose requirement and risk of bleeding complications in a Korean population.

• Journal of Gastric Cancer
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• 제10권3호
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• pp.118-125
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• 2010

Purpose: Operative morbidity and mortality from gastric cancer have decreased in recent years, but many studies have demonstrated that its prevalence is still high. Therefore, we investigated the risk factors for morbidity and mortality considering the type of complication in patients with gastric cancer. Materials and Methods: A total of 259 gastrectomies between 2004 and 2008 were retrospectively reviewed. Results: Overall morbidity and mortality rates were 26.6% and 1.9%, respectively. A major risk factor for morbidity was combined resection (especially more than two organs) (P=0.005). The risk factors for major complications in which a re-operation or intervention were required were type of gastrectomy, upper location of lesion, combined resection, and respiratory comorbidity (P=0.042, P=0.002, P=0.031). Mortality was associated with preexisting neurologic disease such as cerebral stroke (P=0.016). In the analysis of differen complication's risk factors, a wound complication was not associated with any risk factor, but combined resection was associated with bleeding (P=0.007). Combined resection was an independent risk factor for a major complication, surgical complication, and anastomotic leakage (P=0.01, P=0.003, P=0.011, respectively). Palliative resection was an independent risk factor for major complications and a previous surgery for malignant disease was significantly related to anastomosis site leakage (P=0.033, P=0.007, respectively). Conclusions: The risk factors for gastrectomy complications of gastric cancer were combined resection, palliative resection, and a previous surgery for a malignant disease. To decrease post-gastrectomy complications, we should make an effort to minimize the range of combined resection, if a palliative gastrectomy is needed for advanced gastric cancer.

• 대한예방의학회:학술대회논문집
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• 대한예방의학회 2005년도 제57차 추계 학술대회 연제집
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• pp.335-335
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• 2005

• 대한예방의학회:학술대회논문집
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• 대한예방의학회 2005년도 제57차 추계 학술대회 연제집
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• pp.337-337
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• 2005

• Asian Pacific Journal of Cancer Prevention
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• 제13권4호
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• pp.1081-1091
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• 2012

Myelodysplastic syndromes (MDS) represent a heterogeneous group of clonal hematologic neoplasms characterized by morphologic dysplasia, aberrant hematopoiesis and peripheral blood refractory cytopenias. MDS is recognized to be associated with an increased risk of symptomatic anemia, infectious complications and bleeding diathesis, as well as a risk of progression to acute myeloid leukemia, particularly in patients with a high IPSS score. The advent of use of hematopoietic growth factors such as granulocyte colony-stimulating factor (G-CSF) and recombinant erythropoietin (EPO) has improved symptoms in MDS patients in addition to some data that suggest there might be an improvement in survival. G-CSF is an effective therapeutic option in MDS patients, and it should be considered for the management of refractory symptomatic cytopenias. G-CSF and EPO in combination can improve outcomes in appropriate MDS patients such as those with lower-risk MDS and refractory anemia with ring sideroblasts (RARS). This article reviews use of growth factors for lower-risk MDS patients, and examines the data for G-CSF, EPO and thrombopietic growth factors (TPO) that are available or being developed as therapeutic modalities for this challenging disease.

• Journal of Periodontal and Implant Science
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• 제50권3호
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• pp.183-196
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• 2020

Purpose: This practice-based cross-sectional study aimed to investigate whether common risk indicators for peri-implant diseases were associated with peri-implant mucositis and peri-implantitis in patients undergoing supportive implant therapy (SIT) at least 5 years after implant restoration. Methods: Patients exclusively restored with a single implant type were included. Probing pocket depth (PPD), bleeding on probing (BOP), suppuration, and radiographic bone loss (RBL) were assessed around implants. The case definitions were as follows: peri-implant mucositis: PPD ≥4 mm, BOP, no RBL; and peri-implantitis: PPD ≥5 mm, BOP, RBL ≥3.5 mm. Possible risk indicators were compared between patients with and without mucositis and peri-implantitis using the Fisher exact test and the Wilcoxon rank-sum test, as well as a multiple logistic regression model for variables showing significance (P<0.05). Results: Eighty-four patients with 169 implants (observational period: 5.8±0.86 years) were included. A patient-based prevalence of 52% for peri-implant mucositis and 18% for peri-implantitis was detected. The presence of 3 or more implants (odds ratio [OR], 4.43; 95 confidence interval [CI], 1.36-15.05; P=0.0136) was significantly associated with an increased risk for mucositis. Smoking was significantly associated with an increased risk for peri-implantitis (OR, 5.89; 95% CI, 1.27-24.58; P=0.0231), while the presence of keratinized mucosa around implants was associated with a lower risk for peri-implantitis (OR, 0.05; 95% CI, 0.01-0.25; P<0.001). Conclusions: The number of implants should be considered in strategies to prevent mucositis. Furthermore, smoking and the absence of keratinized mucosa were the strongest risk indicators for peri-implantitis in patients undergoing SIT in the present study.

• International Journal of Control, Automation, and Systems
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• 제2권1호
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• pp.39-54
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• 2004

We developed an automatic blood pressure control system to maintain the blood pressure of patients at a substantially low level during a surgical operation. The developed system discharges two functions, continuous feedback control of the mean arterial pressure (MAP) by a state-predictive servo controller and risk control based on the inference by fuzzy-like logics and rules using measured data. Twenty-eight clinical applications were made beginning in November 1995, and the effects of the automatic blood pressure control on the operation time and on bleeding were assessed affirmatively by means of Wilcoxon testing. This paper essentially reports the engineering details of the control system.

• 대한기관식도과학회지
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• 제2권2호
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• pp.280-284
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• 1996

Carotid body tumors are uncommon tumors of the head and neck Surgery is the primary treatment for the tumor. Large carotid body tumors frequently encircle the common, internal, and exernal carotid arteries, and extensive bleeding often complicates the resection, increasing the risk of carotid artery rupture and damange to major cranial nerves. Grafting should be used in high-risk patients. We have experienced a case of carotid body tumor which encircle the common, internal and external carotid arteries, treated with ligation of external carotid artery and grafting using Gortex between common carotid artery and internal carotid artery.

• Journal of Dental Anesthesia and Pain Medicine
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• 제18권4호
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• pp.271-275
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• 2018

The purpose of this study was to report and discuss the diagnosis and treatment of obstructive atelectasis secondary to pus obstruction in a patient who had developed a maxillofacial abscess, and to review the literature on similar cases. Persistently discharging pus within the oral cavity can act as an aspirate, and may lead to obstructive atelectasis. Additionally, maxillofacial surgery patients should be carefully assessed for the presence of risk factors of obstructive atelectasis, such as, epistaxis after nasotracheal intubation, oral bleeding, and mucus secretion. Furthermore, patients with these risk factors should be continuously followed up by monitoring $SPO_2$, breath sounds, and chest x-ray.