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The Role of Bronchoscopy for the Staging in Patient with Peripheral Lung Cancer (말초형 폐암 환자에 있어서 병기판정을 위한 기관지 내시경검사의 필요성)

  • Baek, Seung-Min;Sea, Hyang-Eun;Kim, Se-Hwan;Kim, Seong-Kyu;Kim, Yean-Jae;Lee, Byung-Ki;Kim, Won-Ho;Park, Jae-Yang;Jung, Tae-Hoon
    • Tuberculosis and Respiratory Diseases
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    • v.51 no.2
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    • pp.147-154
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    • 2001
  • Background : Bronchoscopy has been widely used for a histologic diagnosis through a transbronchial lung biopsy or for staging of patients with peripheral lung cancer. However a transthoracic needle aspiration (TTNA) has been used more widely for a histologic diagnosis in patient with a small size nodule or a nodule located in the outer portion of the lung because of the low diagnostic yield of bronchoscopy in these cases. The role of bronchoscopy for staging is not well established in patients with peripheral lung cancer diagnosed by a TTNA or patients who are undergoing surgery without a histologic diagnosis. Method: To evaluate the role of bronchoscopy for the staging in patients with peripheral lung cancer, who were diagnosed by TTNA, the medical records of 86 patients with peripheral lung cancer who underwent bronchoscopyat Kyungpook National University Hospital between January 1995 and May 1997 were reviewed. Results : While 53 cases had normal bronchoscopic findings, 33 cases had abnormal bronchoscopic findings comprising 9 cases of tumor, 10 cases of infiltration and 14 cases of compression of which there were 25 cases of T1 and 8 T2 endoscopically. The bronchoscopic staging did not influence the changes of the clinical stage of lung cancer. The frequencies of bronchial involvement tended to increase as the sizes of the nodule increased. Among the 42 patients who underwent surgery, 9 patients staged higher after operation because of lymph node involvement in 8 patients and the involvement of the pulmonary artery in 1 patient. No case staged above after operation due to a bronchial invasion. Conclusion : These findings suggests that bronchoscopy is not useful for staging in patients with peripheral lung cancer diagnosed by a TTNA.

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Delayed Treatment of Pulmonary Tuberculosis in a University Hospital (대학병원에서 발생하는 폐결핵 치료지연)

  • Kang, Shin Myung;Lee, Jun Gu;Chung, Jae Ho;Han, Chang Hoon;Byun, Min Kwang;Chung, Wou Youn;Park, Moo Suk;Kim, Young Sam;Kim, Se Kyu;Chang, Joon;Kim, Sung Kyu
    • Tuberculosis and Respiratory Diseases
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    • v.60 no.3
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    • pp.277-284
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    • 2006
  • Background : Delayed treatment of pulmonary tuberculosis is an important problem because it results in greater mortality and the nosocomial transmission of tuberculosis. This study was conducted to analyze the factors that contribute to the delayed treatment of pulmonary tuberculosis in a university hospital and we wanted to provide basic data for instituting an effective management program for tuberculosis. Methods : we retrospectively reviewed the medical records of 155 patients with smear-positive or culture-positive pulmonary tuberculosis and who were treated between May 1999 and October 1999. A case-control study was performed to analyze the factors. We then tried to follow up the patients in delayed treatment group via telephone for the purpose of assessing the therapeutic interventions. Results : Among 150 patients, 55 (37%) were included in the delayed treatment group. The factors associated with delayed treatment on the univariate analysis included age (61 vs 40 years old; p <0.001), a smear-negative sputum test for acid-fast bacilli (AFB) (85% vs 55%; p <0.001) and no visits to a private clinic before the patient presented to the university hospital (56% vs 36%; p = 0.014). Multivariate analysis revealed that old age (p = 0.001), a smear-negative sputum for AFB (p = 0.001), and lower lobe infiltrate on chest X-ray (p = 0.041) were the independent predictors of delayed treatment. Of the 22 patients who did not receive any treatment, 20 of them 91%) consented to our suggestion of revisiting the hospital. Conclusion : Delayed treatment of patients with pulmonary tuberculosis is not uncommon in a university hospital. Old age, smear-negative for AFB, and lower lobe infiltrate on chest X-ray are the risk factors for delayed treatment. A more systematic management system is required for achieving better control of tuberculosis.

Secondary Chondrosarcoma Arising from Osteochondroma(tosis) (골연골종(증)에서 발생한 속발성 연골육종)

  • Cho, Hyun-Min;Rhee, Seung-Koo;Kang, Yong-Koo;Chung, Yang-Guk;Lee, An-Hi;Park, Jung-Mi;Bahk, Won-Jong
    • The Journal of the Korean bone and joint tumor society
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    • v.16 no.1
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    • pp.21-26
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    • 2010
  • Purpose: To analyze clinical, radiological and pathological features as well as clinical outcome after surgical treatment of patients with secondary chondrosarcoma arising from osteochondroma(tosis). Materials and Methods: We retrospectively reviewed clinical records, radiographs, pathologic slides of 14 patients. Nine patients were male and fi ve were female. The mean age was 34 years. The mean follow-up period was 54 months. Results: All patients had a history of previous mass since childhood or puberty. Preexisted osteochondroma was single in 3 patients and multiple in 10. Remaining 1 patient had multiple osteochondromatosis with enchondromatosis. MRI clearly provided thickness of cartilage cap, which was over 2 cm except in 2 cases. Chondrosarcoma was grade 1 in all except 1 case, which was grade 2. Wide excision was performed in 10 patients, marginal excision in 3 and amputation in 1. Twelve patients were doing very well without evidence of disease. Among 3 patients with marginal excision, 1 patient had local recurrence and 1 patient died of disease. Conclusion: Comprehensive understanding of clinical, radiological and pathological features of secondary chondro sarcoma is warranted for accurate diagnosis. The best result can be expected with early recognition of malignant change of osteohcondroma(tosis) and wide excision.

Endocrine dysfunction and growth in children with medulloblastoma (소아 수모세포종 환자에서 치료 후의 내분비적 장애와 성장변화)

  • Yoon, In Suk;Seo, Ji Young;Shin, Choong Ho;Kim, Il Han;Shin, Hee Young;Yang, Sei Won;Ahn, Hyo Seop
    • Clinical and Experimental Pediatrics
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    • v.49 no.3
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    • pp.292-297
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    • 2006
  • Purpose : In medulloblastoma, craniospinal radiation therapy combined with chemotherapy improves the prognosis of tumors but results in significant endocrine morbidities. We studied the endocrine morbidity, especially growth pattern changes. Methods : The medical records of 37 patients with medulloblastoma were reviewed retrospectively for evaluation of endocrine function and growth. We performed the growth hormone stimulation test in 16 patients whose growth velocity was lower than 4 cm/yr. Results : The height loss was progressive in most patients. The height standard deviation score (SDS) decreased from $-0.1{\pm}1.3$ initially to $-0.6{\pm}1.0$ after 1 year(P<0.01). Growth hormone deficiency(GHD) developed in 14 patients. During the 2 years of growth hormone(GH) treatment, the improvements of height gain or progressions of height loss were not observed. Twelve patients(32.4 percent) revealed primary hypothyroidism. One of six patients diagnosed with compensated hypothyroidism progressed to primary hypothyroidism. Primary and hypergonadotropic hypogonadism were observed in two and one patients respectively. There was no proven case of central adrenal insufficiency. Conclusion : Growth impairment developed frequently, irrespective of the presence of GHD in childhood survivors of medulloblastoma. GH treatment may prevent further loss of height. The impairment of the hypothalamic-pituitary-gonadal and hypothalamic-pituitary-thyroidal axis is less common, while central adrenal insufficiency was not observed.

A Study on the Religious Costume in Korea - Buddhist and Taoist Costume - (한국(韓國) 종교복식(宗敎服飾)에 관(關)한 연구(硏究) - 불교(佛敎)와 도교복식(道敎服飾)을 중심(中心)으로 -)

  • Im, Yeong-Ja
    • Journal of the Korean Society of Costume
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    • v.14
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    • pp.63-73
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    • 1990
  • The thought of three religious, Confucianism, Buddhism, and Taoism, had been the mainaxis of Korean spirit of the past. This study is centered on Buddhist and Taoist costume. There have been a lot of studies on Korean costume from many viewpoints. However, there have been few approaches to the inner !"ide of it. That is to say, the research on spiritual back-ground or religious correlation has not done yet. And especially, we are wholly lacking the studies on Taoist costume. In this dissertation, I investigate how they had come to wear Buddhist costume and how it trans, on the basis of related documentary records and existing remains. I also inquiry Taoist costume which was worn at Taoist ceremony in our country, with the help of Korean books and documents and of the sources of Packwoonkwan in China. In the case of Topobyunjeung in Korean costume, in particular, we can catch the source of it only after studying the religious side of Taoist costume and Buddhist costume. As revealed in the theory of Topobyunjeung in Ojuyunmoonja-ngsango by Lee, Kyu Kyung, even old masters and great Confucianists could not know whether Topo, the ordinary clothes of the Sadaeboo, originated from Taoist costume or Buddhist costume. There have been many opinions about the origin, but even now it is true that no one has made it clear. Therefore in this dissertatio I demonstrate mainly how Topo and Hakchangeui appeared in Korean costume through Taoist costume. It is said that Taoists, Buddhists, and literary men wore Topo, Chickchul, and Chickshin in Song dynasty of China. Topo was a clerical robe of Taoists and was also an ordinary clothes. Chick-chul was a clerical robe of Buddhists, and Chick-shin was worn by Zen priests in Won dynaty. Over the Po, Buddhist wore a large robe, namely Kasa, and Taoist wore Packhakchang like Wooeui, when they attended at the religious ceremony. And they regarded such manner of dressing as ceremonial full-dress attire. The style of Topo in China was Saryunggyogeo. The is th say that they put the black Yeon along Sajoo, which are Young, Soogoo, Keum, and Keo, and that they wore Sajodae around their waists so as to let the band down in front of them. Our existing type of Topo is that of Chickryung-gyoin. The characteristics of the type are its Koreum hung on the dress, no Yeon along Sajoo, and Soopok at the back of the dress. And when they put on the dress, they wear Saejodae around their waists. These characteristics considered, we can find the source of Topo from the Po of Chickshin among Buddhist costume. Other types of Topo are those that were transformed elegantly according to our national manners and customs in our country. So-called Wooeui in Chiness Taoism is Hakchang. Originally it was made by weaving for of cranes or other feathered birds. Its remarkable feature is the wide sleeves. Later they called such a robe with wide sleeves Hakchang. Our hakchangeui has Yeon along Sajoo and a belt around waist. We can guess that the features of Topo and wide-sleeved Hakchang mingled and turned into Hakchangeui. Or it might also be that Topa worn by Taoist was regarded as Hakchang and Topa which has Yeon along Sajoo was regarded as Hakchangeui in our country. Such type of Hakchang worn by Taoists was well shown in the Buddhist and Taoist paintings among "The Pictures of Hills, Waters, and Folks" in the latter half of the 16th century. In China Hakchang with a belt around waist could not be seen. Comparing our style of Hakchangeui with the Chinese style, we can recognize the former was similar to that of Chinese Topa. From this, we gather that Topa was regarded as Hakchang, Wooeui worn by Taoists, Ascetics and True Men in Korea. Furthermore I also gather that our Hakchangeui, which has Tongjeong, Koreurn and a belt around waist, was a transformed style in our own country. From the above, we can realize that in costume the three religions, Confucianism, Buddhism, and Taoism, cannot be treated separately although they are different each other in the essential thought. We have to recognize that Korean Costume was established under the closely connected correlation among the religions and that it was transfigured and accepted according to the cultural characteristics. This study is significant in that it is the first attempt to understand Korean costume through the religous approach, which has never been made in our Korean costume studies. We are demanded even more wide and profound investigation on the religious side of costume throughout the general field of costume studies.

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Early Management of Total Parenteral Nutrition Induced Hepatic Dysfunction with Cyclic Parenteral Nutrition (정맥영양 관련 간기능 장애에서 조기 주기성 정맥영양법의 유용성)

  • Lee, Sung Soo;Chang, Ju Young;Yang, Hye Ran;Ko, Jae Sung;Choi, Kyung Hee;Seo, Jeong Kee
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.7 no.1
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    • pp.61-73
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    • 2004
  • Purpose: Liver function test abnormalities have been reported frequently in patients receiving total parenteral nutrition (TPN). In adults, it is known that liver complications decrease with the use of cyclic parenteral nutrition (CPN), especially if the shift to cycling was not too late. However, there are few studies about the effects of cycling on liver injury in children beyond the neonatal period. The aim of this study is to evaluate the effect of the early use of CPN on total parenteral nutrition induced hepatic dysfunction. Methods: Twelve sets of CPN in 11 children (2 months to 17 years) were included in this study. Data on underlying diseases, age, length of time on TPN, macronutrient intake, complications, and biochemical parameters were collected from clinical records. All children had received CPN in the early period of persistent transaminase elevation or cholestasis complicated by previous continuous PN. The duration of infusion off-time in CPN was 2 hours in patients less than 3 months of age and 4 hours in the older children. Results: All 12 cases showed elevated aminotransferase and 5 of them also showed cholestasis. Serum total bilirubin concentration was normalized in all 5 cases with median periods of 8 days (p<0.05) after initiation of CPN. ALT either decreased significantly or was normalized in all cases with median periods of 30 days (p<0.05) on CPN. The CPN was well tolerated without significant complication except for one case of hyperglycemia. Conclusion: The early use of cyclic parenteral nutrition had a beneficial effect in improving hepatic dysfunction complicated by TPN in children.

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Clinical Analysis of Polymicrobial Bloodstream Infections in Pediatric Patients: Epidemiology, Clinical Features, Organisms, and Risk Factors (소아 환자에서 다균혈증에 대한 임상적 고찰)

  • Kim, Jung Min;Park, Hye Jin;Kim, Ki Hwan;Kim, Dong Soo
    • Pediatric Infection and Vaccine
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    • v.17 no.2
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    • pp.83-90
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    • 2010
  • Purpose : Although the incidence of polymicrobial bloodstream infection (PBSI) has increased, only a few studies have so far focused on children. Therefore, in an effort to prevent more serious situations in pediatric patients, we analyzed the clinical features, organisms, and laboratory results of PBSI. Methods : We performed a retrospective review of the case records of 97 patients with polymicrobial bloodstream infection in the Severance hospital, from 2001 to 2008. Using t-test and chi-square test, we analyzed the underlying medical conditions, clinical characteristics, organisms, and laboratory results of those patients. Results : Annual incidence of polymicrobial bloodstream infection increased from 1.4 % in 2001 to 10.9% in 2008 in pediatric patients. Immunocompromised hemato-oncological malignancy was found in 31 (31.9%) patients, and was the most common underlying medical condition; cardiovascular disease was found in 15 patients (15.4%), neurologic disease in 10 patients (10.3%), and so on. Gram positive organisms were recovered in 143 cases and gram negative organisms were recovered in 101 cases of PBSI. Staphylococcus epidermidis was the most common organism. Factors affecting mortality included underlying medical disease, immune status, nosocomial infection, and central catheter-related infection, for which the rate of mortality showed a greater increase (P<0.05). Conclusion : Due to the close connection between PBSI and fatal conditions or high mortality, it requires more aggressive management. Compared with previous studies, we discovered that immunocompromised hemato-oncological malignancy was the most common underlying medical condition and that frequency of gram-positive bacteria and fungus isolated has increased.

Clinical Features and the Associated Factors of Staphylococcal Scalded Skin Syndrome during the Recent 10 Years (최근 10년간 포도알균 열상 피부 증후군의 발생 양상과 관련인자 분석)

  • Park, Chan Hee;Na, Se Rin;Cho, Hyung Min;Yoo, Eun Jung;Jung, Kwon;Kim, Eun Young;Kim, Yong Wook;Kim, Kyoung Sim
    • Pediatric Infection and Vaccine
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    • v.15 no.2
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    • pp.152-161
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    • 2008
  • Purpose : Staphylococcal scalded skin syndrome (4S) is uncommon, but reports of 4S are on the increase during the recent years. The purpose of this study is to determine the clinical features and associated factors of 4S during the recent 10 years. Methods : We retrospectively reviewed the medical records and microbiologic results of 63 patients (27 neonates and 36 children) from January 1998 to December 2007. Results : Since 2003, the incidence of 4S has increased. The mean age of the patients was 16.3 months and the gender ratio was 1:1. The clinical types of 4S were 38 cases of the abortive type (60%), 19 cases of the intermediate type (30%) and 6 cases of the generalized type (10%). The culture results were 36 cases of Methicillin resistant S. aureus (MRSA), 4 cases of Methicillin sensitive S. aureus and 17 cases of no growth. The patients were treated with semi-synthetic penicillin. For the 9 patients who had MRSA isolated and who didn't improve with penicillin, they were treated with vancomycin instead of penicillin. All the patients had no complications. 4S abruptly increased in 2005, and especially in neonates, due to an MRSA outbreak at a local nursery room. The associated factors of 4S in neonates were hospitalization (27 cases), including nursery infection in 2005 (18 cases) and dermatitis (1 case). There was an unknown origin for some children, and the suggested factors for their infection were community acquired infection (24 cases), atopic dermatitis (9 cases) and hospitalization (3 cases). Conclusion : 4S has recently been increasing. The major associated factors of 4S are a history of hospitalization, an outbreak in a nursery room, atopic dermatitis and community acquired infection.

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Classification of Congenital Urinary Tract Anomalies Diagnosed by Antenatal Ultrasonogram (산전 초음파로 발견된 선천성 요로계 기형의 분류)

  • Choi Jin-Ho;Hahn Hye-Won;Won Hye-Sung;Kim Kun-Suk;Yoon Chong-Hyun;Park Young-Seo
    • Childhood Kidney Diseases
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    • v.6 no.2
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    • pp.227-236
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    • 2002
  • Purpose : A study was done to assess the incidence and classification of congenital urinary tract anomalies detected by antenatal ultrasonogram. Methods : We reviewed 558 cases of urinary tract anomaly which were detected by antenatal ultrasonogram and postnatally confirmed between June 1989 and May 2002. We investigated the incidence and classified congenital urinary tract anomalies by review of medical records, antenatal and postnatal radiologic studies retrospectively. Results : In 558 cases of congenital urinary tract anomalies, 292 cases of hydronephrosis were found and the most common. Another anomalies were composed of 65 cases of multicystic dysplastic kidney, 32 cases of hydroureteronephrosis, 31 cases of duplication of kidney, 25 cases of renal agenesis, 21 cases of simple renal cyst, 20 cases of polycystic disease, 13 cases of ureterocele, 11 cases of renal hypoplasia, 10 cases of horseshoe kidney, 9 cases of vesicoureteral reflux, 8 cases of posterior urethral valve, 7 cases of bladder diverticulum, 6 casts of megaureter, 5 cases of ectopia, 2 cases of megacystis, and 1 case of medullary cystic disease. In 82 of the 558 cases, there were two or more combined urinary tract anomalies. Associated diseases other than urinary tract were observed in 13 cases, of which the congenital heart disease was the most common. Conclusion : The congenital urinary tract anomaly is frequently found and diverse during the antenatal ultrasonography. The multicenter study is needed to investigate precise incidence and distribution of each anomalies in general population.

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Clinical Manifestations of Salmonellosis in Children during the last 12 Years: A Single Institution Experience (최근 12년간 발생한 살모넬라증 환아의 임상적 특성: 단일기관 연구)

  • Park, Jae-Hong;Lee, Taek-Jin
    • Pediatric Infection and Vaccine
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    • v.20 no.1
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    • pp.1-8
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    • 2013
  • Purpose : The purpose of this study is to investigate the clinical manifestations and antibiotic resistance of salmonellosis in children. Methods : We reviewed medical records and investigated the clinical characteristics of culture-proven childhood salmonellosis from January 2000 through December 2011 at the CHA Bundang Medical center. Results : We assessed 53 patients. The median age was 3-years-old (minimum 12 days, maximum 18-years-old) and the number of male patients was 33 (62.3%). It occurred most frequently in the summer (39%) and in 2001 (11 cases) however there was no case in 2009 and 2010. Salmonella typhi was isolated in 3 cases with septicemia. Antibiotic resistance to ampicillin was most frequently presented (30.2%) and 63.6% in serogroup B. No antibiotics resistance strains were cultured in patients with positive Salmonella typhi. Admitted patients from 2000 to 2011 were divided into 2 groups; group 1 from 2000 to 2005 and group 2 from 2006 to 2011. 40 cases belonged to group 1 and 13 cases were in the group 2. Group 2 showed more resistance to ampicillin than group 1 but without any statistical significance(25% vs. 38.5%, P=0.349). In group 1, the most common serotype was group D and in group 2, the most common serotype were group C and D. Conclusion : Salmonellosis in children was frequently occurred from 2000 to 2003 but decreased after 2004. There was no difference in clinical manifestations, serotypes and antibiotic resistances between the years.

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