• Journal of Chest Surgery
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• v.41 no.4
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• pp.469-475
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• 2008

Background: Video-assisted thoracic sympathicotomy is a definitive minimally invasive treatment for axillary hyperhidrosis. Different techniques exist for controlling axillary hyperhidrosis, but they are temporary and expensive. We compared the results after using two different levels of sympathicotomy for treating axillary hyperhidrosis: T3-T4 and T4. Material and Method: Between June 2002 and May 2007, 30 patients with isolated axillary hyperhidrosis underwent either T3-T4 or T4 thoracoscopic sympathicotomy in the Department of Thoracic & Cardiovascular Surgery at Wonkwang University Hospital. The patients were divided into two groups. Group I (n=15) was composed of patients who underwent T3-T4 sympathicotomy (thermal ablation), and Group II (n=15) was composed of patients who underwent T4 sympathicotomy (thermal ablation). The procedures were bilateral and simultaneous, involving the use of two 2-mm trocars and a 0-degree 2-mm thoracoscope under general anesthesia with single endotracheal intubation. Outcome parameters included satisfaction rate of treatment, degree of compensatory sweating, and postoperative complications. Patients were interviewed by telephone regarding satisfaction and compensatory hyperhidrosis. Result: There were no differences in age between group I and group II. The mean follow-up for the T3-T4 group was $38.7{\pm}2.3$ months, and the mean follow-up for the T4 group was $18.7{\pm}3.6$ months. The immediate therapeutic success rate (within 2 weeks postoperative) was 100% in both groups, and there were no recurrences in either group during the long-term follow-up period. The satisfaction rate was higher (93.3%) in the T4 group than in the T3-T4 group (53.3%), and the incidence of compensatory hyperhidrosis was lower in the T4 group (6.7%) than in the T3-T4 group (46.7%). Postoperative complications included one mild pneumothorax and two instances of intercostal neuralgia. Digital infrared thermographic imaging (DITI) correlated well with postoperative satisfaction. Conclusion: Both techniques proved effective for controlling isolated axillary hyperhidrosis. The T4 group had a higher satisfaction rate and lower severity of compensatory hyperhidrosis. Hence, thermal ablation of the lower interganglionic fibers of the third thoracic sympathetic ganglion on the fourth rib is a more practical and minimally invasive treatment than is the T3-T4 surgical method, according to the degree of compensatory sweating in isolated axillary hyperhidrosis.

• Tuberculosis and Respiratory Diseases
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• v.65 no.5
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• pp.385-389
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• 2008

Background: There are reports that food deprivation causes emphysematous changes in the lungs of rats and humans. However, the meaning of this phenomenon in patients with chronic obstructive pulmonary disease has not been evaluated. The aim of this study was to determine the correlations between the caloric intake and parameters of the lung function in patients with chronic obstructive pulmonary disease. Methods: Patients with chronic obstructive pulmonary disease who had visited the respiratory clinic from March, 2006 for one year were enrolled in this study. The patients underwent pulmonary function tests, and a dietitian evaluated their nutritional intake using a food record method. Results: There was no correlation between the total caloric intake and forced vital capacity (FVC, %predicted) or forced expiratory volume in one second ($FEV_1$, %predicted). The total caloric intake showed a positive correlation with the diffusing capacity of carbon monoxide (DLCO %predicted, DLCO/VA %predicted), and a negative correlation with the total lung capacity (TLC, %predicted). Of the calories taken, only calories from protein intake correlated with the diffusing capacity of carbon monoxide (DLCO %predicted, DLCO/VA %predicted). Conclusion: The total caloric intake of patients with chronic obstructive pulmonary disease showed a positive correlation with the diffusing capacity of the lung, and a negative correlation with the total lung capacity. Further study on the linkage between the caloric intake and severity of emphysema is needed.

• Clinical and Experimental Pediatrics
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• v.49 no.7
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• pp.769-776
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• 2006

Purpose : Pulse wave velocity(PWV) and ankle brachial index(ABI) are not only noninvasive methods used to assess arterial stiffness in adults, but also useful, simple ways to estimate the severity of hypertension, end stage renal disease and atherosclerosis in adults. But there are few studies on PWV and ABI in adolescents and children. In this study, hypertensive adolescents were compared to normal individuals to find out the usefulness of PWV as the index of progress in the disease. Methods : 413 teenagers were divided into three groups. The first group consisted of adolescents that only had hypertension(Group 1 : 23 teenagers). The second group consisted of the adolescents who had hypertension with obesity(Group 2 : 17 teenagers), and the last group was the normal subjects(Group 3 : 328 teenagers). Weight, height and body mass index were measured. Simultaneous measurements of systolic, diastolic and average blood pressure were obtained from the four extremities. PWV, ABI, ejection time and preejection period were also measured. Results : Right brachial-ankle PWV was significantly higher in both group 1 and group 2 compared with group 3, and significantly higher in group 2 compared with group 1. Likewise, left brachial-ankle PWV also showed significantly higher values in both group 1 and group 2 compared with group 3, and also higher values in group 2 compared with group 1. Positive correlations were found between the systolic, diastolic, average blood pressure and PWV. There were also positive correlations between the blood pressure and weight, body mass index. Conclusion : Higher PWV was demonstrated in adolescents with essential hypertension compared to normal subjects. Follow-up study is needed to evaluate the progress.

• The korean journal of orthodontics
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• v.33 no.4 s.99
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• pp.307-317
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• 2003

Conventional osseointegrated titanium implants have many limitations; large size, limited location for placement of the implant, severity of the surgery, discomfort of initial healing, difficulty of oral hygiene and uncontrollable force direction. Recently titanium miniscrew and miniplate have been used for an alternative to conventional dental implant. But in relation to miniplate, miniscrew has disadvantages in that more potential inflammation, light orthodontic force application and limited orthodontic application. This study was conducted to evaluate the effectiveness of miniplate by observing the reactions of peri-implant tissues to early orthodontic and orthopedic loading of titanium miniplate. In four adult beagle dogs 10 miniplates were inserted into the alveolar bone using 20 osseointegrated titanium screws. 4 miniplates were placed in two dogs(dogA, B) and 6 miniplates in two dogs(dogC, D). In dogA, B miniplates were loaded with 200gm of force immediately after placement for 15 weeks. In dogc, D, miniplates were loaded with 400gm of force immediately after placement for 8 weeks. Miniplates of dogA were removed, dogA was healed for 4 weeks, and the area which was removed of miniscrew was examined. Following an observation period, the miniplates including miniscrews and the surrounding bone of dogB and dogC, D were removed, respectively. Undecalcified section along the long axis of miniscrews were made and the degree of osseointegration was examined under the light microscope. The results were as follows. 1. In the histologic features there was direct contact between bone and miniscrew in all groups except one, dogC control group. The loaded miniscrew demonstrated only a slight increase of the osseous proximaty when compared with unloaded miniscrew 2. There was no significant difference of the osseointegration of Peri-miniscrew surface between dogB and dogC, D. But dogB showed slightly more increased bone apposition than dogC, D 3. The gingiva overlapping the miniplate and miniscrew showed no inflammatory sign in clinical and histological aspects. 4. The impaled hard and soft tissues at the area which was removed of miniscrews showed good healing without inflammatory reaction. 5. The mobility showed slight increase in un-loaded miniplate but that was insignificant. Based on the results of this study, miniplate(C-tube) can be used as a firm osseous orthodontic and orthopedic anchorage unit immediately after insertion.

• Radiation Oncology Journal
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• v.17 no.2
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• pp.129-135
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• 1999

Purpose : This study evaluated early bowel complications in cervix cancer patients, following external radiotherapy (ERT and high dose rate intracavitary radiation (HDR ICR). Factors affecting the risk of developing early bowel complications and its incidence are analyzed and discussed Materials and Methods : The study is the retrospective review of 66 patients who received radiotherapy at Chungbuk National University Hospital from April 1994 to December 1998. The patients underwent 41.4 or 50.4 Gy ERT according to FIGO stage and tumor size, then A point dose was boosted to 71.4 or 74.4 Gy using a remotely controlled afterloading Buchler HDR ICR. The EORTC/RTOG morbidity criteria were used to grade early bowel complications, which are valid from day 1, the commencement of therapy, through day 90. The actuarial incidence, severity of complications were investigated and clinical pretreatment factors relevant to complications were found through univariate (Wilcoxon) and multivariate (Cox proportional hazard model) analysis. Results : Of the 66 patients, 30 patients (46$\%$) developed early bowel complications; 25 patients (38$\%$) with grade 1 or 2, 4 patients (0$\%$) with grade 3 and 1 patient (2$\%$) with grade 4. The complications usually began to occur 3 weeks after the commencement of radiotherapy. The actuarial incidence of early bowel complications was 41$\%$ at 10 weeks. The early bowel complications were associated significantly with an old age and a history of previous abdomino-pelvic surgery. All three patients who had a protracted overall treatment time (about 2 weeks) due to severe bowel complication, suffered from pelvic recurrences. Conclusion : Forty six percent of patients experienced early bowel complications, most of which were grade 1 or 2 and relieved spontaneously or by medication. The patients with an old age or a previous surgery have a high probability of early complications and they may be less compliant with planned radiotherapy. So more careful precaution is necessary for these patients.

• Childhood Kidney Diseases
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• v.7 no.1
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• pp.44-51
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• 2003

Purpose : Acute pyelonephritis in children may result in permanant renal damage which later in life may lead to hypertension and renal failure. The purpose of this study was to evaluate the factors that might be useful for predicting the development of renal scar in children with urinary tract infection(UTI). Methods : We retrospectively reviewed 442 patients with UTI who were admitted to the Department of Pediatrics of Chonbuk National University Hospital, during the period from April 1992 to March 2002. The patients were divided into two groups according to the presence of renal scar on the follow-up DMSA renal scan, and we compared the factors associated with renal scarring between the two groups. Results : There were no significant differences in sex, causative organism and acute phase reactants between the groups with and without renal scar. The age at diagnosis was significantly higher in the renal scar group compared to that without scar. Of the 60 patients with renal scar, 78% had vesicoureteral reflux(VUR), but 13% of patients without scar had VUR. Furthermore, the severity of VUR was significantly correlated with renal scar formation. 53% showed multiple cortical defects on the initial DMSA renal scan, compared to 32% in the non-scar group. In addition, 76% of patients showing multiple cortical defects on the initial DMSA renal scan with VUR had renal scar. Conclusion : The presence and grade of VUR, and findings on the initial DMSA renal scan would contribute to predict risk of renal scar formation in children with UTI.

• Tuberculosis and Respiratory Diseases
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• v.50 no.4
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• pp.462-472
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• 2001

Background : The determinants of intubation and the response to therapy in COPD patients with hypercapnic respiratory failure were retrospectively reviewed. Methods : This study involved a review of 132 episodes of hypercapnic respiratory failure($PaCO_2\;{\geq}\;50\;mmHg$ and $pH\;{\leq}\;7.35$). The time frame for resolution or the time to intubation of patients who were admitted between 1996 and 1999 was analyzed. Results : Out of 132 hypercapnic episodes, 49(37%) required intubation. A comparison was made with the 83 cases that responded to treatment. Patients requiring intubation had a greater severity of illness, which included a higher APACHE II (Acute Physiology and Chronic Health Evaluation II) score ($20{\pm}5$ vs $14{\pm}4$ ; p<0.01), a higher WBC, a higher serum BUN, and greater acidosis (pH, $7.23{\pm}0.11$ vs $7.32{\pm}0.04$ ; p<0.01). Those with the most severe acidosis(pH<7.20) had the highest intubation rate(87%) and shortest time to intubation($2{\pm}3\;h$). Conversely, those with an initial pH 7.31 to 7.35 were less likely to be intubated(20%), and had a longer time to intubation($97{\pm}121\;h$). The patients with a pH 7.21 to 7.25($4.1{\pm}2.9$ day) required longer period of time to respond to medical treatment than patients with a pH of 7.31 to 7.35($2.2{\pm}3.1$ day). Of those patients requiring intubation, half(55%) were intubated within 8 h of admission, and most (75%) within 24 h. Of those patients responding to treatment medical therapy, half(52%) recovered within 24 h and most (78%) recovered within 48 h. Conclusion: Respiratory acidosis at the initial presentation is associated with an increased likelihood of intubation. This should assist in deciding help with the decision whether to treat patients medically, institute noninvasive ventilation, or proceed to intubation.

• Tuberculosis and Respiratory Diseases
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• v.65 no.4
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• pp.292-300
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• 2008

Background: Respiratory failure is a common condition that requires intensive care, and has a high mortality rate despite the recent improvements in respiratory care. Previous reports of patients with respiratory failure focused on the specific disease or included a large proportion of surgical patients. This study evaluated the clinical characteristics, outcomes and prognostic factors of adult patients receiving mechanical ventilation in a medical intensive care unit. Methods: Retrospective chart review was performed on 479 adult patients, who received mechanical ventilation for more than 48 hours in the medical ICU of one tertiary referral hospital. Results: The mean age of the patients was $60.3{\pm}15.6$ years and 34.0% were female. The initial mean APACHE III score was $72.3{\pm}25$. The cause of MV included acute respiratory failure (71.8%), acute exacerbation of chronic pulmonary disease (20.9%), coma (5.6%), and neuromuscular disorders (1.7%). Pressure controlled ventilation was used as the initial ventilator mode in 67.8% of patients, and pressure support ventilation was used as the initial weaning mode in 83.6% of the patients. The overall mortality rate in the ICU and hospital was 49.3% and 55.4%, respectively. The main cause of death in hospital was septic shock (32.5%), respiratory failure (11.7%), and multiorgan failure (10.2%). Males, an APACHE III score >70, the cause of respiratory failure (interstitial lung disease, coma, aspiration, pneumonia, sepsis and hemoptysis), the total ventilation time, and length of stay in hospital were independently associated with mortality. Conclusion: The cause of respiratory failure, severity of the patients, and gender appears to be significantly associated with the outcome of mechanical ventilatory support in patients with respiratory failure.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1979.05a
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• pp.4.4-5
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• 1979

The degree of hearing impairment of chronic otitis media will indicate the nature and severity of middle ear pathology especially condition of ossicular chain, size of ear drum perforation and location of granulation tissue in the middle ear cavity. The subjects were 189 ears of tympanoplasty for chronic otitis media and divided into four groups as follows: Normal ossicular chain with only ear drum perforation (group I), normal ossicular chain with granulation tissue only around the ossicles regardless of any other region (group II), ossicular ankylosis or fixation of handle of malleus to promontory with or without granulation tissue around the ossicle (group III) and ossicular interruption by partial or complete destruction(groupf IV). The results were concluded as follows: 1) The average hearing threshold of chronic otitis media was 44.6 dB and hearing threshold was closely related to the condition of ossicular chain. Hearing threshold became greater in order of normal ossicular chain, ankylosis and interruption. 2) The average hearing threshold of ossicular interrupted group was 49.1 dB and it was greater in the cases of total destruction than that of partial destruction. 3) The hearing loss in the cases of normal ossicular chain with only tympanic membrane perforation was within 45 dB and this level was presumed to represent normal ossicular function. The degree of hearing loss was in proportion to the size of ear drum perforation and when over 45 dB, other middle ear pathology was suggested. 4) In the cases of small ear drum perforation with normal ossicular function, the hearing threshold was within 30 dB. 5) In the type of audiogram, flat type was 30.2% and ascending type 35.4%. Descending type was more frequent in the cases of normal ossicular mobility with granulation tissue around the ossicle and flat type was observed frequently in the cases of ossicular ankylosis. 6) Carhart's notch was seen in 14 cases (7.4%) and observed mainly in ossicular ankylosis. 7) There was no relation between hearing threshold and histopathological type of granulation tissue in chronic otitis media. However the degree of hearing impairment was related to the location of granulation tissue in the middle ear cavity. 8) Authors recognized the granulation tissue compensated the function of interrupted ossicular chain.

• Clinical and Experimental Pediatrics
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• v.45 no.10
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• pp.1213-1218
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• 2002

Purpose : Hydronephrosis constitutes a great portion of fetal anomalies screened by prenatal sonogram. The present authors made an attempt to access its natural courses through follow up neonatal hydronephrosis diagnosed by prenatal sonogram. Methods : The study was composed of 23 neonates(36 renal units) who were diagnosed with hydronephrosis through prenatal sonogram screening and confirmed 3-7 days after birth with sonographic evaluation at Kyung Hee University Hospital. The neonates were closely monitored for 12-24 months with renal sonogram, diuretic renogram, intravenous pyelography(IVP) and voiding cystoureterography(VCUG). Results : The underlying diseases were composed of 16 cases(44%) of functional abnormalities, 14 cases(39%) of ureteropelvic junction(UPJ) obstruction, three cases(8%) of vesicoureteral reflux (VUR) and on case each of multicystic dysplastic kidney, UPJ obstruction with ureteral stenosis and ureterovesical junction(UVJ) obstruction with VUR. The degree of hydronephrosis was divided into three classes according to its severity. In 30 renal units with UPJ obstruction and functional abnormalities, 26(87%) showed mild hydronephrosis, while four(13%) were moderate. During the follow up period, six cases(20%) showed natural resolution of hydronephrosis, 15 cases(50%) showed improvement while two cases(7%) were aggravated with improvement only after surgery of the underlying disease. The cases which showed natural resolution were all mild hydronephrosis at diagnosis and the cases which underwent surgery due to continuous aggravation were mild one case and moderate one case. Conclusion : Those with cases of mild hydronephrosis show rapid natural improvement. On the other hand, in some cases, follow up monitoring reveal aggravation of the situation, emphasizing the necessity for thorough follow up for a long period of time.