• Journal of Trauma and Injury
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• v.25 no.4
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• pp.217-222
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• 2012

Purpose: Diaphragmatic rupture following trauma is often an associated and missed injury. This report is about our experience with treating traumatic diaphragmatic rupture (TDR). Methods: From January 2007 to September 2012, 18 patients who had a diaphragmatic rupture due to blunt trauma or penetrating injury underwent an operation for diaphragmatic rupture at our hospital. We retrospectively reviewed their medical records, including demographic factors, initial vital signs, associated injuries, interval between trauma and diagnosis, injured side of the diaphragm, diagnostic tools, surgical method or approaches, operative time, herniated organs, complications, and mortality. Results: The average age of the patients was 43 years, and 16 patients were male. Causes of trauma included motor vehicle crashes (n=7), falls (n=7), and stab wounds (n=5). The TDR was right-sided in 6 patients and left-sided in 12. The diagnosis was made by using a chest X-ray (n=3), and thorax or upper abdominal computed tomography (n=15). Ten(10) patients were diagnosed within 12 hours. A thoracotomy was performed in 8 patients, a video-assisted thoracoscopic surgery in 4 patients, a laparotomy in 3 patients, and a sternotomy in one patient. Herniated organs were the omentum (n=11), stomach (n=8), spleen and colon (n=6), and liver (n=6). Eighteen diaphragmatic injuries were repaired primarily. Seven patients underwent ventilator care, and two of them had pneumonia and acute respiratory distress syndrome. There were no operative mortalities. Conclusion: Early diagnosis and surgical treatment determine the successful management of TDR with or without the herniation of abdominal organs. The surgical approach to TDR is chosen based on accompanying organ injuries and the injured side.

• The Korean Society of Law and Medicine
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• v.15 no.1
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• pp.211-237
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• 2014

Because of unpredictability and high possibility of abnormal results by clinical trials compared to general medical behaviors, a procedure for ensuring with sufficient explanations by investigators must be secured. Therefore, in a sequence of clinical trials, what kinds of scope, stage, and method of explanations provided by investigators, including doctors or researchers, to trial subjects are closely related to the compensation for damages by violation of liability for explanation. In case of application of clinical trials to patients who have critical illness such as cancer, issues of "Quality of Life" regarding trial subjects, cancer patients, should be discussed. Especially, in case of clinical trials for terminal cancer patients, the right of subjects' self-determination, which is a fundamental principle in medical behaviors, should be discussed. The right of self-determination includes participation in clinical trials for the possibility of life-sustaining even a little bit, or no participation in clinical trials in order to have a time for completing the rest of his life. Like this, if the extent and scope of explanations related to the issues of "Quality of Life" are raised as main issues, the evaluation of "Quality of Life", should be a prerequisite. In many occasions, realistically, despite bad results such as deaths or serious adverse drug reactions after clinical trials, it may not be easy for compensating to trial subjects or their survivors, who requested civil compensation for damage. Futhermore, in abnormal results after concealment of clinical trials or performance of clinical trials without permission, and in the case of trial subjects' failures of proving proximate cause between the clinical trials and abnormal results, problematic results such as no protection to the trial subjects could be occurred. In performing clinical trials, investigators should provide sufficient explanations for trial subjects and secure voluntary informed consents from the trial subjects. Therefore, clinical trials without trial subjects' permissions and the informed consent process violate trial subjects' rights of self-determination, and the investigators shall be liable for compensation for damages. Then, issues might be addressed are what are essential contents of patients' "rights of self-determination" infringed by clinical trials without subjects' permissions. Two perspectives about patients' rights of self-determination might be considered. One perspective regards physical distress of patients (subjects) from therapies without sufficient explanations as the crux of the matter. The other perspective regards infringement of human dignity caused by being subjects without permission as the crux of the matter irrespective of risks' big and small influences. This research follows perspective of the latter. Forming constant fiduciary relation between investigators (doctors) and subjects (patients) pursuant medical contracts, and in accordance with this fiduciary relation, subjects, who are patients, have expectations of explanations and treatments by the best ways. If doctors and patients set this forth as a premise, doctors should assume civil liability when doctors infringe patients' expectations.

• The Journal of Korean Society of Virology
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• v.29 no.1
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• pp.11-22
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• 1999

Sero-epidemiologic survey has been carried out to establish serologically the presence of hantavirus in areas of South Africa. The survey was oriented to search natural infection in both of humans and wild rodents and involvement of human disease. The normal human sera were collected from the residents in urban and rural areas of Western Cape, and rural area of Eastern Cape province. The rodent sera came from various species of rodents trapped in Northern Cape and Western Free provinces. The patient sera were selected from the patients of renal failure, pulmonary syndrome and pyrexia of unknown origin (PUQ) according to diagnostic chart among the patients hospitalized in major hospitals of Cape Town area. The sera were screened and titrated by IFA test using antigens of Hantaan (HTN), Seoul (SEO), Puumala (PUU), and Prospect Hill (PH) viruses primarily. Positive cases were subjected to differential IFA test using HTN, PUU and PH antigens and plaque reduction neutralization test for further confirmation. Anti-hantavirus antibodies were detected from 2 of 352 rural, 1 of 172 urban residents of E. Cape, and 5 of 118 rural, 5 of 368 urban residents of W. Cape. The antibody was also demonstrated from 5 of 221 wild rodents, and it was appeared that 2 different species, Aethomys namaquensis and Tatem leucogaster, are involved. Among 318 patients tested, 3 who were diagnosed as chronic renal failure, acute respiratory distress syndrome (ARDS) and glomerulonephritis were proved to be positive. The reaction patterns obtained from all of these positive sera were distinct from hantaviral sero-patterns ever established. This result suggests that new viruses may exist in this area and play an possible etiologic role in human disease. The feature of serologic survey on anti-hantavirus antibody demonstrable newly from African wild rodents which are different from reservoir species in other continents elicits a conjecture that the virus may be different from known hantaviruses ever found. This fact also suggests that an expanded role in etiologic involvement with other unknown human diseases by newly emerging hantaviruses may be possible in this areas.

• Korean Security Journal
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• no.32
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• pp.151-176
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• 2012

Government organizations (including police, prosecutor, and Financial Supervisory Service) and programs to uncover or prevent from insurance crime are not well developed. However, insurance crime are increasing among not only private insurances such as life insurance, indemnity insurance, and auto insurance but also public insurances including national health insurance and industrial accident compensation insurance. The damages of crimes are serious in both economical and ethical perspectives. Insurance crime deteriorates a current account of insurance companies and the leakages due to insurance fraud worsen loss ratio. Consequently, insurance crime increases customers' costs of insurance. For this reason, insurance companies stated to establish Special Investigation Unit(SIU) to detect insurance crime and fraud by themselves. However, organizational and operational efficiencies are limited. The purpose of this study is to examine the relationship between work environment factors, perception of insurance crime and job satisfaction among Special Investigation Units. Therefore, this study investigated the perception of work environments of Special Investigation Units. In addition, this study examined how their work environments and general perception of insurance crime influence their job satisfaction. In order test the purpose of this study, reliability test, exploratory factor analysis(EFA), multiple regression were employed. The results of this study suggested that clarity of insurance company, distress/difficulty of resolve, compensation, perception of work pressure are statistically significant on jab satisfaction among Special Investigation Unit in South Korea. This exploratory study expected to contribute to understanding of Special Investigation Unit, and their insurance crime prevention system. The results from this analysis will be examined in light of previous findings and policy implications discussed.

• Journal of Physiology & Pathology in Korean Medicine
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• v.21 no.2
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• pp.554-560
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• 2007

This study was aimed to identify the effect of abdominal moxibustion on premenstrual syndrome and dysmenorrhea in university students. The data were collected by using questionnaires from April 25, 2005 to June 20, 2005. The subjects were university students from in the Pusan metropolitan area who had complained of menstrual discomfort. Thirteen students were assigned to the experimental group and fourteen students to the control group. The research design of this study was a nonequivalent control group pretest-posttest design. In the research method pretest were conducted through measurement based on scores of general character, menstrual character, premenstrual syndrome and dysmenorrhea in the experimental group and the control group. Experimentation was conducted by abdominal moxibustion being applied on the kwan-won hole and Ki-hae hole for 25 minutes at a time, three times a week, form the ending of one menstrual cycle to the beginning of the next menstrual cycle were in the experimental group. After treatment was finished, post tests conducted through measurement based on scores of premenstrual syndrome and dysmenorrhea in the experimental group. The control group conducted a point of same time and same measurement with the experimental group. The instruments used in this study MDQ(Menstual Distress Questionnaire) developed by moos(1968) and the VAS(Visual Analogue Scale) developed by Cline(1992). The data were analysed by SPSS/ win 12.0 program with ${\chi}$2-test and t-test to verify identification among subjects' general characteristics and menstrual characteristics. Hypothesis verification was analysed with t-test. The results of the study are as follows: The hypothesis, 'the experimental group who received abdominal moxibustion will decrease premenstrual symptoms more than the control group', was supported (t= -2.121, p=.022). The hypothesis, 'the experimental group who received adbominal moxibustion will decrease dysmenorrhea compared to the control group', was supported (t=-4.424, p=.001). As a result of this study, abdominal moxibustion will be used as a nursing aide to improve and prevent menstrual discomfort of university students who have premenstrual syndrome and dysmenorrhea.

• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.26 no.1
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• pp.64-74
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• 2016

Objectives: The purpose of this study was to investigate whether chemical exposure among workers has relevance to dyspnea using data from the $3^{rd}$ Korea Working Conditions Survey. Methods: The research subjects were 29,711 wage workers. Chemical exposures consist of four factors, (1) breathing in vapors, fumes, dust and dirt, (2) breathing in organic solvent vapors, (3) handling or touching chemicals, and (4) secondhand smoke. Multiple logistic regression analysis was performed to examine the association between chemical exposure and dyspnea in the last 12months using proc surveylogistic in SAS 9.3 statistical software excluding people who had received a diagnosis of hypertension or obesity that can affect the respiratory distress symptoms(n=27,842). Results: Chemical exposure among workers was associated with dyspnea after adjustment for demographics and job characteristics. Prevalence of dyspnea was 4.9 per 1,000 among men and 5.8 per 1,000. Compared to a total score of 0 points of chemical exposure among workers, a total score of 1, 2-3, and 4 points tended to have increased risk of dyspnea in a dose-response manner for both men (OR=1.43, 1.93, and 4.26; P-for trend=0.002) and women(OR=1.10, 2.81, and 7.70; P-for trend=0.002). Stratified analysis by duration of current job showed that the association between chemical exposure and dyspnea tended to get stronger until 15 years and then disappeared afterwards, which reflects healthy worker survivor effect. Conclusions: We observed significant association between chemical exposure and dyspnea using the data of the $3^{rd}$ Korea Working Conditions Survey. Our results warrants providing knowledge related to chemical exposure, performing prevention activities, and creating various health policies to protect workers.

• Journal of Chest Surgery
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• v.44 no.2
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• pp.169-177
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• 2011

Background: Video-assisted thoracic surgery (VATS) lobectomy has been performed with increasing frequency over the last decade. However, there is still controversy as to its indications, safety, and feasibility. Especially regarding lung cancer surgery, it is not certain whether it can reduce local recurrences and improve overall survival. Materials and Methods: We retrospectively reviewed 1,067 cases of VATS lobectomy performed between 2003 and 2009, including the indications, postoperative morbidity, mortality, recurrence, and survival rate. Results: One thousand and sixty seven patients underwent VATS lobectomy for the following indications: non-small cell lung cancer (NSCLC) (n=832), carcinoid tumors (n=12), metastatic lung cancer (n=48), and benign or other diseases (n=175). There were 63 cases (5.9%) of conversion to open thoracotomy during VATS lobectomy. One hundred thirty one (15.7%) of the 832 NSCLC patients experienced pathologic upstaging postoperatively. The hospital mortality rate was 0.84% (9 patients), and all of them died of acute respiratory distress syndrome. One hundred forty-nine patients (14.0%) experienced postoperative complications. The median follow-up was 22.9 months for patients with NSCLC. During follow-up, 120 patients had a recurrence and 55 patients died. For patients with pathologic stage I, the overall survival rate and disease-free survival rate at 3 years was $92.2{\pm}1.5%$ and $86.2{\pm}1.9%$, respectively. For patients with pathologic stage II disease, the overall survival rate and disease-free survival rate at 3 years was $79.2{\pm}6.5%$ and $61.9{\pm}6.6%$, respectively. Conclusion: Our results suggest that VATS lobectomy is a technically feasible and safe operation, which can be applied to various lung diseases. In patients with early-stage lung cancer, excellent survival can be also achieved.

• Journal of Chest Surgery
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• v.45 no.4
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• pp.236-241
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• 2012

Background: Prolonged usage of extracorporeal membrane oxygenation (ECMO) may induce multi-organ failure. This study is aimed to evaluate prognostic factors in the patients with ECMO. Also, the prognosis of ECMO with Kidney Injury Network Scoring system is studied. Materials and Methods: From May 2005 to July 2011, 172 cases of ECMO were performed. The cases of perioperative use of ECMO were excluded. Renal failure patient and younger than 15 years old one were also excluded. As a result, 26 cases were enrolled in this study. Male patients were 15 (57.7%), and mean age was $56.57{\pm}17.03$ years old. Demographic data, ECMO parameters, weaning from ECMO, and application of continuous renal replacement therapy are collected and Acute Kidney Injury Network (AKIN) scores were evaluated just before ECMO and day 1, day 2 during application of ECMO. Results: Venoarterial ECMO was applied in 22 cases (84.6%). The reasons for applications of ECMO were cardiac origin in 21 (80.8%), acute respiratory distress syndrome in 4, and septic shock in 1 case. Successful weaning from ECMO was achieved in 15 cases (57.7%), and survival discharge rate was 9 cases (34.6%). Mean duration of application of ECMO was $111.39{\pm}54.06$ hours. In univariate analysis, myocarditis was independent risk factors on weaning failure. Using the receiver operating characteristic curve, level of hemoglobin on 24 hours after ECMO, and base excess on 48 hours after ECMO were showed more than 0.7. AKIN score was not matched the prognosis of the patients with ECMO. Conclusion: In our study, the prognosis of the patients with myocarditis was poor. Hemoglobin level at first 24 hours, and degree of acidosis at 48 hours were useful methods in relating with prognosis of ECMO. AKIN scoring system was not related with the prognosis of the patients. Further study for prognosis and organ injury during application ECMO may be needed.

• The Korean Journal of Pain
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• v.12 no.1
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• pp.27-35
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• 1999

Background: Fibromyalgia is a common syndrome of musculoskeletal pain and fatigue. Lacking distinctive histological or laboratory abnormality in diagnosis, it has often been considered a form of "psychogenic rheumatism". Fibromyalgia causes much distress to the affected patients and often frustrates physicians, who are unable to start rational therapy on any logical disease pathology. Methods: Growth hormone is essential for muscular homeostasis. In the present study, the notion that the stage-4 sleep anomaly typically seen in the fibromyalgia syndrome may disrupt growth hormone secretion was tested. Because growth hormone has a very short half-life, serum levels of somatomedin C were measured; somatomedin C is the major mediator of growth hormone's anabolic actions and is a prerequisite for normal muscle homeostasis. Serum levels of somatomedin C using acid-extraction procedure and two-site immunoradiome-tric assay (IRMA) and number of tender points were measured in 27 female patients with fibromyalgia from 40 to 60 years old and 27 healthy controls. Results: There were no differences in the concentration of somatomedin C between fibromyalgia patients and controls ($mean{\pm}SD$: $178.3{\pm}75.5$ ng/ml versus $166.3{\pm}76.6$ ng/ml; p=0.55). And there were no correlations between number of tender point and serum somatomedin C level by linear regression analysis. Conclusions: These findings did not support that there is a distinctive disruption of the growth hormone-somatomedin C neuroendocrine axis in a fibromyalgia syndrome. But we can not discard the hypothesis that disturbed sleep predispose to muscle pain.

• The Korean Journal of Pain
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• v.1 no.1
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• pp.53-58
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• 1988

We have treated patients who have visited pain clinic and those admitted to the other departments of Pusan National University Hospital from Mar. 1987 to Feb. 1988 with complaints of severe cancer pain on both upper and lower abdomen and extremities by continuous administration of a very small amount of morphine in the lumbar subarachnoid(group I) and epidural(group II) space in 10 cases respectively. The results of analgesia obtained are as follows: 1. The average duration in onset of analgesia was 8 mins. in group I and 23 mins. in group II. 2. The average duration In maintaining analgesia was 12.4 hrs. in group I and 18.4 hrs. in group II. 3. The efficiency of analgesia in group I was excellent in 5, good in 4, and null in 1, and group II was excellent in 5, good in 2, and moderate in 3. 4. The degree of tolerance in group I was rather mild comparable ti that of pain score 4 till the 22nd. day of morphine administration. 5. The complications are: 2 of respiratory distress in group I, 2 of voiding difficulties in both group I and II, 1 of itching sensation in both group I and II, 1 of euphoria with hallucination In group I, and 1 of C.S.F leakage in group II. As results, it is thought that epidural administration is safer than subarachnoid administration in achieving analgesia with morphine among patients with malignant pain if the problem of tolerance is solved.