For the purpose of clinical analysis of secundum atrial septal defect, the patients with atrial septal defect operated on during the period from Aug. 1959 to Aug. 1983 were analysed. The age of the patients was ranged from 3 months to 60 years and there were 132 males [45.3%] patients and 145 female patients [54.6%] in this series. The most frequent type was oval type defect in 219 [86.9%]. The PAPVC were present in 7 patients of high defect group. Clinical analysis revealed 53 patients [19.9%] were asymptomatic. The QP/QS above than 3.61 were 45 patients and less than 1.5 were 24 patients. The pulmonary artery pressure was 10 to 100 mmHg. The majority of the defects were closed in primary suture and closed with a Dacron patch in 19 patients. The postoperative complications occurred in 35 patients [13.1%] and the most frequent complication was wound problem which was present in 10 patients. The hospital mortality rate was 1.6%.
Open lung biopsy still has important roles for the marking of diagnosis of diffuse infiltrative lung disease even though transbronchial bronchoscopic lung biopsy and percutaneous needle aspiration biopsy gain popularity nowadays. This is clinical retrospective review of the 56 patients with diffuse infiltrative lung disease undergoing open lung biopsy by minithoracotomy from 1984 to Dec. 1992 in the Department of Thoracic & Cardiovascular Surgery of Catholic University Medical College. 27 men and 29 women, aged 17 to 73 year [mean 49 year , were enrolled & divided into 2 groups;Group A consisted of patients with immunocompromised state [n=19 , Group B patients with non-immunocompromised state[n=38 . Pathologic diagnosis was made in 54 cases[96.4% of these two groups and as follows: infectious; 12 patients[21.4% , Neoplastic; 10 patients[17.9% , granulomatous; 4 patients[7.1% , interstitial pneumonia; 12 patients[21.4% , Pulmonary fibrosis; 8 patients[14.3% , others; 3 patients[5.4% , nonspecific; 5 patients[8.9% , and undetermined; 2 patients[3.6% . Therapeutic plans were changed in 39 patients[69.6% after taking of tissue diagnosis by open lung biopsy. Group B has higher incidence of infectious diseases and change of therapeutic plan than the Group A. The postoperative complications developed in 8 cases[14.3% ,and there is no difference of incidence between the 2 groups. 4 patients belongs to group A, died of respiratory distress syndrome [2 and sepsis [2 which were not related with open lung biopsy procedure. In conclusion, open lung biopsy is a reliable method to obtain a diagnosis in diffuse pulmonary infiltrates and can be performed safely, even in acutely ill, immunosuppressed patients.
The pain clinic in our institution opened on of June, 1984. since then until December 1994, we have had 1,741 patients who had been treated on an out-patient basis. The patients were analysed retrospectively according to their sex, age, and retrospective disease. There were 969 male(55.7%) and 772 female patients(44.3%) In the age distribution of the patients, the highest incidence was in the forties with 463 patients(26.6%). The second highest age incidence was in the thirties with 357 patients(20.5%), and the third highest age incidence was in the sixties with 341 patients(19.6%). In this figure, there were 203(26.6%) stomach cancer patients, 135(17.7%) cervix and uterine cencer patients, 81(10.6%) colorectal cancer patients, 74(9.7%) hepatoma patients, and 68 (8.9%) pancreatic cancer patients. The patients with non malignant chronic pain numbered 977(56.1%). In this figure, there were low back pain of 188(19.2%), sudden deafness of 17.5%, Buerger's disease of 63(6.5%) and postherpetic neuralgia of 56(5.7%).
Background and objectives : There may be frequent lymphatic neck metastasis among supraglottic cancer patients after their primary surgery. The aim of this study was to evaluate the effectiveness of prophylactic neck dissections in supraglottic cancer patients to lower the neck metastasis. Material and method : The authors retrospectively reviewed medical records of 52 patients (7 females. 45 males) who had received the operations for the supraglottic cancer from 1995 to 2000. They were preoperatively examined with Computer Tomographic images, and also examined by the cervical neck palpations. Postoperative pathologic specimens were reviewed and the Pathologic stagings were confirmed by the pathologist. Results : Among 52 patients who received surgery for supraglottic carcinoma, 5 patients received ipsilateral neck dissection, 12 patients received ipsilateral neck dissection with postoperative radiation therapy, 10 Patients received bilateral neck dissection and 25 patients received bilateral neck dissection with postoperative radiation treatment. In comparison of the data of N0 to N+ conversion rate of neck, there were 11 ipsilateral T3 N0 patients and 2 patients(18%) were converted to N+ status, and there were 8 Patients with T4 N0 stages, and 3 patients(38%) were converted to N+ status. In comparing the data of contralateral neck dissection on N0 patient, there were 8 patients of T3 N0 patients, and there was 1 patient (13%) who showed recurrence. There were 5 patients of T4 N0 stages and there was 1(20%) patient with recurrences. When the ipsilateral N stages were N2a, and N2b, there 1 case of contraleral N+ conversions, respectively. In recurrences, there were 2 patients of N2b staged patients and 1 patient of N2c patient that showed recurrence during the follow up period. Conclusion : This data shows that at least an ipsilateral neck dissection is necessary in order to prevent the recurrences, and also suggests that bilateral neck dissection is necessary for the higher T stage. Since the higher N staged patients showed higher rate of recurrence, so that neck dissection is mandatory for the higher N staged patients.
Background: The ear is composed of elastic cartilage as its framework, and is covered with a thin layer of skin. Auricular reconstruction using autogenous cartilage in microtia patients requires delicacy. This paper reports clinical experiences related to elevation of reconstructed ear in the last 11 years. Methods: This study was based on 68 congenital microtia patients who underwent auricular elevation in our hospital. Among these 68 patients, 47 patients were recruited. We compared the differences in the ear size, auriculocephalic angle, and conchal depth with those in the opposite ear, and the patients' satisfaction levels were investigated using a survey. Results: The difference in the sizes of the two ears was less than or equal to 5 mm in 32 patients, 5 to 10 mm in 10 patients, and greater than or equal to 10 mm in 5 patients. The difference in the auriculocephalic angles of the two ears was less than or equal to 10 degrees in 14 patients, 10 to 20 degrees in 26 patients, and greater than or equal to 20 degrees in 7 patients. The difference in the conchal depths of the two ears was less than or equal to 5 mm in 24 patients, 5 to 10 mm in 19 patients, and greater than or equal to 10 mm in 4 patients. The average grade of 3.9 points out of 5 points was obtained by the patients with satisfactory surveys. Conclusion: We could make enough protrusion and maintain the three-dimensional shape for a long time to satisfy our patients.
Vocal hyperfunction is considered to be the most significant characteristic in larynx disorders which is found among many patients presenting hoarseness Primarily as chief complaint. In Pusan National University Hospital, we executed the voice therapy to 28 patients being 17 female and 11 male patients who visited the Voice & Speech Therapy Clinic, due to the voice disorder, and then compared and analysed the voice before and after its therapy using acoustic and aerodynamic test. The obtained results were as follows. In the analysis by the local findings, it was improved to 88% in the patients of vocal nodule, 75% in mutational falsetto, 75% in the functional dysphonia, 75% in the vocal cord palsy, 50% in the vocal polyp and 50% in dysphonia plica ventricularis. For the acoustic analysis, Fo, litter, Shimmer and NHR were measured. In the patients of mutational falsetto, Fo, Jitter and NHR were shown to be improved significantly and in the patients of vocal nodule, Shimmer was shown to be improved significantly. In the patients of vocal polyp, Fo was significantly improved. In the patients of vocal cord palsy in litter and NHH were significantly improved. In the patients of dysphonia plica ventricularis, Shimmer and NHR were significantly improved and the patients of functional dysphonia were more improved in Fo, litter and Shimmer. For the aerodynamic analysis, MPT was measured. In particular, it was shown to be improved significantly in the patients of vocal nodule, improved in the vocal polyp, vocal cord palsy, functional dysphonia patients.
Background : Even though there were developments in various treatment techniques for acute arterial occlusion this disease still has high rate of mortalities and limb amputations. We investigated the combined diseases symptoms location of occlusion type of treatment complication and prognosis in our patients. Meterial and methods: This study recruited 48 patients(42 men, 6 women, mean age 57.7 years) who received the operation from January 1995 toDecember 1998. We investigated the post-operation course via medical record review or telephone interview with patients or their family members. Result: The most common combined diseases were atherosclerosis in 30 patients. other diseases were 17 diabetes mellitus 16 hypertension and 12 atrial firillation. Pain and clod sensation were noticed in all patients paresthesia in 5 patients fibrillation. Pain and cold sensation were noticed in all patients paresthesia in 5 patients and lower extremity paralysis in 11 patients. In 29 patients the time interval from the onset of symptom to admission was over 72 hours and 15 patients were admitted within 24 hours. The distribution of arterial occlusion location was at 28 femoral arteries 14 popliteal arteries and 6 iliac arteries. All the patients were received embolectomy and 5 patients were received additional bypass grafting. Postoperative complications were 12 reocclusions. 6 compartment syndromes 6 skin necrosis and 2 acute renal failure. The mortality rate was 16.7%(8/48) and the amputation rate was 25% Conclusion : This study revealed 25% reocclusion 25% limb amputation and 16.7% mortaliyt. To improve the prognosis of acute lower extrements arterial occlusion early diagnosis and understand the underlying diseases prompt treatment and operation additional operation including interventional radiologic examination and thorough postoperative care would be appreciated.
Clinical data about vocal nodules have seldom been reported, even though vocal nodules are commonly diagnosed in outpatient speech and voice clinic. This study aims to investigate clinical characteristics of the patients who are diagnosed with vocal nodules. This study analyzed the data for 10 years from the 319 patients diagnosed with vocal nodules (45 males and 274 females with the mean age of 39.4 ranging from 2 to 83) in terms of gender, age, occupation, voice change initiation pattern, change with time, throat clearing, smoking history, type of voice abuse, acoustic analysis, maximum phonation time, GRBAS, and VHI. Thirteen patients (4.08%) had unilateral vocal nodule and 306 patients (95.9%) had bilateral vocal nodule, the majority of which had a pattern of asymmetry (73.9%). The glottal closure pattern was hourglass in 72.1% of patients, posterior chink in 17.9% of patients, and irregular in 7.9% of patients. The most common occupational category was professional voice users (43.4%). The voice abuse pattern included excessive talking in 96 patients (76.8%), loud voice in 78 (62.4%) patients, and excessive singing in 17 patients (21.6%). The patients showed worse scores in G, B, and S than in R and A for the GRBAS evaluation. The most recommended treatment for vocal nodules was voice therapy. The current clinical data will be helpful for treatment planning for the patients of vocal nodule.
The purpose of this study was to provide fundamental data for nursing intervention by assessing self-esteem and quality of life(QL) in patients on hemodialysis and peritoneal dialysis. The subjects of this study were 60 patients on hemodialysis at H university medical center in Seoul and 56 patients on peritoneal dialysis at B company. The analysis was done by using t-test, ANOVA, Scheffe and Stepwise multiple regression. The results were as follows: 1. The average self-esteem score was significantly higher in patients on hemodialysis (27.98) than in patients on peritoneal dialysis (25.64). And there were no statistically significant differences between patients on hemodialysis(128.45) and patients on peritoneal dialysis(122.83) in the scores on QL. Among four factors of QL, hemodiaysis patients showed higher score than peritoneal dialysis patients in all factors. But, only family had statiscally significant differences. Also family showed the highest score in both groups, but psychomental showed the lowest score. 2. In patients on hemodialysis, self-esteem was significantly different by occupation(t=3.122, p=.003) and in patients on peritoneal dialysis by age(F=4.450, p=.007), education level(F=7.458, p=.001) and occupation (t=2.491, p=.017). Also in patients on hemodialysis, QL was significantly different by occupation(t=2.223, p=.033) and in patients on peritoneal dialysis by education level(F=4.007, p=.024), and occupation (t=2.806, p=.007). 3. Self-esteem accounted for 36.3% of variance in QL and monthly income accounted for an additional 6.1% of QL in hemodialysis patients by means of stepwise multiple regression analysis. In peritoneal patients, self-esteem accounted for 65.1% and monthly income accounted for an additional 2.7% in QL.
This report documents the clinical k pathologic features of 33 patients treated for thymoma for 11 years & 6 months between September 1977 and February 1989. At the Thoracic & Cardiovascular Surgery, Yonsei University, College of Medicine of the group, 31 patients treated with surgery were examined for the result of operation & prognosis. Mean age was 50 years. Thirteen were female and twenty were male. Dyspnea on exertion and chest discomfort were common in the patients without myasthenia gravis. Fourteen patients[42.6%] had myasthenia gravis and one patient had autoimmune thyroid disease. Four patients[12.1%] presented without symptoms attributable to their thymoma. Histologic review disclosed 12[36.4%] epithelial thymoma, 10[30.3%] mixed lymphoepithelial, 9[27.3%] lymphocytic, 1[3.0%] spindle cell and 1[3.0%] unknown cell thymoma. They were classified according to Masaoka`s clinical staging criteria; by these criteria, 8 patients were stage I, 5 patients were stage II, 15 patients were stage III and 3 patients were stage IV. Total excision of mass was possible in 20 patients. Partial excision of mass in 4 patients and biopsy in 7 patients were carried out during the operation. There was only one operation mortality. Follow-up was possible in 26 patients and follow-up ranged from 4 months to 10.5 years[mean 28.9 months]. One-year survival rates were 77.8% and eight patients expired during follow-up period. Eleven[78.6%] patients with myasthenia gravis were improved after the operation. This observation suggests that the most significant factor determining the survival is whether or not total surgical excision had been performed.
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