• Title/Summary/Keyword: mortality rate

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Requirements for Cerebrovascular Surgery in Comprehensive Stroke Centers in South Korea

  • Kim, Tackeun;Oh, Chang Wan;Park, Hyeon Seon;Lee, Kunsei;Lee, Won Kyung;Lee, Heeyoung
    • Journal of Korean Neurosurgical Society
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    • v.61 no.4
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    • pp.478-484
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    • 2018
  • Objective : Cerebrovascular disease (CVD) was the third most common cause of death in South Korea in 2014. Evidence from abroad suggests that comprehensive stroke centers play an important role in improving the mortality rate of stroke. However, surgical treatment for CVD is currently slightly neglected by national policy, and there is still regional imbalance in this regard. For this reason, we conducted a survey on the necessity of, and the requirements for, establishing regional comprehensive cerebrovascular surgery centers (CCVSCs). Methods : This investigation was performed using the questionnaire survey method. The questionnaire was consisted with two sections. The first concerned the respondent's opinion regarding the current status of demand and the regional imbalance of cerebrovascular surgery in South Korea. The second section asked about the requirements for establishing regional CCVSCs. We sent the questionnaire to 100 board members of the Korean Society of Cerebrovascular Surgeons. Results : Most experts agreed that cerebrovascular surgery patients were concentrated in large hospitals in the capital area, and 83.6% of respondents agreed that it was necessary to alleviate the regional imbalance of cerebrovascular surgery. With regards to personnel, over 90% of respondents answered that at least two neuro-vascular surgeons and two neuro-interventionists are necessary to establish a CCVSC. Regarding facilities, almost all respondents stated that each CCVSC would require a neuro-intensive care unit and hybrid operating room. The survey asked the respondents about 13 specific neurovascular surgical procedures and whether they were necessary for a regional CCVSC. In the questions about the necessity of cerebrovascular surgical equipment, all seven pieces of equipment were considered essential by all respondents. A further five pieces of equipment were considered necessary on site: computed tomographic angiography, magnetic resonance angiography, conventional angiography, surgical microscope, and surgical navigation. Our results may provide a basis for future policy regarding treatment of cerebrovascular disease, including surgery. Conclusion : Raising the comprehensiveness of treatment at a regional level would lower the national disease burden. Policies should be drafted regarding comprehensive treatment including surgery for cerebrovascular disease, and related support plans should be implemented.

Outbreak of Acinetobacter septicemia in a neonatal intensive care unit (신생아 집중치료실에서 집단 발생한 Acinetobacter septicemia)

  • Kim, Myo Jing;Lee, Hye Jin;Son, Sang Hee;Huh, Jae Won
    • Clinical and Experimental Pediatrics
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    • v.49 no.5
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    • pp.494-499
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    • 2006
  • Purpose : Acinetobacter baumannii is increasingly recognized as an important cause of nosocomial infection, especially in neonatal intensive care units. But little is known about the clinical significance and hospital epidemiology of Acinetobacter species other than A. baumannii. The objective of this study is to describe the clinical characteristics and epidemiology of septicemia due to Acinetobacter species other than A. baumannii. Methods : We retrospectively reviewed 11 cases of blood culture proven nosocomial infection which occured in our neonatal intensive care unit from $4^{th}$ to $24^{th}$, February, 2004. To establish epidemiological analysis, we performed environmental cultures and an antibiogram was obtained from susceptability tests of isolated Acinetobacter species. Results : Clinical manifestations including fever, poor feeding, abdominal distension, diarrhea, bloody stool passage, vomiting, tachypnea and apnea were similar to other infectious diseases. Benign clinical courses were compared with poor prognose, including a high mortality rate in septicemia due to A. baumannii. The major predisposing factor among our patients was the presence of a peripheral intravascular catheter. Antibiogram was similar, but surveillance cultures of environmental specimens failed to identify the source of infection. Conclusion : Acinetobacter species other than A. baumannii were often considered relatively avirulent bacteria, but could be pathologic organisms if cultured in patients with clinical symptoms.

An Overview on Severe Acute Respiratory Syndrome(SARS) in WHO Clinical Reports (중증급성호흡기증후군(SARS)의 한약 치료에 관련된 WHO 임상논문 보고에 대한 개관)

  • Jang, In-Soo;Hsing, Li-Chang;Han, Chang-Ho
    • The Journal of Internal Korean Medicine
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    • v.26 no.2
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    • pp.440-452
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    • 2005
  • Objective: In the winter of 2002, severe acute respiratory syndrome(SARS) began to spread throughout the world. More than 5,000 cases were reported in China, including over 1,700 cases in Hong Kong Special Administrative Region(Hong Kong SAR). The total number of cases reported from Canada and Singapore was more than 200. The total number of SARS cases world-wide reached 8,437 with incidences in 29 counties. Mortality from SARS is estimated at $10{\sim}12%$. When the SARS outbreak occurred in China, the State Administration of Traditional Chinese Medicine of China immediately initiated clinical research projects on the use of integrated herbal medicine and Western medicine for treating SARS. and, in Hong Kong SAR, research on the use of herbal medicine for the prevention and treatment of SARS. Reports were released during convalescence. The objective of this study is to overview twelve clinical SARS reports of WHO on the treatment of SARS with herbal medicine and evaluate the efficacy and safety of treatment of SARS with herbal medicine, and further to share experiences and knowledge of the treatment of SARS. Methods: Twelve clinical reports about SARS from the WHO were selected, overviewed and evaluated for efficacy and safety of treatments of SARS. Results and Conclusion: Twelve clinical reports about SARS showed that the integrated treatment may have advantages, and the advantages are reflected in the following findings: Firstly, herbal medicine is not targeted only at a specific etiology or a certain pathological link, but also at the pathological status of the patients at that particular time. Therefore, comprehensive readjustment was made through various angles, targets and channels to restore the balance of the body. Secondly, there are advantages in the differentiation of the disease and the treatment. Based on the various symptoms, herbal medicine enables the physician to adopt the most suitable principle, provide individual treatment, and to administer medicine in accordance with the actual process and nature of the illness. Thirdly, there are advantages in the results of the treatment; herbal medicine can relieve symptoms, promote absorption of lung inflammation, improve the degree of blood oxygen saturation, regulate immunological functions, reduce the required dosage of glucocorticoid and other Western medicines, and reduce case fatality rate, in addition to lowering the cost of treatment.

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Temporary Abdominal Coverage with Malex Mesh Prosthesis in Cases of Severely Injured Abdominal Trauma Patients (중증 외상환자에서 mesh를 이용한 일시적 수술창 봉합의 경험)

  • Kim, Yeon Woo;Jung, Yong Sik;Kim, Wook Hwan;Min, Young Gi;Kim, Ki Woon;Lee, Kug Jong
    • Journal of Trauma and Injury
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    • v.18 no.1
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    • pp.70-79
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    • 2005
  • Background: Abdominal compartment syndrome has multiple etiologies that are not only related to trauma but also any problem condition in the absence of abdominal injury. To determine whether prevention of the abdominal compartment syndrome after celiotomy for trauma victims justifies the use of temporary abdominal coverage with monofilament knitted polypropylene mesh (Malex mesh) in severely injured patients. Method: Medical records at the Ajou University Medical Center were reviewed for a 32-month period from May 1st, 2002 to December 31st, 2004. Twenty-nine consecutive patients requiring celiotomy who were survived until at the end of celiotomy received temporary abdominal coverage and staged abdominal repairs with Malex mesh. One of them was dissecting aortic aneurysm patient and the others were all trauma victims. Malex mesh prosthesis coverage was used in cases of abdominal compartment syndrome due to excessive fascial tension, severe bowel edema and retroperitoneal hemorrhage or edema followed by staged abdominal repairs. Result: Eighteen of twenty-nine patients were survived. Demographic characteristics, injury severity number of abdominal-pelvic bone injuries, mortality rate, complications, number of operations for permanent closure, required time for permanent closure showed no difference between man and women or child and adult. Except one dissecting aortic aneurysm patient, trauma cases showed $3.24{\pm}0.98$ injury sites. All cases that received temporary abdominal coverage and staged abdominal repairs did not show abdominal compartment syndrome. $10.08{\pm}5.85$ days and $2.27{\pm}0.82$ times of operation required making permanent abdominal closure after temporary abdominal coverage followed by staged abdominal repairs. Most of surviving patients have shown antibiotic-resistant organism and fungus infection. Patients who received permanent closure recovered from infectious problem completely. Conclusion: The use of Malex mesh for temporary abdominal coverage in severely injured patients undergoing celiotomy was effective treatment method.

Clinical Analysis of Patients with Multiple Organ Injuries Who Required Open thoracotomy (개흉술이 필요했던 다발성 외상환자에 대한 임상적 고찰)

  • 이성광;정성운;김병준
    • Journal of Chest Surgery
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    • v.31 no.8
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    • pp.804-810
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    • 1998
  • Background: Multiple trauma patients have rapidly increased due to traffic accidents, industrial disasters, incidental accidents, and violence. Multiple trauma can involve injuries to the heart, lung, and great vessels and influence the lives, necessitate prompt diagnosis and treatment. Most of the thoracic injuries can be managed with conservative method and simple surgical procedures, such as closed thoracostomy, but in certain cases open thoracotomy is necessary. Materials and methods: The author analyzed the surgical result of 70 cases of open thoracotomy after multiple organ injury including thoracic organ. Results: The most common type of thoracic lesion was hemothorax with or without pneumothorax and diaphragmatic rupture was the second. Sixty percent of the patients were associated with bone fractures, 42.9% with abdominal injuries, and 37.1% with head injuries. The modes of operation were ligations of torn vessels for bleeding control(48.6%), repair of diaphragm(35.7%), and repair of lung laceration(25.7%) in this order of frequency and additional procedures were splenectomy(14.3%), hepatic lobectomy (8.6%) and repair of liver lacerations(5.7%). Postoperative complications were atelectasis (8.6%), wound infection (8.6%), and pneumonia(4.3%). Postoperatively six patients died(The mortality rate was 8.6%) and the causes of death were respiratory failure(2), acute renal failure(2), sepsis(1), and hypovolemic shock(1).

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Clinical Analysis of the Chest Trauma (흉부 손상의 임상적 고찰)

  • 이재덕;이계선
    • Journal of Chest Surgery
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    • v.29 no.1
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    • pp.79-85
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    • 1996
  • A clinical evaluation was performed on 305 cases of chest trauma experienced at the department of the Thoracic and Cardiovascular Surgery, Dae Jeon Eul Ji Hospital, during the period from March 1991 to November 1994. Age distribution was from 4 to 85 years, the mosts common age groups were 4-th, 5th and 6th decades. The ratio of male to female was 229:76(3:1), the ratio showed male predominance, the most common cause of trauma was traffic accidents in nonpenetrating trauma and stab wounds in penetrating trauma. Hemothorax, pneumothorax, and hemopneumothorax were observed in 159 cases (52.1 %) of total cases, Rib fracture was observed in 236 cases (77.4%) of total cases, location distribution was right : left : Both (102 : 142 : 45), with left predominant, rib fracture commonly involved from the 3th to 8th rib. Lag period from accident to admission was 155 cases (50.8%) under 6hr The principles of therapy for early complications of chest trauma were rapid r expansion of the lungs by thoracentesis 5 cases(1.6%) and closed thoracostomy 1-42 cases(46.6%), but open thoracotomy had to be done on 17 cases (5.6%) because of massive bleeding 13 cases or ruptured diaphragm, foreign body. Conservative nonoperative treatment was 140 cases (45.9%). Overall mortality rate was Bcases (2.6%) and common causes of the death were respiratory insufficiency and shock.

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Clinical Outcomes of Surgical Repair with a Composite Graft for Abdominal Aortic Aneurysm Accompanied by Iliac Artery Aneurysm

  • Sohn, Bongyeon;Kim, Hak Ju;Chang, Hyoung Woo;Lee, Jae Hang;Kim, Dong Jung;Kim, Jun Sung;Lim, Cheong;Park, Kay Hyun
    • Journal of Chest Surgery
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    • v.53 no.6
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    • pp.339-345
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    • 2020
  • Background: Iliac artery aneurysm is frequently found in patients undergoing surgical repair of an abdominal aortic aneurysm. The use of commercial bifurcated grafts is insufficient for aorto-biiliac replacement with complete iliac artery aneurysm resection. We evaluated the effectiveness of handmade composite grafts for this purpose. Methods: A total of 233 patients underwent open surgery for abdominal aortic aneurysm between 2003 and 2019, including 155 patients (67%) treated with commercial grafts and 78 patients (33%) treated with handmade composite grafts. Their operative characteristics, postoperative outcomes, and late outcomes were retrospectively reviewed. Results: The early mortality rate did not differ significantly between the groups. On average, the handmade composite graft technique took approximately 15 minutes longer than the commercial graft technique (p=0.037). Among patients who underwent elective surgery, no significant differences between the conventional and composite groups were observed in the major outcomes, including red blood cell transfusion volume (2.8±4.7 units vs. 3.1±4.7 units, respectively; p=0.680), reoperation for bleeding (2.7% vs. 3.1%, respectively; p>0.999), bowel ischemia (0% vs. 1.6%, respectively; p=0.364), and intensive care unit stay duration (1.9±6.6 days vs. 1.6±2.4 days, respectively; p=0.680). The incidence of target vessel occlusion also did not differ significantly between groups. Conclusion: The increased technical demand involved with handmade composite grafting did not negatively impact the outcomes. This technique may be a viable option because it overcomes problems associated with commercial grafts.

Estimation of THI Index to Evaluate Thermal Stress of Animal-occupied Zone in a Broiler House Using BES Method (BES 기법을 이용한 육계사 내부 고온 스트레스 평가를 위한 THI 지수 모의)

  • Ha, Taehwan;Kwon, Kyeong-seok;Hong, Se-Woon;Choi, Hee-chul;Lee, Jun-yeob;Lee, Dong-hyun;Woo, Saemee;Yang, Ka-young;Kim, Rack-woo;Yeo, Uk-hyeon;Lee, Sangyeon;Lee, In-bok
    • Journal of The Korean Society of Agricultural Engineers
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    • v.60 no.2
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    • pp.75-84
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    • 2018
  • Thermal stress of livestock has been issued due to recent climate change trends and this causes reproductive disorders, decreased feed consumption, immunosuppression, and increased mortality of animals. Concept of THI has been widely used to quantitatively evaluate the degree of thermal stress for animals, however use of this concept is restricted for animals living in the enclosed facilities such as mechanically ventilated broiler houses. In this study, time-based internal energy flow and variation trends of temperature and humidity were analyzed based on BES technique. Local weather data, insulation characteristics of building materials, heat and moisture generation rate from broilers according to age, algorithm of ventilation operation were adopted for boundary condition of the model to accurately compute THI values inside the mechanically ventilated broiler house. From the BES computation, excess frequency of THI threshold in Jeju city was highest on the assumption that air conditioning equipments were not installed. When general raising density ($39kg\;m^{-2}$) was adopted, total 2,191 hours were exceeded. Excess hours of THI threshold were strongly related to the cumulative air temperature ($R^2=0.87$).

Aerial Application Tests with Some Low toxicity Insecticides Against the Fall Webworm, Hyphantria cunea Drury (Lepidoptera: Arctiidae) (저독성약제(低毒性藥劑)를 이용(利用)한 미국흰불나방의 항공방제효과(航空防除效果))

  • Chung, Sang-Bai;Ko, Je-Ho
    • Korean Journal of Environmental Agriculture
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    • v.4 no.2
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    • pp.108-113
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    • 1985
  • Aerial application tests with a biological insecticide (Thuricide$^{(R)}$) and two low toxicity insecticides, Diflubenzuron (Dimilin$^{(R)}$) and Triflumuron (Alsystin$^{(R)}$) were carried out against the fall webworm (Hyphantria cunea Drury). For experimental application by helicopter, dilutions of 30x and 45x Thuricide, 180x and 240x Alsystin, and 180x Dimilin were utilized. The solutions were applied at a rate of 30 liters per hectare. The results are as follows: 1) All treatments, Dimilin 25% wp, Thuricide wp, and Alsystin 25% wp, were found to very effec tive against fall webworm larvae. Percentages of mortality averaged between 93.9% and 97%. 2) No significant differences in percentages of larval kill were found between dilutions of Thuricide (30x and 45x) or Alsystin (180x and 240x). 3) Assessment of parasite densities in the treated areas 35 days after treatment indicated that percentages of reduction for all five species found, including Brachymeria lasus(Walker) (=obscurata [Walker]), were lower than for areas treated with the conventional insecticide Diplox$^{(R)}$ (trichlorfon) 25% wp. In particular, the percentage of reduction in Thuricide-treated areas was only 21% as compared with the untreated (control) areas. 4) Aerial applications of Dimilin were very effective and economical for control of the fall webworm by comparison with [aerial] applications of Thuricide.

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Control Effects of Imicyafos GR against Two Species of the Root-knot Nematodes (Meloidogyne incognita and Meloidogyne hapla) (살선충제 Imicyafos 입제의 2종 뿌리혹선충에 대한 방제 효과)

  • Kim, Hyeong Hwan;Jung, Young Hak;Kim, Dong Hwan;Ha, Tae Ki;Yoon, Jung Beom;Park, Chung Gyoo;Choo, Ho Yul
    • The Korean Journal of Pesticide Science
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    • v.19 no.2
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    • pp.101-105
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    • 2015
  • Efficacy of novel nematicide, imicyafos GR was evaluated against two species of the root-knot nematodes in pot and greenhouse conditions. When tested in pots, the population of Meloidogyne incognita and M. hapla was reduced sixty days after treatment, with mortality rate of 91.5% and 90.6%, respectively. Suppression effect of imicyafos GR on root galling in tomato was tested. The number of root galls caused by M. incognita and M. hapla was reduced 60 days after nematode inoculation, with the efficacy of 94.2% and 95.1%, respectively. Under greenhouse conditions planted with watermelon, melon, cucumber, and tomato, the efficacy of imicyafos GR on M. incognita persisted up to 60 days after treatment, showing 90% of control efficacy. Moreover, the number of root galling was more reduced than fosthiazate treatment, with the potential as a control agent.