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The Study on the Contents and Satisfaction of Oriental Medicine Examination Program (한방건강검진 프로그램의 내용과 참가자들의 만족도에 관한 연구)

  • Lee Eun-Kyoung;Jahng Doo-Sub;Song Yung-Sun;Lee Ki-Nam
    • Journal of Society of Preventive Korean Medicine
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    • v.6 no.1
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    • pp.51-95
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    • 2002
  • 1. As a point at issue of occidental medicine examination, followings have been indicated, 1) Occidental medical examination is performed by mainly test and instrument and therefore, role of doctors could be excluded and it could be diagnosed only for target disease and 2) in Korea, it could not be conducted in public medical system and therefore improvement effect of public health promotion could not be made due to increase of total medical expenses and infirmity of post management. These points are substantial limit of paradigm resided in occidental medicine and also problem caused by unique characteristics of medical system of Korea. In Korea, result of occidental medical examination show increased health risk from aged thirties and major diagnosed diseases are circulatory disease or chronic disease such as hepatic, hyperlipemic, hypertensional disease and diabetes, etc. Accounting that those chronic disease make a role as major public health risk, it is difficult that medical examination by only occidental medicine make effect on public health promotion. 2. Characteristics of oriental medicine examination could be summarized as diagnosis (information acquisition based on the facts) and demonstration (speculation based on acquired information) and in addition, quadruple diagnosis, as a medical examination method, include test as well as basic examination. Accounting on oriental medical examination, principally it is performed by independent herbalist and therefore, herbalist could acquire systemic result during first medical examination. Based on the theory of inner-outer examination, oriental medical examination has a principle of universe theory, systemic analysis of quadruple diagnosis, demonstration & reasoning. In addition, root of oriental medical examination could be found in pre-disease theory, a principal theory of oriental medicine. Pre-disease service could prove the advantage of oriental medicine in medical examination activities and therefore, it is needed that content of oriental medical examination should be actualized in current medical system. 3. In this study, oriental medical examination program, comprised of pulse-diagnosis, contrast muscular taking and medical consultation of herbalist is progressed communally with occidental medical examination. As pre-examination, questionary was given of general characteristics, health promoting life style, physical constitution and subjective symptom of musculoskeletal system. In addition, post-examination notification was given to subjects about health promoting control, physical constitution regimen and management of musculoskeletal system. During this study program, verification was conducted for input of acquired information and difference of each information after analysis and in addition, performed was analysis of factor influencing health promoting life style and musculoskeletal subjective symptom and evaluation of relationship of physical constitution and health promoting life study. In addition, it was verified of difference between musculoskeletal subjective symptom and result of muscle contrast picture evaluation. 4. Evaluation of oriental medical examination model is divided into 2 categories of oriental medical examination-consultation and result evaluation -post management. Oriental medical examination-consultation demands establishment of examination system, standardization of examination and establishment of examination form and in addition, it should be admitted as enlarged examination assists systemic quadruple diagnosis of herbalist not a key of oriental medical examination. In addition, information acquisition for research purpose should be performed according to the systemic research plan based on the separation of questionary for examination purpose and research purpose. For evaluation of the result, it was concluded that needed are result evaluation meets oriental medical system and post-notification system, informing health management information, based on examination result. 5. Accounting on satisfaction for oriental medical examination model, affirmative reply was much higher (66%) than negative (8.64%). Satisfaction of each area was in order of consultation of herbalist, systemic muscle contrast taking, pulse examination, post-notification and questionary fill-up and dissatisfaction was in order of post-notification, questionary fill-up, consultation of herbalist, systemic muscle contrast taking and pulse measurement. Satisfaction for collaborative examination of occidental and oriental medicine was over 60% and over 75% hope oriental examination would be included in later medical examination program. Based on this result, collaborative examination including occidental and oriental medicine could increase satisfaction of subjects for medical examination program.

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Determinants of IPO Failure Risk and Price Response in Kosdaq (코스닥 상장 시 실패위험 결정요인과 주가반응에 관한 연구)

  • Oh, Sung-Bae;Nam, Sam-Hyun;Yi, Hwa-Deuk
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.5 no.4
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    • pp.1-34
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    • 2010
  • Recently, failure rates of Kosdaq IPO firms are increasing and their survival rates tend to be very low, and when these firms do fail, often times backed by a number of governmental financial supports, they may inflict severe financial damage to investors, let alone economy as a whole. To ensure investors' confidence in Kosdaq and foster promising and healthy businesses, it is necessary to precisely assess their intrinsic values and survivability. This study investigates what contributed to the failure of IPO firms and analyzed how these elements are factored into corresponding firms' stock returns. Failure risks are assessed at the time of IPO. This paper considers factors reflecting IPO characteristics, a firm's underwriter prestige, auditor's quality, IPO offer price, firm's age, and IPO proceeds. The study further went on to examine how, if at all, these failure risks involved during IPO led to post-IPO stock prices. Sample firms used in this study include 98 Kosdaq firms that have failed and 569 healthy firms that are classified into the same business categories, and Logit models are used in estimate the probability of failure. Empirical results indicate that auditor's quality, IPO offer price, firm's age, and IPO proceeds shown significant relevance to failure risks at the time of IPO. Of other variables, firm's size and ROA, previously deemed significantly related to failure risks, in fact do not show significant relevance to those risks, whereas financial leverage does. This illustrates the efficacy of a model that appropriately reflects the attributes of IPO firms. Also, even though R&D expenditures were believed to be value relevant by previous studies, this study reveals that R&D is not a significant factor related to failure risks. In examing the relation between failure risks and stock prices, this study finds that failure risks are negatively related to 1 or 2 year size-adjusted abnormal returns after IPO. The results of this study may provide useful knowledge for government regulatory officials in contemplating pertinent policy and for credit analysts in their proper evaluation of a firm's credit standing.

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ATHEROSCLEROSIS, CHOLESTEROL AND EGG - REVIEW -

  • Paik, I.K.;Blair, R.
    • Asian-Australasian Journal of Animal Sciences
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    • v.9 no.1
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    • pp.1-25
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    • 1996
  • The pathogenesis of atherosclerosis can not be summarized as a single process. Lipid infiltration hypothesis and endothelial injury hypothesis have been proposed and investigated. Recent developments show that there are many points of potential interactions between them and that they can actually be regarded as two phases of a single, unifying hypothesis. Among the many risk factors of atherosclerosis, plasma homocysteine and lipoprotein(a) draw a considerable interest because they are independent indicators of atherogenicity. Triglyceride (TG)-rich lipoproteins (chylomicron and VLDL) are not considered to be atherogenic but they are related to the metabolism of HDL cholesterol and indirectly related to coronary heart disease (CHD). LDL can of itself be atherogenic but the oxidative products of this lipoprotein are more detrimental. HDL cholesterol has been considered to be a favorable cholesterol. The so-called 'causalist view' claims that HDL traps excess cholesterol from cellular membranes and transfers it to TG-rich lipoproteins that are subsequently removed by hepatic receptors. In the so-called 'noncausalist view', HDL does not interfere directly with cholesterol deposition in the arterial wall but instead reflects he metabolism of TG-rich lipoproteins and their conversion to atherogenic remnants. Approximately 70-80% of the human population shows an effective feedback control mechanism in cholesterol homeostasis. Type of dietary fat has a significant effect on the lipoprotein cholesterol metabolism and atherosclerosis. Generally, saturated fatty acids elevate and PUFA lower serum cholesterol, whereas MUFA have no specific effect. EPA and DHA inhibit the synthesis of TG, VLDL and LDL, and may have favourable effects on some of the risk factors. Phospholipids, particularly lecithin, have an antiatherosclerotic effect. Essential phospholipids (EPL) may enhance the formation of polyunsaturated cholesteryl ester (CE) which is less sclerotic and more easily dispersed via enhanced hydrolysis of CE in the arterial wall. Also, neutral fecal steroid elimination may be enhanced and cholesterol absorption reduced following EPL treatment. Antioxidants protect lipoproteins from oxidation, and cells from the injury of toxic, oxidized LDL. The rationale for lowering of serum cholesterol is the strong association between elevation of plasma or serum cholesterol and CHD. Cholesterol-lowing, especially LDL cholesterol, to the target level could be achieved using diet and combination of drug therapy. Information on the link between cholesterol and CHD has decreased egg consumption by 16-25%. Some clinical studies have indicated that dietary cholesterol and egg have a significant hypercholesterolemic effect, while others have indicated no effect. These studies differed in the use of purified cholesterol or cholesterol in eggs, in the range of baseline and challenge cholesterol levels, in the quality and quantity of concomitant dietary fat, in the study population demographics and initial serum cholesterol levels, and clinical settings. Cholesterol content of eggs varies to a certain extent depending on the age, breed and diet of hens. However, egg yolk cholesterol level is very resistant to change because of the particular mechanism involved in yolk formation. Egg yolk contains a factor of factors responsible for accelerated cholesterol metabolism and excretion compared with crystalline cholesterol. One of these factors could be egg lecithin. Egg lecithin may not be as effective as soybean lecithin in lowering serum cholesterol level due probably to the differences of fatty acid composition. However, egg lecithin may have positive effects in hypercholesterolemia by increasing serum HDL level and excretion of fecal cholesterol. The association of serum cholesterol with egg consumption has been widely studied. When the basal or control diet contained little or no cholesterol, consumption of 1 or 2 eggs daily increased the concentration of plasma cholesterol, whereas that of the normolipemic persons on a normal diet was not significantly influenced by consuming 2 to 3 eggs daily. At higher levels of egg consumption, the concentration of HDL tends to increase as well as LDL. There exist hyper-and hypo-responders to dietary (egg) cholesterol. Identifying individuals in both categories would be useful from the point of view of nutrition guidelines. Dietary modification of fatty acid composition has been pursued as a viable method of modifying fat composition of eggs and adding value to eggs. In many cases beneficial effects of PUFA enriched eggs have been demonstrated. Generally, consumption of n-3 fatty acids enriched eggs lowered the concentration of plasma TG and total cholesterol compared to the consumption of regular eggs. Due to the highly oxidative nature of PUFA, stability of this fat is essential. The implication of hepatic lipid accumulation which was observed in hens fed on fish oils should be explored. Nutritional manipulations, such as supplementation with iodine, inhibitors of cholesterol biosynthesis, garlic products, amino acids and high fibre ingredients, have met a limited success in lowering egg cholesterol.

Drinking Pattern and Nonfatal Injuries of Adults in Korea (성인에서 AUDIT와 손상의 연관성)

  • Yoo, In-Sook;Choi, Eun-Mi;Kwon, Ho-Jang;Lee, Sang-Gyu
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.13 no.4
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    • pp.1690-1698
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    • 2012
  • As alcohol use is one of the most important risk factors for injuries, this study was intended to clarify and evaluate any relationship between drinking patterns and the incidence rates/specific characteristics of injuries in adult populations, using a widely accepted tool, the Alcohol Use Disorders Identification Test (chronic alcohol drinking behaviors measurement, hereinafter the AUDIT) developed by the World Health Organization to help to assess the behaviors in a more accurate and reliable manner. This study used the data collected from the 2009 Korea National Health and Nutrition Examination Survey (KNHANES), in which 7,511 of 7,893 adult participants aged ${\geq}19$ years answered the questions about injuries, and excluding 104 non-respondents, 6,258 of participants in the questionnaire survey of drinking patterns were finally analyzed. The incidence rates and specific characteristics of injuries as classified by the AUDIT categories (i.e., body regions, types and mechanisms) were assessed and estimated in terms of their relative risk using t-test, ANOVA, and logistic regression. SPSS 19.0 statistical package software was employed for statistical analyses. These analyses indicate that the incidence rates of overall injuries were significantly higher in male respondents than in female respondents. The risks of alcohol use related injuries were 8.3 times higher in male respondents than in female ones. Regarding educational background, high school graduates showed the highest rates in the AUDIT with significant difference from the other groups. The married group and the group of respondents having monthly income estimated at KRW 2.01 to 3 million also showed the highest rates in the AUDIT compared to the other groups, indicating statistically significant difference. Significantly increased in problematic drinkers and those with alcohol dependence, the incidence rate of injuries body regions was 0.0371 in the head/neck, and with respect to the AUDIT and the mechanisms of external causes of injuries, transport accidents ranked first, followed by slippage, others, crash and fall. In regard to the classified types of injuries, it was statistically significant in others (e.g., laceration, contusion, addiction, or penetrating wound). In conclusion, the mechanisms of external causes of injuries as well as injuries attributed to alcohol use are very important, and a strategy is required to reduce such the injuries in the manner of decreasing the frequency of drinking after motivation by professional counsellors.

Sexuality, Contraception, and Induced Abortion among Adolescents and Young Adults in the Export Processing Zones of Korea (미혼여성의 성, 피임, 그리고 인공유산 - 수출공단지역의 사례연구)

  • 조성남
    • Korea journal of population studies
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    • v.19 no.1
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    • pp.93-122
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    • 1996
  • This is a study of the determinants of sexual, contraceptive, and abortion behavior among unmarried female adolescents and young adults, which has emerged as a growing and serious health problem in Korea. As part of a larger project, data were gathered in three export zones: Kuro (Seoul), Kumi (Kyngbuk) Masan Changwon (Kyongnam) ; and the study samples are regrouped into three categories: 1) factory workers, i.e. , the reference group serving as program participants, 2) entertainment workers, and 3) ob-gyn patients. This study indicates that entertainment workers are at highest risk of experiencing premarital sex, STDs, contraceptive failure, unwanted pregnancies, and induced abortion. Of them, 20 percent had STDs as a result of first sexual experience: and about seven tenths had two or more pregnancies due to the adoption of low-efficacy methods. The proportion of those who had ever been pregnant was 60 percent for the group as a whole: 36 percent for the program participants: 64 percent for the entertainment workers ; and 91 percent four the ob-gyn patients. These proportions are exactly the same for abortion in each group, which means that all pregnancies ended in induced abortion. Of the respondents who said that they were sexually active at the time of survey, abortions were very high: 1.6 for the program participants, 2.3 for the entertainment workers, and 1.9 for the ob-gyn patients. About 80 percent of the women had abortions during the first trimester, and two thirds of the first abortions took place between the ages of 20 and 23. About one fourth experienced post-abortion complication, which was highest among the program participants (39 percent). Sixty percent of those with complications visited a hospital or took medicine to treat the problem. Even after the experience of induced abortion, the use of contraception was very low, except among the entertainment workers, whose level of use reached 53 percent. The most obvious recommendation, arising from this research, is that 'good-quality' counselling and family planning services be established under the auspices of both national and local government, particularly targeted for the entertainment workers as well as the factory workers in various textile, electronic, manufacturing, and other industrial sectors. We believe that entertainment sectors should be restructured radically so that young women who work for amusement bars and other entertainment sectors obtain protection from the risk of having unwanted pregnancies, STDs, and induced abortion.

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Prioritizing Noxious Liquid Substances (NLS) for Preparedness Against Potential Spill Incidents in Korean Coastal Waters (해상 유해액체물질(NLS) 유출사고대비 물질군 선정에 관한 연구)

  • Kim, Young-Ryun;Choi, Jeong-Yun;Son, Min-Ho;Oh, Sangwoo;Lee, Moonjin;Lee, Sangjin
    • Journal of the Korean Society of Marine Environment & Safety
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    • v.22 no.7
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    • pp.846-853
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    • 2016
  • This study prioritizes Noxious Liquid Substances (NLS) transported by sea via a risk-based database containing 596 chemicals to prepare against NLS incidents. There were 158 chemicals transported in Korean waters during 2014 and 2015, which were prioritized, and then chemicals were grouped into four categories (with rankings of 0-3) based on measures for preparedness against incident. In order to establish an effective preparedness system against NLS spill incidents on a national scale, a compiling process for NLS chemicals ranked 2~3 should be carried out and managed together with an initiative for NLS chemicals ranked 0-1. Also, it is advisable to manage NLS chemicals ranked 0-1 after considering the characteristics of NLS specifically transported through a given port since the types and characteristics of NLS chemicals relevant differ depending on the port. In addition, three designated regions are suggested: 1) the southern sector of the East Sea (Ulsan and Busan); 2) the central sector of the South Sea (Gwangyang and Yeosu); and 3) the northern sector of the West Sea (Pyeongtaek, Daesan and Incheon). These regions should be considered special management sectors, with strengthened surveillance and the equipment, materials and chemicals used for pollution response management schemes prepared in advance at NLS spill incident response facilities. In the near future, the risk database should be supplemented with specific information on chronic toxicity and updated on a regular basis. Furthermore, scientific ecotoxicological data for marine organisms should be collated and expanded in a systematic way. A system allowing for the identification Hazardous and Noxious Substances (HNS) should also be established, noting the relevant volumes transported in Korean waters as soon as possible to allow for better management of HNS spill incidents at sea.

Relationship between Intake of Milk and Milk Products and Bone Health by Sex and Age-Group in Koreans - Using Data from the Korea National Health and Nutrition Examination Survey 2008~2011 (성별, 연령별에 따른 우유·유제품 섭취와 골 건강과의 관련성 - 2008~2011 국민건강영양조사 자료를 이용하여)

  • Baek, Sang Woo;Lee, Heon Ok;Kim, Hyun Ja;Won, Eun Sook;Ha, Young Sik;Shin, Yong Kook;Om, Ae Son
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.46 no.4
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    • pp.513-522
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    • 2017
  • This study was conducted to examine the relationships between milk and milk product intake and bone health. The data from the 2008~2011 Korean National Health and Nutrition Examination Survey (KNHANES) were used for data analysis. Subjects included 4,626 men and 6,144 women aged 19 to 64 years. Daily intake frequency of milk and milk products was obtained using a food frequency questionnaire and divided into two categories: less than one serving per day and more than one serving per day. Bone mineral density (BMD) values of total femur, femoral neck, and lumbar spine were compared based on daily intake frequency, and relationships between milk and milk product daily intake frequency and osteoporosis risk were evaluated based on logistic regression. In men aged 30~39, BMDs of total femur and femoral neck were significantly higher in the group that consumed milk more than one serving per day (P<0.05). Intake frequency of milk and milk products was also significantly related to both BMDs of total femur and femoral neck. The odds ratio (OR) for milk intake frequency (more than one serving per day) compared to intake frequency less than one serving per day was 0.36 [95% confidence interval (CI) 0.21~0.62], and the OR for milk and milk products intake frequency (more than one serving per day) was 0.49 (95% CI 0.28~0.86) in women aged 50~64. These results indicate that increased consumption of milk and its products is associated with reduced risk of bone health disease, and adequate intakes of milk and milk products might play an important role in maintaining optimum bone health. Further research on the causal relationship and dose-response association between milk intake and bone heath using prospective cohort data is required prior to applying the observed results to programs that prevent bone health problems.

An Exploratory Study on Marketing of Financial Services Companies in Korea (한국 금융회사 마케팅 현황에 대한 탐색 연구)

  • Chun, Sung Yong
    • Asia Marketing Journal
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    • v.12 no.2
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    • pp.111-133
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    • 2010
  • Marketing financial services used to be easier. Today, the competition in financial services is fierce. Not only has the competition become more intense, financial services have also changed structurally. In an environment with various customer needs and severe competitions, the marketing in financial services industry is getting more difficult and more important than before. However, there are still not enough studies on financial services marketing in Korea whereas lots of research papers have been published frequently in some international journals. The purpose of this paper is (1)to review the literature on financial services marketing, (2)to investigate current marketing activities based on in-depth interview with financial marketing managers in Korea, and (3)to suggest some implications for future research on the financial services marketing. Financial products are not consumer products. In fact, they are not products at all in the way product marketing is usually described. Nor are they altogether like services. The financial industry operates in a unique way, and its marketing tasks are correspondingly complex. However, the literature review shows that there has been a lack of basic studies which dealt with inherent characteristics of financial services marketing compared to the research on marketing in other industries. Many studies in domestic marketing journals have so far focused only on the general customer behaviors and the special issues in some financial industries. However, for more effective financial services marketing, we have to answer following questions. Is there any difference between financial service marketing and consumer packaged goods marketing? What are the differences between the financial services marketing and other services marketing such as education and health services? Are there different ways of marketing among banks, securities firms, insurance firms, and credit card companies? In other words, we need more detailed research as well as basic studies about the financial services marketing. For example, we need concrete definitions of financial services marketing, bank marketing, securities firm marketing, and etc. It is also required to compare the characteristics of each marketing within the financial services industry. The products sold in each market have different characteristics such as duration and degree of risk-taking. It means that there are sub-categories in financial services marketing. We have to consider them in the future research on the financial services marketing. It is also necessary to study customer decision making process in the financial markets. There have been little research on how customers search and process information, compare alternatives, make final decision, and repeat their choices. Because financial services have some unique characteristics, we need different understandings in the customer behaviors compared to the behaviors in other service markets. And also considering the rapid growth in financial markets and upcoming severe competition between domestic and global financial companies, it is time to start more systematic and detailed research on financial services marketing in Korea. In the second part of this paper, I analyzed the results of in-depth interview with 20 marketing managers of financial services companies in Korea. As a result, I found that the role of marketing departments in Korean financial companies are mainly focused on the short-term activities such as sales support, promotion, and CRM data analysis although the size and history of marketing departments to some extent show a sign of maturity. Most companies established official marketing departments before 2001. Average number of employees in a marketing department is about 58. However, marketing managers in eight companies(40% of the sample) still think that the purpose of marketing is only to support and manage general sales activities. It shows that some companies have sales-oriented concept rather than marketing-oriented concept. I also found three key words which marketing managers think importantly in financial services markets. They are (1)Trust in customer relationship, (2)Brand differentiation, and (3)Rapid response to customer needs. 50% of the sample support that "Trust" is the most important key word in the financial services marketing. It is interesting that 80% of banks and securities companies think that "Trust" is the most important thing, whereas managers in credit card companies consider "Rapid response to customer needs" as the most important key word in their market. In addition, there are different problems recognition of marketing managers depending on the types of financial industries they belong to. For example, in the case of banks and insurance companies, marketing managers consider "a lack of communication with other departments" as the most serious problem. On the other hand, in the case of securities firms, "a lack of utilization of customer data" is the most serious problem. These results imply that there are different important factors for the customer satisfaction depending on the types of financial industries, and managers have to consider them when marketing financial products in more effective ways. For example, It will be necessary for marketing managers to study different important factors which affect customer satisfaction, repeat purchase, degree of risk-taking, and possibility of cross-selling according to the types of financial industries. I also suggested six hypothetical propositions for the future research.

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Comparisons of Unicortical and Bicortical Lateral Mass Screws in the Cervical Spine : Safety vs Strength (경추부의 후관절 나사못 고정술에서 단피질삽입법과 양피질 삽입법 간의 특성에 관한 비교)

  • Park, Choon-Keun;Hwang, Jang-Hoe;Ji, Chul;Lee, Jae Un;Sung, Jae Hoon;Choi, Seung-Jin;Lee, Sang-Won;Seybold, Eric;Park, Sung-Chan;Cho, Kyung-Suok;Park, Chun-Kun;Kang, Joon-Ki
    • Journal of Korean Neurosurgical Society
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    • v.30 no.10
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    • pp.1210-1219
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    • 2001
  • Introduction : The purpose of this study was to analyze the safety, pullout strength and radiographic characteristics of unicortical and bicortical screws of cervical facet within cadaveric specimens and evaluate the influence of level of training on the positioning of these screws. Methods : Twenty-one cadavers, mean 78.9 years of age, underwent bilateral placement of 3.5mm AO lateral mass screw from C3-C6(n=168) using a slight variation of the Magerl technique. Intraoperative imaging was not used. The right side(unicortical) utilized only 14mm screws(effective length of 11mm) while on the left side to determine the length of the screw after the ventral cortex had been drilled. Three spine surgeons(attending, fellow, chief resident) with varying levels of spine training performed the procedure on seven cadavers each. All spines were harvested and lateral radiographs were taken. Individual cervical vertebrae were carefully dissected and then axial radiographs were taken. The screws were evaluated clinically and radiographically for their safety. Screws were graded clinically for their safety with respect to the spinal cord, facet joint, nerve root and vertebral artery. The grades consisted of the following categories : "satisfactory", "at risk" and "direct injury". Each screw was also graded according to its zone placement. Screw position was quantified by measuring a sagittal angle from the lateral radiograph and an axial angle from the axial radiograph. Pull-out force was determined for all screws using a material testing machine. Results : Dissection revealed that fifteen screws on the left side actually had only unicortical and not bicortical purchase as intended. The majority of screws(92.8%) were satisfactory in terms of safety. There were no injuries to the spinal cord. On the right side(unicortical), 98.9% of the screws were "satisfactory" and on the left side(bicortical) 68.1% were "satisfactory". There was a 5.8% incidence of direct arterial injury and a 17.4% incidence of direct nerve root injury with the bicortical screws. There were no "direct injuries" with the unicortical screws for the nerve root or vertebral artery. The unicortical screws had a 21.4% incidence of direct injury of the facet joint, while the bicortical screws had a 21.7% incidence. The majority of "direct injury" of bicortical screws were placed by the surgeon with the least experience. The performance of the resident surgeon was significantly different from the attending or fellow(p<0.05) in terms of safety of the nerve root and vertebral artery. The attending's performance was significantly better than the resident or fellow(p<0.05) in terms of safety of the facet joint. There was no relationship between the safety of a screw and its zone placement. The axial deviation angle measured $23.5{\pm}6.6$ degrees and $19.8{\pm}7.9$ degrees for the unicortical and bicortical screws, respectively. The resident surgeon had a significantly lower angle than the attending or fellow(p<0.05). The sagittal angle measured $66.3{\pm}7.0$ degrees and $62.3{\pm}7.9$ degrees for the unicortical and bicortical screws, respectively. The attending had a significantly lower sagittal angle than the fellow or resident(p<0.05). Thirty-three screws that entered the facet joint were tested for pull-out strength but excluded from the data because they were not lateral mass screws per-se and had deviated substantially from the intended final trajectory. The mean pull-out force for all screws was $542.9{\pm}296.6N$. There was no statistically significant difference between the pull-out force for unicortical($519.9{\pm}286.9N$) and bicortical($565.2{\pm}306N$) screws. There was no significant difference in pull-out strengths with respect to zone placement. Conclusion : It is our belief that the risk associated with bicortical purchase mandates formal spine training if it is to be done safely and accurately. Unicortical screws are safer regardless of level of training. It is apparent that 14mm lateral mass screws placed in a supero-lateral trajectory in the adult cervical spine provide an equivalent strength with a much lower risk of injury than the longer bicortical screws placed in a similar orientation.

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Esophageal Atresia and Tracheoesophageal Fistula in Korea - A National Survey of Its Members by the Korean Association of Pediatric Surgeons - (선천성 식도 무공증 및 기관식도 누공 - 대한 소아외과학회 회원을 대상으로 한 전국 조사 -)

  • Park, W.H.;Kwon, S.I.;Kim, S.C.;Kim, S.K.;Kim, W.K.;Kim, I.K.;Kim, J.E.;Kim, H.H.;Park, K.W.;Park, Y.S.;Song, Y.T.;Yang, J.W.;Oh, S.M.;Yoo, S.Y.;Lee, D.S.;Lee, M.D.;Lee, S.C.;Lee, S.K.;Lee, T.S.;Chang, S.I.
    • Advances in pediatric surgery
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    • v.1 no.2
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    • pp.149-161
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    • 1995
  • The first national survey on esophageal atresia and tracheoesophageal fistula was conducted to access the current status of its incidence, clinical manifestation, preoperative diagnosis and management, type of its anomaly, associated anomalies, and surgical results and course. The 43 members of the Korea Association of Pediatric Surgeons received questionnaires and registration forms to be filled out on each patient who were born during the three years from January 1, 1992 through December 31, 1994. Questionnaires composed of six broad areas which include 1) preoperative diagnosis and management, 2) surgical technic, 3) long gap, 4) postoperative management, and 5) complications and courses. A total of 148 cases was returned by 28 members working at 23 institutions and 27 members returned questionnaires. We obtained the following results by analysis of the 148 cases of tracheoesophageal anomalies. The incidence of tracheoesophageal anomaly was about 1/10,000-11,000 in 1994, which is one third of that of anorectal malformations in Korea and the distribution of the patients was almost proportionate to the size of each province. Both sexes are about equally affected. Majority of the members make diagnosis of tracheoesophageal anomaly by taking a simple infantogram with a radiopaque tube in upper pouch and a little under half(46%) prefers to perform echocardiography as a part of preoperative management to identify congenital heart disease and lateralize the aorta. Esophageal atresia with distal TEF(87.5%) was by far the most common and there were pure esophageal atresia(5.6%), H-type TEF(2.1%), and so on. About half(49%) of the patients had one or more associated anomalies in addition to tracheoesophageal anomalies. Congenital heart disease was associated in 46 cases(31%), anorectral malfomations in 19 cases(13%), musculoskeletal anomalies in 15 cases(10%), genitourinary anomalies in 10 cases(7%) and gastrointestinal anomalies in 7 cases(5%). Postoperatively, parenteral nutrition and assisted ventilation were given in 66% and 52% of patients respectively. Ninety three(74%) of 126 cases who underwent sugical procedure, experienced one or more complications such as respiratory complication(65%), leak(22%), stricture(21%) and so on. The survival rates related to the Waterston risk categories were 90.2% in group A, 71.4-75% in $B_1$, $B_2$, and $C_1$, groups, and 28% in group $C_2$, and the overall survival rate was 71.4%. Thirty six(28.6%) of 126 cases died of pneumonia/sepsis(12 cases), respiratory failure(12 cases), and congenital heart disease(4 cases). With short term follow-up, 69% of patients have been excellent whereas remainders of the cases have suffered from some sort of morbidity related to gastroesophageal reflux, recurrent respiratory infection, and esophageal stricture.

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