• Journal of Chest Surgery
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• v.42 no.3
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• pp.331-336
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• 2009

Background: Open surgical repair of abdominal aortic aneurysms was initiated by Dubost in 1952. Despite the rapid expansion of percutaneous endovascular repair, open surgical repair is still recognized for curative intent. We retrospectively analyzed surgical outcome, complications, and mortality-related factors for patients with abdominal aortic aneurysms over a 6 year period. Material and Method: We analyzed 18 patients who underwent surgery for abdominal aortic aneurysms between March 2002 and March 2008. The indications for surgery were rupture, a maximal aortic diameter >60 mm, medically intractable hypertension, or pain. Result: The mean age was $66.6{\pm}9.3$ years (range, $49\sim81$ years). Twelve patients (66.7%) were males a 6 patients were females. Extension of the aneurysm superior to the renal artery existed in 6 patients (33.3%), and extension to the iliac artery existed in 13 patients (72.2%). Five patients (27.8%) had ruptured aortic aneurysms. The mean maximal diameter of the aorta was $72.2{\pm}12.9$ mm (range, $58\sim109$ mm). Surgery was performed by a midline laparotomy, and 6 patients underwent emergency surgery. The mean total ischemic time from aorta clamping to revascularization was $82{\pm}42$ minutes (range, $35\sim180$ minutes). The mortality rate was 16.7%; the mortality rate for patients with ruptured aneurysms was 60%, and the mortality rate for patients with unruptured aneurysms was 0%. The postoperative complications included one each of renal failure, femoral artery and vein occlusion, and wound infection. The patients who were discharged had a long-term survival of $34{\pm}26$ months (range, $4\sim90$ months). Rupture and emergency surgery had a statistically significant mortality-related factor (p < 0.05). Conclusion: Emergency surgery for ruptured aortic aneurysms continues to have a high mortality, but unruptured cases are repaired with relative safety. Successfully operated patients had long-term survival. Even though endovascular aortic repair is the trend for abdominal aortic aneurysms, aggressive application should be determined with care. Experience and systemic support of each center is important in the treatment plan.

• Journal of Chest Surgery
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• v.38 no.1 s.246
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• pp.56-62
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• 2005

Because of high morbidity and mortality, traumatic diaphragm injury remains a diagnostic challenge. In this study, we evaluate that some factors and scores can be used as predictors. Material and Method: From May 1995 to June 2003, 23 patients with traumatic diaphragm injury were enrolled. We examined the clinical features of patients. RTS, TRISS, ISS and APACHE II scores for each patient are calculated for analyzing the relationship of mortality and ICU duration. Result: The study identified 15 men $(65.2{\%})$ and 8women $(34.8{\%})$. There are right sided diaphragmatic injury in 11 patients $(47.8{\%})$, left sided in 11 $(47.8{\%})$, and both sided in 1 ($0.4{\%}$). Plain X-ray, CT, upper GI contrast study and esophagogastroscopy were used as diagnostic tools. Age, hemodynamic status, early diagnosis are not associated with outcome. As prognostic factor, RTS and ISS are associated with mortality and there was negative relationship between RTS and ICU duration (r=0.737, p=0.026). Conclusion: An early diagnosis of traumatic diaphragm injury can frequently be missed in the acute trauma setting. So high index of suspicion and a careful examination are important in multiple trauma patients. An RTS can probably be used effectively as a predictor for the severity and prognosis in patients with traumatic diaphragm injury.

• Journal of Chest Surgery
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• v.42 no.1
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• pp.14-21
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• 2009

Background: Postoperative atrial fibrillation (AF) is a common complication after coronary artery bypass graft (CABG) surgery. Although postoperative AF is regarded as benign, transient and self-limited, it has been associated with increased morbidity, thromboembolic events and an increased duration and cost of hospitalization. Material and Method: From January 1994 to December 2007, 190 patients that had isolated CABG surgery were divided into two groups. Group 1 (n=139) involved those who had postoperative atrial fibrillation, and group 2 (n=51) did not have any such events. We reviewed the medical records retrospectively including the incidence of postoperative AF, patient characteristics, surgery related factors and the outcome of the patients with postoperative AF. Result: The frequency of postoperative AF was 26.8%, the conversion rate to regular sinus rhythm before discharge was 82.4%; 82.4% of the AF developed within the first three postoperative days. Although the postoperative AF group was significantly older and had a prolonged postoperative Intensive care unit (ICU) stay, there was no difference in the aortic crossclamp time or duration of hospitalization. No spontaneous defibrillation at declamping, and longer duration of cardiopulmonary bypass were significantly related to the development of postoperative AF. However, postoperative treatment with a beta blocker was associated with a decreased incidence of postoperative AF. The multivariate analysis showed that age and ICU stay were significantly associated with the development of POAF. Spontaneous defibrillation and postoperative beta blocker treatment were significantly associated with a decreased frequency of POAF. Conclusion: AF after CABG surgery is a common complication associated with increased morbidity and a longer ICU stay. Therefore, various strategies aimed at reducing AF, and its complications, such as postoperative treatment with a beta blocker should be considered.

• Clinical and Experimental Pediatrics
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• v.48 no.9
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• pp.929-934
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• 2005

Purpose : This study describes how often complementary and alternative medical(CAM) therapies, what patterns of CAM therapies utilization, what types of CAM therapies and why CAM therapies are used in children and adolescent with chronic disease. Methods : We interviewed and filled out questionnaires with parents of patients suffering from asthma, atopic dermatitis, congenital myopathy, epilepsy and so on from Mar 2004 to Aug 2004. Results : Two hundred fifty two parents answered questionnaires; 160 cases(63.5 percent) had used CAM therapies. Utilization of CAM therapies according to each chronic disease was as follows : congenital myopathy(100 percent), atopic dermatitis(91.1 percent), asthma(72.5 percent), chronic diarrhea (50.0 percent), epilepsy(17.1 percent) etc. Types of CAM therapy were as follows : dietary supplement (31.1 percent), herb medicine(23.4 percent), massage(14.2 percent), acupuncture(4.6 percent) etc. Sixty four(40.0 percent) case underwent more than two types of CAM therapies simultaneously. One hundred thirty three(83.1 percent) case were asked through non-medical prescription. Ninety nine(61.9 percent) case were recognized positive effect of CAM therapies. Parents' and childrens' ages were influential factors in CAM therapies utilization : the older the parents and the younger the children, the higher the utilization. Conclusion : Although patients receive treatment with western medicine, many of them not only undergo CAM therapies, especially more than two types, but also recognize the positive effects of CAM therapies. As a result, we suggest that it is easy to use of CAM therapies, and the positive effects of CAM therapies are prominent, domestically. Therefore, medical approach and study about the effectiveness and side effects of CAM therapies is necessary to avoid the imprudent use of such therapies.

• Clinical and Experimental Pediatrics
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• v.48 no.10
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• pp.1082-1089
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• 2005

Purpose : Abdominal obesity is encountered as a risk factor for cardiovascular diseases. However, the anthropometric cut-off value to estimate the cardiovascular risk, has not been suggested. This study was designed to find the relationship between the abdominal fat and various parameters of obesity to find the cardiovascular risk factors related to abdominal obesity and to establish practical methods to measure them. Methods : Twenty seven obese Korean adolescents of moderate to severe degree and 22 healthy adolescents were enrolled. The body mass index(BMI), arm circumference and skinfold thickness were measured. Furthermore, blood lipid, sugar, insulin and four different cytokines' levels were checked and the distribution of body composition was measured by bioelectrical impedance analysis. The subcutaneous and intra-abdominal fat thickness by abdominal ultrasonography(US) and the total and intra-abdominal fat area by abdominal computerized tomography(CT) were measured in the obese group. Results : The most accurate method to measure abdominal fat in children is abdominal CT and the fat mass measured by bioelectrical impedance was strongly correlated with it(r=0.954). It was also correlated with arm circumference, fat thickness measured by abdominal US, BMI, aspartate aminotransferase(AST), alanine aminotransferase(ALT) and triglyceride level. Conclusion : Abdominal CT is the most accurate method to measure intra-abdominal fat, and it can be replaced by abdominal US for cost effectiveness. The screening methods that can be used at school or in outpatient basis include bioelectrical impedance, waist/hip ratio, and arm circumference. The cardiovascular risk factors include leptin, triglyceride and insulin level.

• Journal of the Korean earth science society
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• v.26 no.1
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• pp.93-105
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• 2005

Climatological characteristics in the variation of soil temperatures in Korea were investigated using Korea Meterological Administration's observation data. And the impacts of soil moisture on the variation of soil temperature were examined using observed precipitation data. The climatological averages of soil temperatures are ranged from 14.4 to $15.0^{\circ}C$ regardless of depths. And they showed an latitudinal gradient with a warm temperature at the southern region and 'U' shape as in the air temperature with a high value along the coastal region. The relatively higher heat capacity and low conductivity of soil compared to those of the air resulted in the significant delay of the maximum and minimum date with depth. As a results, soil acts as a heat source during winter while a heat sink during summer. Global warming and urban heat island have increased the soil temperatures with an average rate $0.3\~0.5^{\circ}C/10-year$ as in the air temperature during last 30 years $(1973\~2002)$. However, the warming rate is maximized during spring contrary to the winter in the air temperature. The temporal variation of soil temperatures is strongly affected by that of soil moisture through an modification of the heat capacity and heat convection. In general, the increased soil moisture clearly decreased the temporal variations and increased the deep layer soil temperatures during cold season.

• Journal of Gastric Cancer
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• v.7 no.4
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• pp.248-253
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• 2007

Purpose: Surgical wound complications remain a cause of morbidity and mortality among postoperative patients, and the cost of caring for patients with a surgical wound complication is substantial. The purpose of this study was to evaluate the ability of a vinyl wound protector to reduce the rate of wound complications when used in clean-contaminated surgery. Materials and Methods: Between May 2006 and September 2006, 295 patients with a gastric cancer that underwent gastric surgery were studied prospectively, and the patients were randomized into one of two groups: the no wound protector group (n=137) or the polyethylene protector group (n=132). Results: The demographics and operation type and operation time were similar for patients in both groups. The rate of wound complication was different between patients in the no protector group (n=42) and the polyethylene protector group (n=12) (P=0.001) and the rates of seroma (P=0.001), infection (P=0.030) and dehiscence (P=0.282) were different for the two groups. The postoperative hospital stay was significantly shorter in the polyethylene protector group of patients (P=0.040). Conclusion: The use of a polyethylene protector resulted in a reduction of the surgical wound complication rate, and the cost of caring for patients, and morbidity and mortality among postoperative patients could be reduced.

• Clinical and Experimental Pediatrics
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• v.49 no.3
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• pp.278-286
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• 2006

Purpose : Although suprapubic bladder aspiration(SBA) is the most reliable technique for identifying bacteriuria in young infant, no report has been published about the clinical manifestations of urinary tract infection(UTI) diagnosed by aspirated urine in Korea. This study was performed to examine clinical manifestations and related factors of UTI confirmed by a positive urine culture obtained by SBA in young infants. Methods : We reviewed medical records of 159 infants younger than six months of age, who had been admitted for UTI to Korea University Ansan Hospital from January 2002 to June 2005. Results : The male:female ratio was 5.1 : 1. The most common pathogen in urine culture was Escherichia coli(92.5 percent). Most of the gram-negative pathogens had high sensitivity to amikacin, or third generation cephalosporins and had low sensitivity to ampicillin, trimethoprim-sulfamethoxazole, or gentamicin. Hydronephrosis and vesicoureteral reflux(VUR) were present in 32.7 percent and 27.7 percent respectively. Renal cortical defects observed on DMSA scans were detected in 37.1 percent. Prolonged fever duration and hospital day, high erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) levels, hydronephrosis and VUR were related to the renal cortical defects(P<0.05). Rates of UTI-associated bacteremia and aseptic meningitis were 8.3 percent and 6.6 percent. Conclusion : Early differential diagnosis is very important in infants younger than 6 months of age with UTI because the clinical findings are non-specific and UTI-associated bacteremia and aseptic meningitis are concomitantly found. Because prolonged fever and higher ESR and CRP levels are risk factors of the renal cortical defects, radiologic evaluations and nephrologic follow-up were needed in identifying the predisposing congenital abnormalities and chronic renal scarring.

• Clinical and Experimental Pediatrics
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• v.49 no.3
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• pp.312-316
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• 2006

Purpose : Growth hormone(GH) has been recognized as an effective treatment for short children born small for their gestational ages(SGA), and nowadays it has been widely used for the treatment of short children born SGA. The aim of this study is to assess the efficacy of GH treatment for the children born SGA. Methods : The study population was made of 40 short children born SGA with GH-treated(n=26) and untreated control group(n=14). In order to evaluate the effect of GH treatment, the changes in standard deviation scores(SDS) of the GH-treated group were compared to the changes in SDS before and after treatment from the control group in the same period. Results : There were no differences between the GH-treated group and the control group in gestational age, birth weight, chronological age, target height and the period of follow-up observation; however, the GH-treated group had lower height SDS($-3.3{\pm}0.9$) than the control group($-2.4{\pm}0.4$) before treatment(P<0.05). The GH-treated group had gained $1.2{\pm}1.0$ height SDS during GH treatment while the control group had gained $0.5{\pm}0.6$ height SDS. In the GH treatment group, HDL-cholesterol increased from $48.5{\pm}9.9mg/dL$ to $56.1{\pm}8.7mg/dL$(P<0.05) and LDL-cholesterol decreased from $88.1{\pm}23.3mg/dL$ to $76.4{\pm}19.4mg/dL$(P<0.05) after treatment. There were no changes in total cholesterol, triglyceride, free fatty acid and fasting blood sugar. IGF-I increased from $224.9{\pm}191.3{\mu}g/L$ to $443.2{\pm}152.5{\mu}g/L$(P<0.05) and IGFBP-3 also increased from $3.7{\pm}1.3mg/L$ to $5.6{\pm}1.2mg/L$(P<0.05). Conclusion : We conclude that growth hormone treatment is effective in the treatment of short children born SGA.

• Neonatal Medicine
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• v.15 no.2
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• pp.151-159
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• 2008

Purpose : This study determined the prenatal and postnatal factors associated with complications and prognosis in premature infants with leukemoid reaction. Methods : We retrospectively reviewed the medical records of premature infants with gestational ages <37 weeks and low birth weights (<2,500 g) who were admitted immediately after birth to the neonatal intensive care unit at the Dongguk University Ilsan Hospital between June 2005 and July 2006. A leukemoid reaction was defined as an absolute neutrophil count (ANC) >30,000/$mm^3$. The infants who had leukemoid reaction comprised the study group, while the remainder of infants made up the control group. The relationships between maternal and neonatal variables and ANC were studied. Results : Leukemoid reaction was detected in 3.1% of the study infants (8 of 252). Factors more frequently associated with infants with leukemoid reaction were as follows: maternal chorioamnionitis, high levels of maternal and infant C-reactive protein, gestational age <37 weeks, birth weight <2,500 g, low Apgar score, prolonged ventilator support, and a high incidence of bronchopulmonary dysplasia (BPD). However, there were no significant differences with respect to the antenatal usage of steroids, the incidences of patent ductus arteriosus, necrotizing enterocolitis, intraventricular hemorrhage, retinopathy of prematurity, and mortality between the two groups. Conclusion : Leukemoid reaction in premature infants was associated with chorioamnionitis and high levels of serum C-reactive protein in mothers and infants, and BPD in infants. These findings suggest that leukemoid reaction is secondary to inflammation caused by infection.