• Journal of Chest Surgery
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• v.36 no.3
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• pp.157-163
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• 2003

Traditionally, patients with stage IIIB non small cell lung cancer (NSCLC) have been con-sidered Inoperable due to the short-term survival rate of this disease. However, some recent papers have reported good surgical treatment results for T4 lesions in stage IIIB NSCLC. This study reports the results of stage IIIB NSCLC patients who underwent surgical treatment at our institute. Material and Method: This study includes 109 patients who were diagnosed with pathological stage IIIA lung cancer and 59 patients who were diagnosed with pathological stage IIIB at our institute between 1994 to December 2001. Patients who underwent neo-adjuvant chemotherapy and radiation therapy were excluded from this study. According to the TNM classification, 13 patients from stage IIIA were classified into T3N1, 12 into T1N2, 73 into T2N2 and 11 into T3N2. Stage IIIB patients consisted of 26 patients with T4N0, 18 with T4Nl, 14 with T4N2, and 1 with T4N3. Result: The 30-day mortality for stage IIIA and IIIB were 4.58% and 5.08% respectively. The overall survival rate at the 1st, 2nd, 3rd, and 5th year were 69.1%, 53.7%, 41.6%, and 30.7% respectively in stage IIIA and 68.8%, 55.6%, 42.9%, and 35.9% respectively in stage IIIB. Patients with satellite nodules in the same lobe & no Iymph node involvement had a survival rate of 53.9% in 3 years compared with 15.2% in patients with satellite nodules in the same lobe with Iymph node involvement. Conclusion: Surgical treatment is recommended for selected stage IIIB NSCLC patients (pathological N0 stage & completely resectable patients), particularly for patients with satellite nodules in the same lobe & no lymph node involvement.

• Journal of Korean Orthopaedic Sports Medicine
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• v.9 no.1
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• pp.48-57
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• 2010

Purpose: To compare the incidence and risk factors for osteoarthritis after anterior cruciate ligament (ACL) reconstruction between two groups using bone-patellar tendon-bone (BPTB) and hamstring tendon (HT) autograft. Materials and Methods: 53 cases of ACL reconstruction using patellar tendon and 40 cases using hamstring tendon were followed up at least 8 years. Radiographic evaluation was done according to the Kellgren and Lawrence's classification. Clinical functional testing (Lysholm Knee Scores, the Tegner activity scores) and laxity testing (Lachman, pivot shift tests), and the instrumented laxity testing with $Telos^{(R)}$ were all examined in relation to the development of osteoarthritis. Results: Radiographic osteoarthritic changes were detected in 24 patients (45.3%) in BPTB group and 14 patients (35.0%) in HT group. Accompanying meniscal injury (BPTB p<0.001; HT p=0.091), intervals from the injury to reconstruction of > 12 months (BPTB p=0.037; HT p=0.021), and patient's age at reconstruction of > 25 years (BPTB p=0.003; HT p=0.048) were found to be significant independent predictors of osteoarthritis. However, no statistically significant correlations were found between the development of osteoarthritis and the clinical outcome or the radiographic stability in both groups. Conclusion: Although ACL reconstruction using BPTB or HT autograft had good clinical results at an average follow-up of 10 years, considerable incidence of radiographic osteoarthritic changes were noted. Various factors such as accompanying meniscal injury, protracted time from injury to reconstruction, more than 25 years old at the time of reconstruction were related to radiographic osteoarthritic changes.

• Clinical and Experimental Pediatrics
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• v.52 no.6
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• pp.674-679
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• 2009

Purpose : The authors aimed to analyze the long-term effects of treatments, especially external beam radiotherapy (EBRT), in bilateral retinoblastoma patients. Methods : This retrospective study analyzed the medical records of 22 bilateral retinoblastoma patients who were registered between October, 1987 and October, 1998 and followed-up for more than 10 years. They were treated by enucleation, EBRT, and systemic chemotherapy. Age at diagnosis, sex, delay prior to treatment, Reese-Ellsworth (RE) classification, and the local treatment modalities were analyzed in relation to recurrence-free survival (RFS) and complications. Results : Median age at diagnosis was 7.0 months (range 1.7-31.6 months). Leukocoria was the most common presenting feature. Two patients had a familial history. The RE classifications of the 44 eyes were group II in 4, III in 14, IV in 4, and V in 22. At the end of a median follow-up period of 141 months (range 55-218 months), 20 patients were alive. The 10-year ocular survival rate of the 44 eyes was $56.8{\pm}7.5%$. The 10-year RFS and ocular survival rate of the 29 eyes treated by combined EBRT and chemotherapy were 75.9% and 86.2%, respectively. Treatment delay (>3 months) was found to be related to higher risk of recurrence. Complications after EBRT were cataract, retinal detachment, phthisis bulbi, and facial asymmetry. No patient developed a second malignancy during the follow-up period. Conclusion : Early detection and prompt treatment can increase ocular survival rates. In addition, careful attention should be paid to possible long-term sequelae in these patients.

• Clinical and Experimental Pediatrics
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• v.50 no.12
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• pp.1188-1193
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• 2007

Purpose : The prevalence of rickets in the world is on the rise not only in developing but also in developed countries. In Korea, breastfeeding has increased. There have been few studies on the possible association of rickets with breastfeeding. The purpose of this study was to identify the development and the clinical presentation of subclinical rickets in breastfed infants. Methods : We investigated patients who were breastfed and had hypovitaminosis D in the blood from May 2006 to April 2007, and who were diagnosed with vitamin D deficient rickets from May 2003 to April 2006. We evaluated the results of blood tests, x-rays and other relevant information in the medical record. A questionnaire that included questions on the diet of patients, the mothers activity during pregnancy and place of residence was administered. Results : Twelve patients (66%: male, 34%: female) were enrolled in this study. There were eight in the asymptomatic and four in the symptomatic group. The median age for each group was 8 months (range 4-11 month) and 5.5 months (5-8 month). All patients in the symptomatic group were breastfed until diagnosed. In the asymptomatic group, they were breastfed for four to six months, and then weaned with only thin rice soup and vegetables. Nine patients had a vitamin D concentration below 20 ng/mL and three patients had levels between 20 and 29 ng/mL. Alkaline phosphatase (ALP) and parathyroid hormone (PTH) were elevated in both groups. There were statistically significant $25-OHD_3$ levels in the blood in both groups (P=0.008). Ten of the patients (83%) also had iron deficient anemia. Conclusion : Vitamin D deficiency and subclinical rickets has been identified in Korea. However, the prevalence of this disease has not been determined. The main limitation of this study was the small number of patients and the absence of a control group.

• Clinical and Experimental Pediatrics
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• v.48 no.8
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• pp.857-864
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• 2005

Purpose : The objectives of this study was to evaluate the correlations between the indices of insulin sensitivity using fasting glucose and insulin level, and the body fat mass measured by bioelectrical impedance analysis(BIA) and dual energy X-ray absorptiometry(DEXA), and to determine the clinical usefulness of insulin sensitivity indices when obese children were followed up. Methods : In this study, 28 simple obese children and adolescents were included. Anthropometric data including body weight, height, obesity degree(OD), body mass index(BMI), and waist-to-hip ratio were collected and then body fat mass was measured by using BIA and DEXA. For metabolic data, 12 hour fasting serum glucose, insulin and lipid profiles were measured and indices for insulin sensitivity(G/I ratio, $log_{insulin}$, HOMA-IR, $log_{HOMA-IR}$, QUICKI) were calculated. Results : BMI had a higher correlation with insulin sensitivity indices than OD(G/I ratio, -0.463 vs -0.209; $log_{insulin}$, 0.417 vs 0.196; HOMA-IR, 0.301 vs 0.238; $log_{HOMA-IR}$, 0.403 vs 0.198; QUICKI, -0.451 vs -0.224). But OD had a higher correlation with body fat mass measured by BIA and DEXA than BMI(BIA, 0.612 vs 0.316; DEXA, 0.667 vs 0.512). The G/I ratio was correlated with body fat mass in BIA(r=-0.420, P<0.05) and DEXA(r=-0.512, P<0.01), percentage of body fat(percentage of fat) in BIA(r=-0.366, P<0.05) and DEXA(r=-0.449, P<0.01). HOMA-IR was only correlated with body fat mass in DEXA(r=0.341, P<0.05). Conclusion : This study revealed that G/I ratios had a statistically significant correlation with anthropometric obesity indices(OD and BMI) and also had a correlation with both body fat mass and percentage of fat. These results suggest that G/I ratios could be used as useful index when obese children and adolescence are followed up.

• Clinical and Experimental Pediatrics
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• v.48 no.5
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• pp.534-538
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• 2005

Purpose : Kawasaki disease(KD) is a multisystemic inflammatory vasculitis of unknown etiology. Many complications other than cardiovascular involvement have been recognized in KD. However, there have been few reports published concerning involvement of the lungs in this disease. The purpose of this study was to examine the relationship between serum TNF-${\alpha}$, the degree of coronary artery dilatation and chest X-ray(CXR) findings. In addition, we have investigated serum anti-Mycoplasma antibody(AMA) titers in patients with KD who have abnormal CXR findings. Methods : Eighty four patients with KD were included in this study(group I; 41 patients with normal CXR fndings, group II; 43 patients with abnormal CXR findings). Serum levels of TNF-${\alpha}$ and AMA titer were measured. Results : We reviewed the CXR findings and clinical courses of 84 patients with Kawasaki disease and found abnormal CXR findings in 43 patients(51.2 percent). Peribronchial cuffing was the most frequent abnormality(22.4 percent). In the group with abnormal CXR findings(group II), a statistical difference was not noted in age, sex, duration of fever, hemoglobin, WBC, platelet, ESR, and CRP levels and incidence of coronary arterial lesions as compared with the group having normal CXR findings(group I). No difference was noted in serum TNF-${\alpha}$ level between group I and group II. 2 patients(12.5 percent) of 16 KD patients with abnormal CXR findings have positive AMA titer(above 1 : 320). Conclusion : Most of the abnormal CXR findings in KD patients were peribronchial cuffing. The abnormal CXR findings in KD patients did not mean severe inflammations. It is difficult to consider that CXR abnormalities are related to coronary arterial lesions. In addition, further study on the relationship between Mycoplasma infection and Kawasaki disease is needed.

• Tuberculosis and Respiratory Diseases
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• v.59 no.1
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• pp.30-38
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• 2005

Background : Arsenic trioxide ($As_2O_3$) has been used to treat acute promyelocytic leukemia, and it induces apoptosis in a variety of solid tumor cell lines including non-small cell lung cancer cells. However, nonsteroidal antiinflammatory drugs (NSAID) can enhance tumor response to chemotherapeutic drugs or radiation. It was previously demonstrated that a combination treatment with $As_2O_3$ and sulindac induces the apoptosis of NCI-H157 human lung carcinoma cells by activating the caspase cascade. This study aimed to determine if a combination treatment augmented its apoptotic potential through other pathways except for the activation of the caspase cascade. Material and Methods : The NCI-H157 cells were treated with $As_2O_3$, sulindac and antioxidants such as glutathione (GSH) and N-acetylcysteine (NAC). The cell viability was measured by a MTT assay, and the level of intracellular hydrogen peroxide ($H_2O_2$) generation was monitored fluorimetrically using a scopoletin-horse radish peroxidase (HRP) assay. Western blotting and mitochondrial membrane potential transition analysis were performed in order to define the mechanical basis of apoptosis. Results : The viability of the cells was decreased by a combination treatment of $As_2O_3$ and sulindac, and the cells were protected using antioxidants in a dose-dependent manner. The increased $H_2O_2$ generation by the combination treatment was inhibited by antioxidants. The combination treatment induced changes in the mitochondrial transmembrane potential as well as the expression of the Bcl-2 family proteins, and increased cytochrome c release into the cytosol. However, the antioxidants inhibited the effects of the combination treatment. Conclusion : Combination treatment with $As_2O_3$ and sulindac induces apoptosis in NCI-H157 human lung carcinoma cells via ROS generation with a mitochondrial dysfunction.

• Journal of the Korean Geographical Society
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• v.42 no.5
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• pp.808-834
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• 2007

This study attempts to elucidate manifold dimensions of gendered accessibility experiences. How gender roles(household responsibilities) differentiate accessibility experiences between women and men is explored through the comparison of married dual-earner couples' parental status, using the US Portland activity-travel diary dataset with GIS-based geocomputation results of(time-geography based) space-time accessibility. First, this study shows how gender division of labor within the household still permeates current society, despite the widespread belief of the social change toward a gender-egalitarian society. Then, the study pays special attention to the way gender roles structure individual accessibility experiences of women and men differently, and, in turn, the way such accessibility experiences take a form of gendered spatiality. Gendered spatiality is examined through the analysis of accessibility space as well as activity space in order to ascertain women's home-attached and spatially entrapped characteristics. More household responsibilities throughout a day and, even more, the time constraint of picking up children at the daycare centers after work lead women's possible activity space to be more home-centered. The analysis of the spatio-temporal context of accessibility space makes gendered spatiality visible. However, the findings suggest that behavioral outcomes should be understood with an explicit awareness of constraints individuals face. It is because the revealed activity spaces can be not only an outcome of constraint but also an outcome of choice. Behavioral outcomes should not be treated as a straightforward expression of the level of constraints. It is problematic to expect that behavioral outcomes directly mirror the level of constraints. It is also problematic to suppose that the level of constraints can be straightforwardly elicited from revealed behavioral outcomes.

• Tuberculosis and Respiratory Diseases
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• v.48 no.5
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• pp.720-729
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• 2000

Background : Histological analysis of tuberculosis shows a spectrum of findings, from well formed granulomatous inflammation with few bacilli in patient with normal immune response to M. tuberculosis to poorly formed granulomatous inflammation with many bacilli in patient with defective immune response. To evaluate the degree of immune response to M. tuberculosis, we studied the histologic features, including the presence of acid fast bacilli(AFB) in lymph node of patients with cervical tuberculous lymphadenitis, and compared them with clinical characteristics. Methods : We reviewed the histologic features of 33 cases of cervical tuberculous lymphadenitis and processed the excised nodes for auramine-rhodamine staining to detect AFB. The AFB positivity in tissue was compared with the histologic features(degree of granuloma formation, presence of caseation necrosis, presence of neutrophilic infiltration) and clinical characteristics(lymph node size, duration of symptom, presence of local symptom or radiologic evidence of pulmonary tuberculosis). Results : 1) The mean age at diagnosis was 42.4 years, and male to female ratio was 1:4.5. 2) Histologically, all cases showed well formed granuloma and variable degrees of caseation necrosis, and 39% of the cases showed neutrophilic infiltration in the granulomatous inflammation. 3) AFB were confirmed in 52% of the cases, and they were found extracellularly and at the periphery of caseation necrosis. 4) There was no association between AFB positivity and histological features or clinical characteristics. Conclusion : Cervical tuberculous lymphadenitis showed well formed granulomatous inflammation with caseation necrosis, and there was no association between AFB positivity in the tissue and histological or clinical characteristics.

• Pediatric Infection and Vaccine
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• v.15 no.2
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• pp.129-137
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• 2008

Purpose : Human metapneumovirus (hMPV) was recently discovered in children with respiratory tract infection. The aim of this study was to determine the frequency and the clinical manifestation of hMPV infection in Korean children. Methods : From January to December, 2005, we collected throat swabs from 1,098 children who were hospitalized for acute respiratory illness at the Department of Pediatrics, Kwang-Ju Christian Hospital. hMPV was detected by performing reverse transcriptase-polymerase chain reaction (RT-PCR). The medical records of the patients with positive results were retrospectively reviewed. Results : We detected hMPV in 25 (2.2%) of the 1,098 hospitalized children. The mean age of the hMPV infected children was 2.3 years, and 84% of the illnesses occurred between April and June. The most common diagnoses were pneumonia (60%) and bronchiolitis (20 %). The clinical manifestations included cough, fever, coryza, rale, wheezing and injected throats. Peribronchial infiltration and consolidation were the common chest X-ray findings. Four (16%) of 25 patients with hMPV infection had exacerbation of asthma. Coinfection with other respiratory viruses was found in six children (24%). Conclusion : hMPV is the cause of an important proportion of acute respiratory tract infection in Korean children. Additional studies are required to define the epidemiology and the extent of disease caused by hMPV and to determine future development of this illness in Korean children.