• Tuberculosis and Respiratory Diseases
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• v.60 no.2
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• pp.215-220
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• 2006

Background : A spirometric reference equation was recently developed for the general population in Korea. The applicability of the new Korean equation to clinical practice was examined by comparing it with the Morris equation, which is one of the most popular reference equations used for interpreting the spirometric patterns and for grading the disease severity in Korea. Methods : Spirometry was performed on 926 men and 694 women, aged 20 years or older, in November 2004 at the Asan Medical Center, Seoul, Korea. The subjects' age, gender, height, weight, and spirometric values ($FEV_1$ [forced expiratory volume in one second], FVC [forced vital capacity], and $FEV_1/FVC$) were obtained. The spirometric patterns and disease severity were evaluated using both equations, and the results of the Korean equation were compared with the Morris equation. The spirometric patterns were defined as normal, restrictive, obstructive, and undetermined according to the level of $FEV_1/FVC$ and FVC. The disease severity was defined according to the level of $FEV_1$ level for subjects with an airflow limitation, and according to the FVC level for those subjects without an airflow limitation. Results : Spirometric patterns were differently interpreted in 22.5% (208/926) of the men and 24.8% (172/694) of the women after the application of the Korean equation compared with the Morris equation. Of the subjects with airflow limitation, disease severity was differently graded in 30.2% (114/378) of the men and 39.4% (37/94) of the women after the application of the Korean equation. Of the subjects without airflow limitation, disease severity was differently graded in 27.9% (153/548) of the men and 30.2% (181/600) of the women after the application of the Korean equation. Conclusion : Achange in the reference equation for spirometry could have an effect on the interpretation of spirometric patterns and on the grading of disease severity.

• Journal of Gastric Cancer
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• v.4 no.4
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• pp.257-262
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• 2004

Purpose: We reported our preliminary result in 2001. At that time, the follow-up period was too short to evaluate the survival benefit of adjuvant chemotherapy in gastric cancer without serosal invasion. Therefore, we followed those patients for 66 months to determine the long-term effects of adjuvant chemotherapy. Materials and Methods: We analyzed the recurrence pattern, the survival rate, and the disease-specific survival of 135 patients by reviewing their medical records and calling the patients or their relatives. All enrolled patients were included in the intention-to-treat analysis of efficacy. Results: The follow-up rate was $89.6\%$ (121/135), and the median follow-up duration was 66 months. Among the 135 patients, 4 relapsed in group 1 (5-FU+cisplatin), 7 in group 2 (mitomycin C+oral 5-FU), and 6 in group 3 (oral 5-FU only). The overall survival rate was $89\%$ in group 1, $84\%$ in group 2, and $82\%$ in group 3. There were no differences in the overall survival rates and the disease-specific survival rates among the three groups. Conclusion: Oral chemotherapeutic agents have an acceptable effect for adjuvant chemotherapy compared with intravenous agent. However, a large-scale, prospective, randomized study, including a control group, is needed for an exact evaluation.

• Journal of Gastric Cancer
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• v.7 no.4
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• pp.242-247
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• 2007

Purpose: We assumed that an obese patient has a high rate of postoperative wounds, but there is no objective data showing the relationship between the body mass index (BMI) and the rate of postoperative wounds in Korea. We describe the relationship of BMI and rates of postoperative wound complications. Materials and Methods: From September 2005 to February 2006, 772 patients undergoing elective gastrectomy surgery due to gastric cancer were enrolled in a retrospective study to measure postoperative wound complications. A preoperative history, physical examination and daily progress notes were reviewed retrospectively from the medical records. Postoperative wound complications were detected from the elective medical record and from a doctor in charge statement. Results: The total number of patients was 772, the mean age of the patients was $57{\pm}11.2$ years and the sex ratio (male/female) was 1.82:1. Postoperative wound complication rates were different among the BMI groups (BMI < $20\;kg/m^2$ vs $20{\leq}BMI{\leq}25\;kg/m^2$ vs >$25\;kg/m^2$), and patients with a BMI>$25\;kg/m^2$ that underwent gastrectomy had a significantly higher wound complication rate (4.6%) than underweight and normal weight patients (0.9% and 1.6%, respectively) (P=0.038). Conclusion: Overall, there was a statistical correlation between BMI and the postoperative wound complication rate. Overweight (BMI>$25\;kg/m^2$) patients that underwent gastrectomy had a higher wound complication rate than normal body weight ($BMI{\leq}25\;kg/m^2$) patients. Further studies will be required with a larger population and prospectively designed study considering other factors that affect the wound complication rate.

• Tuberculosis and Respiratory Diseases
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• v.54 no.3
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• pp.283-294
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• 2003

Introduction : Rapidly growing nontuberculous mycobacteria (RGM) can produce numerous types of manifestations including a pulmonary infection. Managing a pulmonary infection due to RGM is unusually difficult to treat because the organism is invariably resistant to traditional antituberculous drugs and has a varying susceptibility to other antibiotics. The experiences of treatments for a RGM pulmonary infection with various antibiotics are also limited. This study evaluated the clinical manifestations, treatment, and the therapeutic outcomes of a RGM pulmonary infection. Subjects and method : Fifty-four cases with RGM from respiratory specimens were identified between November of 1996 and September of 2002 in the Asan medical center. The medical records and radiographic findings in 20 patients who fulfilled the diagnostic criteria of nontuberculous mycobacteria (NTM) pulmonary disease by ATS guidelines. The clinical, laboratory, and radiological parameters between subgroups. Results : Of the 20 patients, 15 were female. The mean age was 57.7 yrs (${\pm}7.5$), and all of the patients had a history of pulmonary tuberculosis. Most (90%) had an underlying lung disease. The majority of the isolates (80%) were M. abscessus. Chest radiography showed bilateral involvement in 80% of the patients. Bronchiectasis and multiple nodules were the main findings. Cavitation was present in 35% of the patients. Even though 70 % of the patients received antituberculous drugs prior to the correct diagnosis, all of the patients eventually received antibiotics. A mean of 3.5 antibiotics were given for an average of 439 days(${\pm}168$). After completing treatment, nine patients showed improvement after a mean 591(${\pm}311$) days of treatment, whereas the antibiotic treatment was unsuccessful in 2 patients. Conclusion : Many patients with a RGM pulmonary infection show an atypical pattern of radiological findings (bronchiectasis and multiple centrilobular nodules). It is very important to differentiate between M. tuberculosis and NTM and to identify the causative organisms among the NTM because a misdiagnosis can lead to an inappropriate and prolonged treatment. Combined antibiotic treatment yielded promising results, and is recommended for treating patients with a RGM pulmonary infection.

• Clinical and Experimental Pediatrics
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• v.49 no.3
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• pp.298-304
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• 2006

Purpose : We compared the asthma predictive index(API) and the modified asthma predictive index (mAPI) of the Tuscon Children's Respiratory Study Group in Korean children with recurrent wheezing. We investigated the atopic profiles and presence of allergen sensitization of each risk group, and ascertained the significant clinical risk factors. Methods : Two hundred and sixty two children, who visited for recurrent wheezing from 1998 to 2005, were enrolled and divided into groups by API and mAPI. We investigated the history of the patients and their families, atopic profiles, and sensitization to aeroallergen and food allergens. Twenty nine children were followed up to 6 years of age and we evaluated the sensitivity, specificity and positive and negative predictive value of both indices. Results : The high risk group of API were of older age, were more likely to be sensitized to aeroallergen(P=0.001) and food allergen(P=0.034) and had higher levels of total eosinophil count, eosinophil percent, serum ECP, total IgE, and D.p-, D.f-specific IgE. High risk group of mAPI showed higher levels of atopic markers such as egg-, milk-, D.p- and D.f-specific IgE. Even though API did not include allergen sensitization, the high risk group was more significantly sensitized to common allergens than the low risk group. Twenty nine children were followed up until 6 years of age; therefore 15 children were diagnosed as asthma, clinically. The sensitivity, specificity, positive and negative predictive values of mAPI were higher than API. Conclusion : Both high risk groups of API and mAPI had higher levels of atopic markers and were more sensitized to common allergens. These findings suggest that sensitization to aeroallergens and food allergens are more objective markers as asthma predictive indices. In addition, mAPI is a more reliable index in predicting asthma in Korean children with recurrent wheezing than is API. But only 29 patients were followed until the age of 6, so we need to include more children with long term follow up for future study.

• Clinical and Experimental Pediatrics
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• v.45 no.9
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• pp.1134-1140
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• 2002

Purpose : Childhood accidents have been increasing recently. Accidents rank as the leading cause of childhood mortality and morbidity. We performed this study to evaluate the causes of childhood accidents. Methods : The authors analysed retrospectively the medical records of 6,410 cases of childhood accidental injuries who visited the emergency room of Asan Medical Center from January 1990 to December 1999. Results : The most common type of accidents was trauma which accounted for 5,038 cases of the total accidents, followed by falls, burns, foreign body aspiration, and poisoning. The most common age of foreign body aspiration was under two years old and the male to female ratio was 2 to 1. The most common site of foreign body aspiration was the esophagus and the stomach, followed by the respiratory tract. In airways, the right and left main bronchus were the most common site for foreign body aspiration and were accompanied by the highest mortality. The most common foreign body in the gastrointestinal tract and respiratory tract were coins and peanuts, respectively. Conclusion : The most common cause of accidents was trauma, followed by falls, burns, foreign body aspiration, and poisoning. The incidence of foreign body aspiration and poisoning is increasing in infants. In cases of foreign bodies in airways, proper management is needed because of the high mortality rate.

• Clinical and Experimental Pediatrics
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• v.45 no.9
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• pp.1120-1125
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• 2002

Purpose : Percutaneous cannulation of the central vein in children and infants may be technically difficult and can cause serious complications. There are many techniques to improve the success rate and to decrease the complications in central vein cannulation. This study was undertaken to determine whether audible Doppler guidance can help operators improve the results of central vein cannultion in pediatric ICU. Methods : A total of 46 central vein cannulations were performed using audible Doppler guidance technique. Using an 8-MHz Doppler ultrasound device(Pocket-Dop II. iMex. USA), the artery and the vein were identified by their characteristic Doppler sounds. Results : There was a total of 46 patients with 20 boys and 26 girls, respectively. The mean age was $3years{\pm}45months$(range : 1-156 months). The number of infants was 18 and the mean age was $6.3{\pm}3.8$ months(range : 1-12 months). The most common site of central vein cannulation was the right internal jugular vein(63%). The cannulation was successful in 44 out of 46 procedures(96%). The success rate at the first attempt was 59% with 48% in the patients who had the history of previous cannulation and 70% in the patients who did not, respectively. The success rate in infants was 94%(17 out of 18). The average access time was $5.2{\pm}8.3$ minutes in children contrary to $7.5{\pm}10.3$ minutes in infants. There were no serious complications, but six patients had complications including four hematoma, one arterial puncture, and one pneumothorax. Conclusion : This central vein cannulation using Doppler guidance may improve the success rate of central vein cannulation and decrease the development of serious complications in infants and children.

• Clinical and Experimental Pediatrics
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• v.53 no.1
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• pp.80-84
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• 2010

Purpose : The aims of this study were to investigate the long-term outcomes in children with infantile spasms (IS) and to identify the prognostic factors influencing their neurodevelopment. Methods : We retrospectively evaluated seventy two children over five years old who were treated for IS at Asan Medical Center, Seoul, Korea, between 1994 and 2007. Forty-three children were contacted by telephone or medical follow-up to assess their current neurodevelopmental status. Multiple logistic regression was used to calculate odds ratios (ORs) and 95% confidence interval (95% CIs) of risk factors for unfavorable outcomes.Results : The mean follow-up duration for these 43 children was $7.2{\pm}1.5$ years (range, 4.5 to 13.0 years). Of these, 13 (30.2%) had cryptogenic and 30 (69.8%) had symptomatic IS. Eleven (25.6%) children were initially treated with adrenocorticotrophic hormone (ACTH) therapy, with a mean treatment lag of $1.3{\pm}1.9$ months (range; 0.1 to 7.0 months). Eighteen (41.8%) children clinically responded to initial treatment, as shown by EEG response. Overall, 22 (51.2%) children had at least moderate neurodevelopmental disorders and 2 (4.8%) died. In univariate analysis, etiology (symptomatic) and poor electroclinical response to initial treatment were related to long-term unfavorable outcomes. In multivariate analysis, response to primary treatment was the sole significant independent risk factor with a high OR. Conclusion : Overall prognosis of children with IS was poor. Electroclinical non-responsiveness to initial treatment was related to unfavorable long-term outcomes, indicating that initial control of seizures may be important in reducing the likelihood of poor neurodevelopment.

• Clinical and Experimental Pediatrics
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• v.51 no.9
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• pp.964-970
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• 2008

Purpose : Methylmalonic aciduria (MMA) and propionic aciduria (PA) are inborn errors in the catabolism of branched-chain amino acids. The study was undertaken to investigate the genotypes and clinical features of Korean patients with MMA and PA. Methods : This study examined 12 patients with MMA and eight with PA. We analyzed various clinical features, laboratory findings, treatments, and neuro-developmental outcomes. Diagnoses were based on the presence of characteristic compounds detected by amino acid analysis in serum and organic acid analysis in urine. Mutation analysis was performed in the genes of MUT, MMAA, MMAB, and MMACHC for MMA and PCCA and PCCB for PA. Results : Among the 20 patients, six patients were diagnosed before one month of age and nine patients were diagnosed after the newborn period. Five patients were diagnosed via a neonatal screening test. Patients with early-onset forms had more severe illness at presentation and generally poor outcomes. A favorable outcome was obtained in 55% patients; most of them were of a late-onset type or diagnosed by neonatal mass screening test without symptoms. Genotypes were confirmed in all patients with MMA. We detected 11 different mutations by MUT gene analysis in 10 patients, and three different mutations in MMACHC genes in two patients. PCCA and PCCB gene mutations were identified in 14 of the 16 alleles, in eight patients with PA. Conclusion : Organic aciduria is a fatal disease; however, better outcomes are expected whenever early diagnosis and prompt management are made possible. Mutation analysis is useful for confirming diagnoses and planning management strategies.

• Neonatal Medicine
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• v.17 no.2
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• pp.193-200
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• 2010

Purpose: Feeding desaturation is a common problem among preterm infants which can result in prolonged hospital stays, longterm feeding difficulties and growth delay. The purpose of this study was to identify the characteristics of premature infants with feeding desaturation and to examine the effect of orocutaneous stimulation on oral feeding. Methods: During the first phase of this study, 125 extremely low birth weight infants were reviewed retrospectively. Characteristics between infants with feeding desaturation (n=34) and those without feeding desaturation (n=91) were examined. During the second phase, 29 infants recruited from March, 2009 to May, 2010 were subjected to orocutaneous stimulation. The results of orocutaneous stimulation were compared to a control group (n=81). Results: The first phase of the study revealed that extremely low birth weight infants with feeding desaturation were significantly lower in gestational ages at birth, and had lower 5 minute apgar scores, more gastroesophageal refluxes and bronchopulmonary dysplasia. Infants without feeding desaturation reached full enteral feeding significantly earlier and showed shorter duration of hospital stay. At the second phase, infants in the intervention group showed shorter days to achieve initiation of bottle feeding, shorter days in achievement of full bottle feeding, last episodes of feeding desaturation and length of hospital stay compared to the control group of similar characteristics. Conclusion: Orocutaneous stimulation among extremely low birth weight infants results in earlier achievement of full bottle feedings without episodes of feeding desaturation hence shortens the length of hospital stay.