• Journal of Hospice and Palliative Care
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• v.10 no.4
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• pp.178-183
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• 2007

Purpose: The prevalence and mortality of gastric lancer is high. We studied clinical characteristics and prognostic factors of the advanced gastric canter patients who had died in the hospice care unit. and our study is the basic report for efficient hospice and palliative care for the terminally ill patients with gastric cancer. Methods: We retrospectively reviewed the medical records of 99 advanced gastric cancer patients who had died in a hospice rare unit from May 2004 to August 2007. The survival days during the hospice and palliative care were analyzed using Kaplan-Meier method of SPSS version 13.0. Results: There were 62 males (63%) and 37 females (37%). Median age of patients was 60.9 years and liver metastasis was as high as 38 patients (38%) of all. The most prevalent symptom of admission was general weakness (97%) and poor or intake (86%). There were also bypoalbuminemia (88%), anemia (73%), and hyponatremia (61%). Palliative procedure was performed on 17 (63%) out of 27 patients with intestinal obstruction. Of these stents were inserted to 11 patients. The stores of ECOGPS and dyspnea were significantly correlated with the length of survival. The duration of median survival and hospitalization in the hospice and palliative care was 22 days and was 20 days respectively. Conclusion: We need to study more about clinical characteristics of advanced gastric rancor patients to predict the length of survival for an effective hospice and palliative care.

• Tuberculosis and Respiratory Diseases
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• v.50 no.4
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• pp.462-472
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• 2001

Background : The determinants of intubation and the response to therapy in COPD patients with hypercapnic respiratory failure were retrospectively reviewed. Methods : This study involved a review of 132 episodes of hypercapnic respiratory failure($PaCO_2\;{\geq}\;50\;mmHg$ and $pH\;{\leq}\;7.35$). The time frame for resolution or the time to intubation of patients who were admitted between 1996 and 1999 was analyzed. Results : Out of 132 hypercapnic episodes, 49(37%) required intubation. A comparison was made with the 83 cases that responded to treatment. Patients requiring intubation had a greater severity of illness, which included a higher APACHE II (Acute Physiology and Chronic Health Evaluation II) score ($20{\pm}5$ vs $14{\pm}4$ ; p<0.01), a higher WBC, a higher serum BUN, and greater acidosis (pH, $7.23{\pm}0.11$ vs $7.32{\pm}0.04$ ; p<0.01). Those with the most severe acidosis(pH<7.20) had the highest intubation rate(87%) and shortest time to intubation($2{\pm}3\;h$). Conversely, those with an initial pH 7.31 to 7.35 were less likely to be intubated(20%), and had a longer time to intubation($97{\pm}121\;h$). The patients with a pH 7.21 to 7.25($4.1{\pm}2.9$ day) required longer period of time to respond to medical treatment than patients with a pH of 7.31 to 7.35($2.2{\pm}3.1$ day). Of those patients requiring intubation, half(55%) were intubated within 8 h of admission, and most (75%) within 24 h. Of those patients responding to treatment medical therapy, half(52%) recovered within 24 h and most (78%) recovered within 48 h. Conclusion: Respiratory acidosis at the initial presentation is associated with an increased likelihood of intubation. This should assist in deciding help with the decision whether to treat patients medically, institute noninvasive ventilation, or proceed to intubation.

• Sleep Medicine and Psychophysiology
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• v.21 no.1
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• pp.14-20
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• 2014

Objectives: Several studies suggest that nocturia may be related to obstructive sleep apnea syndrome (OSAS). The mechanism by which OSAS develops nocturia has not been determined. The present study aimed to determine the prevalence of nocturia among adults with OSAS and to identify factors that may be predictive in this regard. Methods: Retrospective review of clinical and polysomnographic data obtained from patients evaluated at the sleep clinics of the St. Paul's Hospital between 2009 and 2012. The urinary symptoms were assessed on the basis of the International Prostate Symptom Score (IPSS). Pathologic nocturia was defined as two or more urination events per night. OSAS was defined as apnea-hypopnea index (AHI) ${\geq}5$. A multivariate analysis using logistic regression was performed to examine the relationship between polysomnographic variables and the presence of pathologic nocturia, while controlling for confounding factor. Results: A total of 161 men >18 years of age (mean age $46.7{\pm}14.1$), who had been referred to a sleep laboratory, were included in the present study. Among these, 27 patients with primary snoring and 134 patients with obstructive sleep apnea were confirmed by polysomnography. Nocturia was found in 53 patients with OSAS (39.6%) and 8 patients with primary snoring (29.6%). The AHI was higher in patients with nocturia than in those without nocturia (p=0.001). OSAS patients with nocturia had higher arousal index (p=0.044), and lower nadir oxyhemoglobin saturation (p=0.001). Multiple regression analysis showed that age (${\beta}$=0.227, p=0.003), and AHI (${\beta}$=0.258, p=0.001) were associated with nocturia, and that the presence of pathologic nocturia was predicted by age (OR 1.04 ; p=0.004) and AHI (OR 1.02 ; p=0.001). Conclusion: Nocturia is common among patients with OSAS. The strongest predictors of nocturia are age and AHI in patients with OSAS.

• Tuberculosis and Respiratory Diseases
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• v.58 no.6
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• pp.562-569
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• 2005

Background : The severity scoring system is useful for predicting the outcome of critically ill patients. However, the system is quite complicated and cost-ineffective. Simple serologic markers have been proposed to predict the outcome, which include troponin-I, lactate and C-reactive protein(CRP). The aim of this study was to evaluate the prognostic values of troponin-I, lactate and CRP in critically ill non-cardiac patients. Methods : From September 2003 to June 2004, 139 patients(Age: $63.3{\pm}14.7$, M:F = 88:51), who were admitted to the MICU with non-cardiac critical illness at Gyeongsang National University Hospital, were enrolled in this study. This study evaluated the severity of the illness and the multi-organ failure score (Acute Physiologic and Chronic Health EvaluationII, Simplified Acute Physiologic ScoreII and Sequential Organ Failure Assessment) and measured the troponin-I, lactate and CRP within 24 hours after admission in the MICU. Each value in the survivors and non-survivors was compared at the 10th and 30th day after ICU admission. The mortality rate was compared at 10th and 30th day in normal and abnormal group. In addition, the correlations between each value and the severity score were assessed. Results : There were significantly higher troponin-I and CRP levels, not lactate, in the non-survivors than in the survivors at 10th day($1.018{\pm}2.58ng/ml$, $98.48{\pm}69.24mg/L$ vs. $4.208{\pm}10.23ng/ml$, $137.69{\pm}70.18mg/L$) (p<0.05). There were significantly higher troponin-I, lactate and CRP levels in the non-survivors than in the survivors on the 30th day ($0.99{\pm}2.66ng/ml$, $8.02{\pm}9.54ng/dl$, $96.87{\pm}68.83mg/L$ vs. $3.36{\pm}8.74ng/ml$, $15.42{\pm}20.57ng/dl$, $131.28{\pm}71.23mg/L$) (p<0.05). The mortality rate was significantly higher in the abnormal group of troponin-I, lactate and CRP than in the normal group of troponin-I, lactate and CRP at 10th day(28.1%, 31.6%, 18.9% vs. 11.0%, 15.8 %, 0%) and 30th day(38.6%, 47.4%, 25.8% vs. 15.9%, 21.7%, 14.3%) (p<0.05). Troponin-I and lactate were significantly correlated with the SAPS II score($r^2=0.254$, 0.365, p<0.05). Conclusion : Measuring the troponin-I, lactate and CRP levels upon admission may be useful for predicting the outcome of critically ill non-cardiac patients.

• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.17 no.1
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• pp.53-62
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• 2007

목적: 1990년대 초반부터 시작된 우리나라의 산업 보건에 대한 사회적 관심의 증대와 시장의 요구에 따라 산업위생기관의 양적인 팽창이 이루어지긴 하였으나 실험실 관련 안전보건규정이 미비한 상태에서 추진되어 산업위생 실험실에서 다양한 유해 위험성 인자를 취급함에도 불구하고 사용되는 량이 소규모로 인해 안전보건과 관련된 사항은 대부분 간과하고 있으며, 산업위생 실험실의 안전보건관리 실태는 선진외국에 비해 상당히 낙후되어 있는 실정이다. 따라서 본 연구는 우리나라 산업위생 실험실과 관련한 안전보건관리 실태를 평가함으로써 향후 실험실의 안전보건관리 수준을 향상 시키는데 효과적인 자료로 활용하는데 기여하고자 한다. 방법: 산업위생실험실의 안전보건 실태를 파악하기 위해 설문조사를 수행하였으며, 설문은 실험실의 전반적인 안전보건, 화학물질 저장 및 용기, 가연성 및 인화성 화학물질, 가스 실린더, 의사전달, 응급처치 및 비상사태 장비, 정리정돈, 소방안전, 전기안전, 개인보호구, 흄후드 및 환기, 및 이황화탄소 취급 사례로서 12개 영역으로 구성되었다. 연구대상은 2001년 한국산업안전공단 정도관리프로그램에 참여한 기관으로서 총 대상은 119개 기관이었다. 연구기간은 2002년 7월 01일부터 8월 30일까지 약 60일 이었다. 설문은 반송봉투에 넣어 설문완성 후 연구자에게 보낼 수 있도록 배려하였으며, 1차 설문을 보낸 후 2주 후에 설문 참여를 독려하기 위해 엽서를 발송하였고, 다시 2주 후에 각 산업위생기관에 개별 전화 연락을 취하였다. 그 결과 63% (75개 기관)의 완성된 설문을 얻을 수 있었다. 설문의 총 조사항목은 79문항으로 구성되어 있으며, 산업위생실험실의 안전보건 수준을 정량적으로 평가하기 위해 안전보건 매뉴얼, 교육훈련프로그램 및 한국산업안전공단 실험실 지침서를 보유한 기관과 그렇지 않은 기관간의 차이는 선별된 67문항에 대해 각 문항에 합당하거나 적절할 경우 1점을 부여하는 방식으로 점수화하였다. 이들의 관련성을 파악하기 위하여 Microsoft-Excel 2000 프로그램을 이용하여 two-tailed t-test 분석을 실시하였다. 결과 1. 산업위생실험실 운영과 관련한 67개 항목(항목별로 각 1점 부여)에 대한 안전보건 성과지수화 (100점으로 점수 환산) 결과 안전보건 매뉴얼을 보유한 기관은 $42.98{\pm}13.36$(p<0.001)점, 교육훈련프로그램을 보유한 기관은 $50.75{\pm}14.12$(p<0.01)점, 한국산업안전공단 실험실 지침서를 보유한 기관은 $43.58{\pm}11.92$(p<0.01)점으로 그렇지 않은 기관에 비해 통계적으로 유의하게 높은 점수분포를 보였다. 2. 화학물질 보관 캐비닛이 있는 기관 중 64.8%의 기관은 화학물질을 알파벳 순으로, 27.8%는 분류 기준에 따라, 그리고 7.4%는 무작위로 보관하고 있었다. 3. 단지 8.0% (6개)의 기관만이 실험실내에 눈세정 분수(2 개), 샤워기(3개) 및 눈세정물병(3개, 2개 중복 응답 기관)과 같은 응급처치 장치 및 물품을 갖추고 있었다. 4. 89.0%의 기관이 흄후드내에 화학물질을 보관하고 있었다. 5. 물질안전보건자료, 흄후드 기록지, 비상사태 절차서 및 한국산업안전공단 실험실 지침서와 같은 문서관리는 부적절하게 관리 및 기록되고 있었다. 6. 대부분의 산업위생 실험실은 응급처치 장비, 화학물질 또는 가스용기 보관실과 같은 실험실 안전설비가 부족할 뿐만 아니라 정리정돈, 화학물질 저장 캐비닛, 안전보호구 및 흄후드와 같은 관리가 미비하였다. 결론: 이상의 결과에 근거하여 기관장은 실험실의 안전보건관리를 위하여 문서관리체계를 제공하고, 모든 실험실 종사자가 적절한 개인보호구를 착용할 수 있도록 하며, 비상 장비를 설치하고, 실험실과 관련한 적절한 규정을 제정하며, 교육훈련 프로그램을 제공하여야 한다. 또한 실험실 종사자는 실험 중 적절한 개인보호구의 착용하고, 비상장비 이용에 대한 교육훈련에 참여하며, 적절한 실험실 운영관리에 대한 책임감을 가져야 한다. 위의 권고사항 이행을 위해서 KOSHA는 KQCP 프로그램에 실험실 안전보건관리 항목을 삽입하여 주기적인 평가를 수행할 필요가 있다. 우리나라 실험실의 특성을 고려할 때 본 연구결과는 일반 실험실에도 적용될 수 있을 것으로 생각된다.

• Journal of Korean Orthopaedic Sports Medicine
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• v.8 no.2
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• pp.95-101
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• 2009

Purpose: The purpose of this study was to determine how many of our patients who had had anterior cruciate ligament (ACL) reconstruction returned to their previous levels of sports and to identify why not doing so. Material and Methods: We evaluated 43 knees with a minimum of two years follow-up among whom undergoing 109 ACL reconstruction from September 2003. The mean age of patients was 26 years (17 to 45 years) Clinical results was evaluated according to the Lysholm Knee scores, Tegner activity score, subjective IKDC questionnaires, objective IKDC evaluation form and KT-1000 arthrometer. Results: The overall clinical results demonstrated significant improvement at the final follow-up comparing to preoperative data (P<0.05). Among 43 patients, 25 patients (58%) returned to their previous level of sports and 18 patients (42%) did not. Of whom, 11 patients (61%) were not able to return to sports due to fear to re-injury and 7 patients (39%) suffered from instability and pain. The differences in the Lysholm Scores, KT-1000 arthrometer and subjective IKDC in the 3 groups of patients by ANOVA test were found to be statistically significant (P<0.001). Although there is no difference in objective IKDC and KT-1000 arthrometer, the difference was observed in Tegner activities, subjective IKDC obtained by those who returned to sport and those who had fear to reinjury (P<0.001). Conclusion: This study showed that a quater of patients could not return to their previous level of sport after ACL reconstruction because of fear to reinjury. We thought that not only improving the technique of ACL reconstruction and systemic rehabilitation but also considering psychological factor of patients could allow more patients to return to the previous level of sports.

• Clinical and Experimental Pediatrics
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• v.49 no.1
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• pp.29-33
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• 2006

Purpose : The aim of this study was to analyze the results and contributing factors of catch-up growth in very low birth weight infants(VLBWI) at the corrected age of 2 years. In addition, we looked for a relationship between the catch-up growth and the development by the bayley scales of infant development II(BSID II). Methods : A retrospective analysis by evaluating medical records was done for the 76 VLBWI whose follow-up was possible up to a corrected age of 2 years, out of the 114 who had been treated in the neonatal intensive care unit during the January of 2000 to December of 2001 at Samsung Cheil Hospital. Based on the Standard Korean Infant's Growth Curve, the catch-up growth group was defined over the 10th percentile of weight at 2 years as the corrected age and the failed catch-up growth group was defined under the 10th percentile. We investigated the clinical factors and courses of each group and compared the scores of the BSID II. Results : The catch-up growth group of the VLBWI was 51 infants and the failed catch-up growth group was 25 infants. In comparison with maternal clinical factors, use of antenatal steroids was significantly higher in the catch-up growth group. In comparisn with clinical factors and courses of VLBWI, two clinical factors were significantly different between the two groups : birth weight and intrauterine growth retardation(IUGR). Numbers of delayed development were increased in the failed catch-up growth group but statistically significant differences could not be observed. Conclusion : The catch-up growth of the VLBWI was affected by the use of antenatal steroids, birth weight and IUGR. No significant differences regarding neurodevelopmental outcome were observed between the catch-up and failed catch-up growth groups.

• Clinical and Experimental Pediatrics
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• v.52 no.10
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• pp.1140-1146
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• 2009

Purpose:The pathophysiology of magnesium, the second highest common compound in humans, is still unclear, especially in preterm babies. We accessed the association between total magnesium (tMg), ionized Mg (iMg), and gestational age (GA) and that between serum magnesium (sMg) and intraventricular hemorrhage (IVH) in preterm babies. Methods:In all, 119 inborn preterm infants admitted between July 2006 and February 2008 were divided into the IVH group (19) and the control group (100) and were prospectively analyzed. TMg, iMg, pH, total calcium (tCa), and ionized Ca (iCa) levels were determined immediately after delivery or within 3 hours after birth, and their correlation with GA were investigated. Results:TMg was not correlated with GA, tCa, iCa, and pH. IMg was correlated with tMg (r=0.288, P=0.002) and iCa (r=0.212, P=0.021); however, it was not correlated with GA and pH. Mean GA and birth weight were significantly lower (P=0.002) and smaller (P=0.030) in the IVH group. Mean sMg was higher in the IVH group ($2.5{\pm}0.9mg/dL$) than in the control group ($2.1{\pm}0.6mg/dL$) (P=0.021). SMg was a risk factor even after logistic regression analysis (OR, 2.798; 95% C.I., 1.265-6.192; P=0.011). Conclusion:In less than 37-week-old preterm babies, tMg and iMg were similar, regardless of GA. High sMg may be a risk factor for IVH in premature babies, regardless of their exposure to antenatal magnesium.

• Journal of the Korean Society of Food Science and Nutrition
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• v.43 no.6
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• pp.916-925
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• 2014

The purpose of this study was to compare dietary and lifestyle habits in middle-aged women based on their self-perceived health-related physical fitness (SPF) level as well as investigate the effects of dietary and lifestyle habits on SPF. The study subjects were divided into two groups, 'High' group (${\geq}3.2$, n=64) and 'Low' group (<3.2, n=69), based on average SPF value (3.2). Women in the 'High' group showed a greater lean mass (P<0.05), whereas women in the 'Low' group had higher triglycerides (P<0.05). In analyzing characteristics of lifestyle habits, it was found that the 'High' group showed significantly higher scores for 'vitality level (P<0.001)', 'self-rated health status (P<0.001)', 'regular medical checkups (P<0.05)', and 'regular exercise (P<0.05)'. The average score for dietary habits was significantly high in the 'High' group (P<0.05). Furthermore, ordinary dietary habits showed a significant positive correlation (P<0.001) with SPF in the regression analysis after adjusting for disturbance factors. From these results, ordinary desirable dietary habits were shown to be an important factors having positive effects SPF. Therefore, healthy dietary and lifestyle habits should be practiced to improve the SPF of middle-aged women. For this purpose, related educational programs should be developed for the middle-aged women to take interest in their dietary habits.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.6 no.1
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• pp.1-9
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• 2013

Purpose: The purpose is to perform objective evaluation for rotator cuff using ultrasonography and validate factors influencing cuff integrity as well as efficacy of follow-up ultrasonography after unreamed antegrade intramedullary nailing for humerus fracture. Materials and Methods: Seventeen patients with an average age of $55.7{\pm}18.6$ years underwent antegrade intramedullary nailing for humerus fracture and follow-up ultrasonography of shoulder joint. Mean follow-up period was $43.5{\pm}32.2$ months. Intraoperative evaluation for preoperative cuff tear was performed, of which four cuffs were repaired by single row repair technique. Clinical evaluation included visual analogue scale (VAS), range of motion, Korean Shoulder Scoring System (KSS) and American Shoulder and Elbow Society (ASES) score. Ultrasonographic evaluation was performed on cuff integrity and protrusion of proximal nail tip as well. Radiographic evaluation included time to union, protrusion of proximal nail tip and migration of proximal interlocking screw which could affect shoulder joint function. Results: Mean VAS at last follow-up was $1.65{\pm}1.84$ points. Range of motion showed forward flexion of $137.0{\pm}33.5^{\circ}$, external rotation of $43.5{\pm}12.7^{\circ}$ and internal rotation of $16.4{\pm}2.0^{\circ}$ while KSS score and ASES score were $79.6{\pm}20.7$ and $83.7{\pm}17.0$ points, respectively. Bone union was demonstrated in all cases and average time to union was $3.4{\pm}1.3$ months. Migration of proximal interlocking screw was shown in 6 cases (35%). On ultrasonographic evaluation, there were normal in 8 (47%), weaving in 4 (24%), partial tear in 5 cases (29%), but no complete tear. Protrusion of proximal nail tip was demonstrated in 8 cases (47%) on plain radiographs whereas in 11 cases (65%) on ultrasonography and was associated with increasing age (p=0.038). Ultrasonographic weaving and partial tear was associated with protrusion of proximal nail tip (p=006), but not with repair of preoperative tear (p>0.05). Conclusion: Because weaving and partial tear on ultrasonography originated from protrusion of proximal nail tip, careful insertion of nail and meticulous repair of cuff during operation lead to stable fixation with satisfactory recovery of shoulder function follow-up ultrasonography can be a useful tool for evaluating protrusion of nail tip and rotator cuff tear, of which diagnosis is difficult on plain X-ray after antegrade intramedullary nailing for humerus fracture.