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Surgical Treatment of Primary Lung Cancer (원발성 폐암의 외과적 치료)

  • 김성완;구본원;이응배;전상훈;장봉현;이종태;김규태;강덕식
    • Journal of Chest Surgery
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    • v.31 no.2
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    • pp.134-141
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    • 1998
  • Primary lung cancer has recently increased progressively in its incidence in Korea. It is clearly evident that surgical resection offers the best offortunity for cure of non-small cell carcinoma. This study was designed to analyse the clinical data of 100 primary non-small cell carcinoma patients who underwent lung resection surgery from January 1992 to July 1995 at the department of Thoracic and Cardiovascular Sugery, Kyungpook National University Hospital. There were 86 males and 14 females(6:1). In the age distribution, the peak incidence was recorded in the seventh decade(43%). The methods of tissue diagnosis were bronchoscopic biopsy in 53 patients(50.5%), percutaneous needle aspiration in 17 patients(16.2%), transbronchial lung biopsy in 11 patients(10.5%), mediastinoscopic biopsy in 2 patients (1.9%), sputum cytology in 2 patients(1.9%), and thoracotomy in 20 patients(19.0%). Fifty-five lobectomies, 22 pneumonectomies, 15 bilobectomies, 2 segmentectomies, 4 sleeve lobectomies, a sleeve pneumonectomy, and a wedge pneumonectomy were performed. Operative mortality occured in 4 cases(sepsis in 2 cases, respiratory failure in 1 case, and acute myocardiac infarction in 1 case). The histologic types of tumor were 67 squamous cell carcinomas, 26 adenocarcinomas, 6 large cell carcinomas, and an adenosquamous cell carcinoma. Eighteen patients with N2 mediastinal lymph node metastases had 8 squamous cell carcinomas(11.9%), 9 adenocarcinomas(34.6%), and a large cell carcinoma(16.7%). The primary tumors in these patients were in the right upper lobe in 4 patients, the right middle and lower lobe in 9 patients, the left upper lobe in 3 patients, and the left lower lobe in 2 patients. With regard to pathologic stages, 45 patients had stage I disease; 13 patients, stage II; 36 patients, stage IIIa; 5 patients, stage IIIb; and 1 patient, stage IV. The overall actuarial survival rate was 77.5% at 12 months, 56.1% at 24 months and 43.7% at 43 months. The actuarial survival rates at 43 months were 81.3% in Stage I, 20.8% in Stage II, 27.9% in Stage IIIa, 25.0% in Stage IIIb and 33.3% in Stage IV. These facts suggest that early detection and surgical resection are recommended for favorable postoperative survival in non-small cell lung cancer.

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Impacts of Diastolic Function on Clinical Outcomes in Young Patients with Acute Myocardial Infarction (젊은 급성 심근경색증 환자에서 좌심실 이완 기능 및 충만압이 관상동맥중재술 후 임상 경과에 미치는 영향)

  • Cho, Eun Young;Jeong, Myung Ho;Yoon, Hyun Ju;Kim, Yong Cheol;Sohn, Seok-Joon;Kim, Min Chul;Sim, Doo Sun;Hong, Young Joon;Kim, Ju Han;Ahn, Youngkeun;Cho, Jae Young;Kim, Kye Hun;Park, Jong Chun
    • The Korean Journal of Medicine
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    • v.93 no.6
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    • pp.538-547
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    • 2018
  • Background/Aims: The impact of left ventricular (LV) diastolic function and filling pressure on clinical outcomes in young patients with acute myocardial infarction (AMI) has been poorly studied. Therefore, the aim of this study was to investigate the impact of LV diastolic function and LV filling pressure on major adverse cardiac events (MACEs) in young patients with AMI. Methods: A total of 200 young patients (males < 45 year, females < 55 year) with AMI were divided into two groups according to the diastolic function; normal (n = 46, $39.5{\pm}5.3$ years) versus abnormal (n = 154, $43.5{\pm}5.1$ years). Results: Despite regional wall motion abnormalities, normal LV diastolic function was not uncommon in young AMI patients (23.0%). During the 40 months of clinical follow-up, MACEs developed in 26 patients (13.0%); 14 re-percutaneous coronary intervention (7.0%), 8 recurrent MI (4.0%), and 4 deaths (2.0%). MACEs did not differ between the normal and abnormal diastolic function group (13.6% vs. 10.9%, p = 0.810), but MACEs were significantly higher in the high LV filling pressure group than the normal LV filling pressure group (36.8% vs. 10.5%, p < 0.001). On multivariate analysis, high LV filling pressure was an independent predictor of MACEs (hazard ratio 3.022, 95% confidence interval 1.200-7.612, p = 0.019). Conclusions: This study suggested that measurement of the LV filling pressure (E/e' ratio) would be useful in the risk stratification of young patients with AMI. However, it would be necessary to monitor this category of patient more carefully.

Bivenrticular Repair of Double Outlet Right Ventricle with Remote Ventricular Septil Defect. (비상관성 심실중격결손중을 동반한 양대혈관우심실기시증 환자에서의 양심실성 교정)

  • 방정현;이영탁
    • Journal of Chest Surgery
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    • v.30 no.7
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    • pp.641-646
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    • 1997
  • Understanding of the surgical anatomy of patients with double outlet right ventricle (DORV) is important in the planning of biventricular repair From May 1995 to September 1996, 7 patients underwent biventricular repair for DORV with remote ventricular septal defect. There were 5 males and 2 (tamales. Age at operation varied from 2 to 9 years(mean 3.4$\pm$ 2.7years). Preoperative diagnostic assessment was made by two-dimensional echocardiography and cardiac catheterization. Ventricular septal defect was perimembranous inlet type in all patients. Associated cardiac anomalies were pulmonary atresia in two, pulmonary stenosis in five and tricuspid chordal attachment to zonal septum in five. The operations were performed intraventricular repair and pulmonary enlargement in two, REV operation in two, and Rastelli operation in three. There was no early postoperative deaths and complications. The follow-up period war from 1 month to 18mon1hs, averaging 10: 6.1 months. In the past, we considered the Fontal operation indicative as primary choice when DORV was associated with abnormal tricuspid chordal attachment to the zonal septum, but now we believe that biventricular repair is feasible for those cases by making conal flap or reattachment method. Biventricular repair has theoretic advantages because it estabilishes normal anatomy and physiology, and it was concluded that the precise preoperative evaluation using both echocardiography and cardiac catheterization was essential to the successful surgery.

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Changes of Dynamic Stereoacuity Depending on Distance between Rods and Rod Thickness in Three Rods Test (세막대 검사에서 막대 간 거리와 막대두께 차이에 의한 동적입체시력의 변화)

  • Han, Kyung-Do;Lee, Min-Jae;Kim, Sang-Yeob;Moon, Byeong-Yeon;Yu, Dong-Sik;Cho, Hyun Gug
    • Journal of Korean Ophthalmic Optics Society
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    • v.21 no.3
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    • pp.253-257
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    • 2016
  • Purpose: To determine whether the distance between objects and the size of object are factors to be able to affect dynamic stereoacuity. Methods: Subjects were 37 adults (26 males and 11 females) with an average age of $23.89{\pm}1.76$. Refractive error was fully corrected for all subjects and each visual acuity of them was over 0.9. Three rods test was performed for measurement of stereoacuity. The viewing angles from left rod to right rod were set $5^{\circ}$, $10^{\circ}$, and $15^{\circ}$ and the rod thickness used 7 mm, 14 mm, and 21 mm, respectively. Stereoacuity was repeatedly measured three times in each test condition at 2.5 m distance, and reported the average value of them. Results: When rod thickness was 7 mm or 14 mm, dynamic stereoacuity decreased as the viewing angle increased, and they were significantly decreased (p<0.01) at viewing angles of $10^{\circ}$ and $15^{\circ}$ as compared with that of at $5^{\circ}$, respectively. When rod thickness was 21 mm, dynamic stereoacuity decreased as the viewing angle increased, especially, that of at $15^{\circ}$ decreased significantly (p<0.01) as compared with that of at $5^{\circ}$. The dynamic stereoacuity depending on the rod thickness have an increasing tendency as the rod thickness increased. Conclusions: The viewing angle between objects and the size of viewing object were factors that affect to dynamic stereoacuity.

A Study on Oral Health Related Quality of Life in Elders Concerning to Residence at Urban and Rural (도시농촌 노인의 구강건강과 삶의 질에 관한 연구)

  • Yoon, Young-Suk
    • Journal of dental hygiene science
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    • v.6 no.1
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    • pp.23-28
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    • 2006
  • This study was conducted to investigate the oral health related quality of life in elders concerning to residence at urban and rural. The subjects were 215 old persons who were over the 60 years old, living at Sahagu in Busan(113persons) and Geojer Si in Kyungnam (102persons). The data for this study were collected by direct interviewing method from May 30 th to June 30 th and September 12 th, 2005. Cushing & Sheiham's Sociodental Scale which measures oral health related quality of life was used for this study. The data were analysed by a computerized program named statistical package for social science including frequency, percentage, t-test. The results of this study were summarized as follows; 1. Mean score of the oral health related quality of life in elders is $2.42{\pm}1.03$ 2. There was a significant difference in oral health related quality of life in elders between the age 60 ~ 70 years group and the over than 71 years group(P < 0.01). 3. There was a significant difference in oral health related quality of life in elders between the urban and rural group(P < 0.05). Above findings suggest that further study about proper program for geriatric oral health evaluation is necessary in improving the oral health related quality of life in elders.

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Consumption Values on the Intention to Re-use on Geriatric Hospitals (노인요양병원 재이용 의사에 영향을 미치는 소비가치 요인)

  • Kwon, Jin
    • The Journal of the Korea Contents Association
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    • v.13 no.12
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    • pp.921-930
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    • 2013
  • Objective: After introduction of the Elderly Long Term Care Insurance, number of geriatric hospitals increased greatly. However, few studies were conducted on the satisfaction of the patients of the geriatric hospitals especially on the intention to reuse geriatric hospitals. Methods: The current study modified Sheth's consumption value model, useful for the development of an effective marketing strategy for geriatric hospitals, and tested it in Korean circumstances. The survey was conducted at two municipal hospitals and three private hospitals in Seoul and Gyeonggi Province between August 1 and September 30 of 2012. Data were collected from 472 inpatients who are 60 years or older. The structured research tool was developed and distributed. Factor analysis and hierarchical logistic regression analysis were conducted using SPSS(version 14.0) Results: The result of the research suggested that the satisfaction on rehabilitation services, which is a functional value, among the consumption values was the strongest factor on the intention to reuse geriatric hospitals. Impression of high-end luxury, reliability of care, and outside locus of control on health followed. Conclusion: It is recommended that geriatric hospitals ought to improve rehabilitation programs, facilities, and equipments and enhance kindness of staff to encourage intention to reuse geriatric hospitals.

The Clinical Experiences of Patch Angioplasty in Isolated Critical Left Main Coronary Artery Stenosis (첨포를 이용한 좌주관상동맥 협착증의 치료)

  • 윤치순;유경종;이교준;김대준;강면식
    • Journal of Chest Surgery
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    • v.31 no.7
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    • pp.674-678
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    • 1998
  • The conventional surgical treatment of isolated critical stenosis of the left main coronary artery restores a less physiologic perfusion of the myocardium, leads to occlusion of the left coronary ostium, and consumes an appreciable length of bypass material. From June 1994 to February 1996, eleven patients, three male and eight female, underwent patch angioplasty and additional bypass graft to left anterior descending artery (10 internal mammary artery, 1 saphenous vein) in isolated critical left main coronary artery stenosis. Their ages ranged from 34 to 62 years, mean 44 years. All had 60% to 90% stenosis of the left main coronary artery and Class III angina. The angiogram showed nine osteal lesion and three main stem stenosis. The operation was performed with conventional cardiopulmonary bypass and cold blood cardioplegia. We approached anteriorly and used bovine pericardium as onlay patch in all patients. There were one leg wound dehiscence, but no operative deaths and infarctions. All patients are free of symptoms after a mean follow-up of 15.5 months. Angiographic restudy at an average 14.4 months was obtained in five patients and showed widely patent left main coronary artery with excellent runoff. But additional graft to left anterior descending coronary artery were stenosed in two patients and showed diminutive flow in others. Our preliminary results suggest that angioplasty of the left main coronary artery can be carried out with low operative risks. But additional bypass graft to left anterior descending coronary artery may be unnecessary. The technique appears to be a promising alternative to conventional coronary artery bypass grafting in isolated left main coronary artery stenosis.

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Economic and Political Responses to Globalization: Economic Restructuring and Local Government as an Entrepreneur (세계화에 따른 경제${\cdot}$정치적 동향: 경제재구조와 기업가로서의 지방정부)

  • Koh, Tae-Kyung
    • Journal of the Korean Geographical Society
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    • v.31 no.4
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    • pp.662-671
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    • 1996
  • Since the world's economic and political structures have changed, the term 'globlization' has shown up as a dominant power and as a necessity for regional and national development. Each nation is responding to the globalization process economically and politically in various ways. In general, however, the economic response to the globalization is economic restructuring from the Fordist industries to 'flexible specialization'. And the political response to the globalization is 'global localization' as a new type of local politics(i.e., local policy activism or growth-enhancing local development policies). The crisis of Fordism shifted the role of local governments towards more involovement with local economic development. Local governments are mobilizing for loca economic development, they are taken into a process of institutional change that tends to redefine their responsibilities inside the state. Local governments thus tend to act as an entrepreneur in order to restructure theiir local economies and to compete with other national and international regions. State restructuring towards enerepreneurialism and efficient regional policy pursuing a pro-growth coalition trategy is chosen as a new mode of regulation for the post-Fordism at the local level. The flexible specialization as the post-Fordist economy and the local government as an entrepreneur are the global choice for globalization and a post-Fordist society. The paper focuses on the regulation theory which comprises the political economic perspective on resturcturing. Economic restructuring and state restructuring will be discussed in detail. And the paper tries to combine the economic globalization and the global localization as economic and political responses to globalization.

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Analysis of Characteristics and Symptoms in Home-Based Hospice-Palliative Care Patients Registered at Local Public Health Centers (일 지역 보건소 등록 호스피스 완화돌봄 대상자의 특성 및 증상 분석)

  • Choi, Soon-Ock;Kim, Sook-Nam
    • Journal of Hospice and Palliative Care
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    • v.18 no.4
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    • pp.329-334
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    • 2015
  • Purpose: This study was aimed at analyzing the characteristics and symptoms in home-based hospice-palliative care (HBHPC) patients registered at local public health centers. Methods: A retrospective study was performed; Data of 144 HBHPC patients registered at six public health centers in Pusan City were analyzed, including their initial visit records (registration cards, initial pain evaluation and symptom evaluation). Results: The average age of the patients was 67.7 years old. Among all, 46.2% of the patient lived alone, and 65% had middle school education or lower. The most popular (36.3%) religion was Buddhism, and 47.5% received medical assistance from the government. The most frequent diagnosis was lung cancer followed by stomach cancer and liver cancer in that order. Of all, 48.9% were functionally too weak to lead a daily life, 39.6% were under cancer treatment when registered at the public health center, and 84.5% were aware of the fact that they have reached the terminal phase. Moreover, 83.6% complained about pain, and the pain level was moderate or severe in 36.5% of them. Besides pain, fatigue was the most complained symptom (84.7%), and 49.3% of them rated their fatigue as moderate or severe. Conclusion: Most of the HBHPC patients were socio-economically underprivileged and complained about moderate or worse pain and symptoms. Therefore, it appears necessary to develop an integrated strategy that is tailored for each patient reflecting their characteristics.

Analysis of Antibiotic Resistant Patterns in Conjugant and Transformant of Three ESBL gene Harboring Klebsiella pneumoniae (세 가지의 ESBL 유전자를 가지고 있는 Klebsiella pneumoniae의 유전자접합체와 헝질전환체의 항생제내성분석)

  • Kim, Yun-Tae
    • Journal of Life Science
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    • v.17 no.10
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    • pp.1426-1433
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    • 2007
  • To investigate the antibiotic resistant patterns of the bacteria producing ESBL, we isolated one organism of Klebsiella pneumoniae from a clinical laboratory in Busan. The organism that produces ESBL gene was detected by double disk synergy test and the presence of three ESBL genes (TEM-1, SHV-12, CTX-M-15) was confirmed by polymerase chain reaction and DNA sequencing analysis. To analyse the characteristics of three ESBL genes, we performed transconjugation, transformation and cloning experiment with the organism. The MIC of Klebsiella pneumoniae was revealed that ceftazidime, cefotaxime and ceftriaxone were $256\;{\mu}g/ml,\;128\;{\mu}g/ml\;and\;128\;{\mu}g/ml$ respectively. The MIC of conjugant (E. coli $RG176^{Na(r)}$) af was revealed that ceftazidime, cefotaxime and ceftriaxone were $256\;{\mu}g/ml,\;64\;{\mu}g/ml\;and\;128\;{\mu}g/ml$ respectively. The MIC of transformant (E. cofi $DH5{\alpha}$) was revealed that ceftazidime, cefotaxime and ceftriaxone were $128\;{\mu}g/ml,\;32\;{\mu}g/ml,\;and\;32\;{\mu}g/ml$ respectively, The MIC of cloned organism of SHV-12 gene (E. coli $DH5{\alpha}$) was revealed that ceftazidime, cefotaxime and ceftriaxone were $128\;{\mu}g/ml,\;8\;{\mu}g/ml,\;and\;32\;{\mu}g/ml$ respectively. The results indicated that MIC of conjugant was higher than MIC of transformant and also SHV-12 gene were not resistant against cefotaxime antibiotic.