• Korean Journal of Head & Neck Oncology
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• v.10 no.1
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• pp.53-62
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• 1994

미세외과 수술에 의한 유리 피판술의 도입은 두경부 종양제거후 재건에 괄목할 만한 진보를 가져왔다. 특히 광범위한 종양의 제거가 필요하며 인근의 조직으로 수복이 어렵고 기능 및 외모상의 재건이 문제가 되는 경우 유리 피판은 절대적인 적응이 된다. 구강은 언어구사 와 연하(deglutition)기능을 담당하므로 재건을 위해서는 얇고 부드러운 조직으로 수복하여 주어야 한다. 전완부 유리피판은 혈관경의 위치가 대부분 일정하고 종양 제거후 결손의 모양에 따라 피판을 계획할 수 있기 때문에 구강암 제거후 가장 많이 이용되는 유리피판이다. 저자는 1982년 부터 1988년까지 영국 글라스고우 소재 서부 스코틀랜드 성형 및 구강외과 병원에서 구강의 편평상피암환자로 암종제거 후, 전완부 피판에 의한 재건 및 방사선 치료를 받은 151명의 치료결과(재발율 및 생존율)를 분석하였다. 절제연의 종양조직의 양성(P<0.05), 경부 임파절의 extracapsular node spread여부(P<0.001), 경부 임파절 곽청술의 종류(P<0.05) 등은 재발율과 관련하여 통계적으로 유의하였다. 반면에 종양의 구강내 위치, 하악골의 침범여부등은 통계적의의가 없었다. 생존율에 관하여는 종양의 구강내 위치 (P<0.05), 종양절제연 종양여부(P<0.005), 하악골의 침범여부(P<0.05), 경부 임파절의 extracapsular node spread여부(P<0.001) 등이 통계적으로 유의할 만한 요소로 밝혀졌다. 젊은 나이의 환자들에서(50세이하) 특징적으로 높은 사망률을 보였다. 하악골절제방법의 차이는 환자의 생존예후에 통계적으로 유의할 만한 영향을 주지 못했다.

• Clinical and Experimental Pediatrics
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• v.45 no.8
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• pp.961-966
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• 2002

Purpose : We compared the underlying or associated diseases according to the frequency of platelet transfusions in neonates with thrombocytopenia to know the factors predicting which patients will require multiple platelet transfusions. We also compared mortality. Methods : A retrospective study was performed in 72 neonates who received the platelet transfusions in neonatal intensive care unit(NICU) between August 1996 and July 2001. Group I received one platelet transfusion and group II received two or more. We compared the frequency of underlying or assodiated diseases such as sepsis/disseminated intravascular coagulopathy(DIC), respiratory distress syndrome(RDS), intraventricular hemorrhage(IVH), patent ductus arteriosus (PDA), necrotizing enterocolitis(NEC), liver or renal disease, and mortality between two groups. Results : Of the 72 patients, 29(40.2%) received one and 43(59.7%) received two or more transfusions; 16(22.2%) received four or more. There were no statistically significant differences in gestational age, birth weight, sex, and maternal history between two groups. C-section rate was higher in group II(20.7% vs. 55.8%, P<0.05) and the incidence of PDA was higher in group I (55.2% vs. 30.2%, P<0.05). Otherwise, there were no statistically significant differences in the incidence of sepsis/DIC, RDS, IVH, RDS, CLD, NEC, liver or renal disease, pulmonary hemorrhage and hypoxic ischemic encephalopathy, and mortality between group I and group II. Conclusion : There was no significant difference in clinical morbidity and mortality according to the frequency of platelet transfusion in neonates with thrombocytopenia. Further study is needed to know the predicting factor for multiple platelet transfusions in neonates with thrombocytopenia.

• Journal of the Korean Data and Information Science Society
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• v.26 no.1
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• pp.101-109
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• 2015

SMRs (standardized mortality rates) for major diseases, accidents, cancer are considered in small areas of administrative units such as Eup/Myeon/Dong from years 2005 to 2008. Due to small sample issue in small areas, the precision of directly estimated crude SMR for each area can be low. In this study, we consider the HGLM (hierarchical generalized linear model) with MRF (Markov random field) to account for the spatial correlations among the small areas. The effects of covariates for cause of mortality by Dongs in Seoul and disease maps based on the estimated SMR are presented. The results suggest how we analyze and interpret the difference in mortalities by small areas such as Dongs by revealing the spatial patterns.

• Journal of Chest Surgery
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• v.43 no.3
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• pp.285-291
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• 2010

Background: Thoracic trauma is one of the leading causes of morbidity and mortality in developing countries. A rib fracture that is secondary to blunt thoracic trauma is an important indicator of the severity of the trauma. The purpose of study was to determine the morbidity and mortality rates and the management of rib fractures. Material and Method: We performed a retrospective study that involved all the blunt trauma patients with rib fractures, excluding those that were transferred to other hospital within 3 days, that were seen at our hospital between May 2002 and December 2008. Of the 474 admitted patients, 454 met the inclusion criteria. There were 356 male and 98 females, and their overall mean age was 53 years (range: 5~90 years). The outcome parameters included the mechanism of injury, the number of fractured ribs, the length of stay in the ICU, the Injury Severity Score (ISS), the length of the hospital stay, the pulmonary complications and the mortality. Result: The mechanism of trauma included traffic accidents in 189 (41.7%) cases, slipping down in 103 (22.7%) cases, falls in 85 (18.7%) cases, cultivator accidents in 30 (6.6%) cases, industrial accidents in 32 (7.0%) cases and assault in 15 (3.3%) cases. Intrathoracic injury was noted such as hemothorax in 269 (59.3%) cases, pneumothorax in 144 (31.7%) cases, pulmonary contusion in 95 (20.9%) cases, subcutaneous emphysema in 29 (6.4%) cases and great vessel injury in 5 (0.1%) cases. Conservative treatment was administered to most of the patients. Tube thoracostomy was administered in 234 (51.5%) cases, whereas thoracotomy was performed in 18 (4.0%) cases. The mean duration of thoracostomy was $5.2{\pm}6.2$ days. Most of the cases with rib fracture were treated in wards and their mean duration of hospital stay was $22.5{\pm}20$ days. The mean Injury Severity Score (ISS) was $14.8{\pm}10.9$ (range: 3~75). The mortality rate was calculated to be 4.8% (n=22). The main factors correlated with an adverse outcome were the number of ribs fractured, the duration of thoracostomy and pulmonary disease. Industrial insurance affected the length of hospitalization. Pulmonary contusion and the Injury Severity Score (ISS) affected the mortality. Conclusion: Rib fractures are a indicator of severe injury. Because of the complication and associated injuries, we believe these patients should be admitted for evaluation and treatment. Recent studies on the impact of rib fractures after blunt trauma have shown that patients as young as 40 years of age demonstrate increased morbidity and mortality with similar injuries as compared to that of older patients. The ISS and pulmonary contusion influenced the mortality rate. Patients with isolated rib fractures should be hospitalized if the number of fractured ribs is one or more.

• Clinical and Experimental Pediatrics
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• v.50 no.7
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• pp.636-642
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• 2007

Purpose : Fluconazole prophylaxis for very low birth weight (VLBW) infants has been shown to reduce invasive fungal infection and its mortality. This study aims to evaluate the effect of fluconazole prophylaxis in VLBW infants on the incidence and mortality of fungal infection. Methods : VLBW infants with endotracheal intubation and central vascular access admitted to the Neonatal Intensive Care Unit (NICU) at Chonnam University Hospital were enrolled. Twenty eight infants of 7-month baseline period from January to July 2005 ('non-fluconazole group') were compared with 29 infants of a 7-month fluconazole period from January to July 2006 ('fluconazole group'). Results : Gestational age, birth weight, sex, mode of delivery, frequency of twin pregnancy, chorioamnionitis, antenatal steroid and rupture of membranes were similar between the fluconazole and non-fluconazole groups. The rate of extremely low birth weight (ELBW) infants, frequency and duration of prophylactic antibiotics, total parenteral nutrition and umbilical catheters, duration of intralipid, mechanical ventilation and nasal continuous positive airway pressure (CPAP) were also not significant. However, frequency of percutaneous central venous catheterization (PCVC) and intralipid administration, and duration of PCVC were significant between the two groups. The overall incidence and mortality of fungal infection were not different between the two groups. Although the Malassezia infection was increased in the fluconazole group (P<0.05), candida was significantly decreased compared to the non-fluconazole group (P<0.05). Conclusion : Fluconazole prophylaxis in high risk VLBW infants decreased the candida infection significantly. Antifungal prophylaxis is recommended in terms of cost effectiveness, but further study is needed to clarify the reason for the increase of Malassezia infection.

• Neonatal Medicine
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• v.18 no.1
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• pp.111-116
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• 2011

Purpose: To evaluate the impact of delayed interval delivery on neonatal outcomes. Methods: This was a retrospective study of infants who were born at Seoul National University Hospital by delayed interval delivery from June 2005 to July 2010. Outcomes (neonatal mortality and morbidity) of later babies were compared to those of the first babies and the control group whose gestational ages and birth weights were similar to them. Results: There were 4 twin and 5 triplet pregnancies. The first babies (group 1, n=9) were delivered at $22^{+6}$ to $27^{+5}$ weeks of gestational age, and the later babies (group 2, n=14) were born at $24^{+6}$ to $28^{+0}$ weeks. The mean interval between the first and later deliveries was 10 days, and there was no delay between the second and third deliveries in all triplet pregnancies. There were more small for gestational age (SGA) infants in group 1 than group 2 (66.7% and 21.4% respectively, P=0.03). Two of three babies who died in group 1 were born before 24 weeks of gestational age and expired within a week after birth. The mortality rate of group 2 (7.1%) was lower than group 1 (33.3%), but not significantly (P=0.106). The control group matched to group 2 consisted of 28 infants. There were no significant differences in neonatal mortality and morbidity between the two groups. Conclusion: Although there is a limitation to the number of infants in this study, it suggested that delayed delivery in a multiple pregnancy could decrease the incidence of SGA of the remaining fetuses and that prolonged gestation would not be harmful to those fetuses after birth.

• Journal of Chest Surgery
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• v.31 no.7
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• pp.660-667
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• 1998

Background: This study is to evaluate the effectiveness and application of Lecompte procedure as a treatment for various complex cardiac anomalies with pulmonary outflow tract obstruction. Methods: Between July 1988 and December 1997, 44 patients underwent Lecompte procedure in Seoul National University Children's Hospital. The male to female ratio was 24 to 20 and the mean age was 29.2 months(range, 3 to 83). Of these patients, 28(63.6%) had transposition of great arteries with ventricular septal defect and pulmonary stenosis(or pulmonary atresia), 14(31.8%) had double outlet right ventricle with pulmonary stenosis(or pulmonary atresia), and so on. The principles of the technique are 1) extension of the ventricular septal defect or conal resection, 2) construction of a intracardiac tunnel connecting the left ventricle to the aorta, and 3) direct connection, without a prosthetic conduit, of the pulmonary trunk to the right ventricle. Results: There were 3 in-hospital deaths and their causes were sustained hypoxia, myocardial failure, and sepsis, respectively. There was 1 late death due to sepsis. Reoperations were performed in 6 patients who had pulmonary outflow tract obstructions(4 cases), residual muscular ventricular septal defect(1 case), and recurrent septic vegetation(1 case). The cumulative survival rates by the Kaplan-Meier method were 92.7%, 92.7%, and 92.7% at 1, 2, and over 4 years. The reoperation free survival rates were 92.7%, 92.7%, and 70.2% at 1, 3, and over 5 years. Among the risk factors for the operative death, aortic cross clamping time had statistical significance(p<0.05) and all the risk factors for the recurrent pulmonary stenosis such as age, pulmonary artery index, and materials used for the pulmonary outflow tract reconstruction had no statistical significance(p>0.05). Conclusions: Our review suggests that Lecompte procedure is an effective treatment modality for various complex cardiac anomalies with pulmonary outflow tract obstruction. Repair in early age is possible and the rates of mortality and morbidity are also acceptable.

• Tuberculosis and Respiratory Diseases
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• v.58 no.6
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• pp.607-613
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• 2005

Background : Early death is an important problem associated with the management of community-acquired pneumonia. However, there is little information on the risk factors associated with it. The aim of this study was to identify the factors associated with early death in community-acquired pneumonia patients. Methods : From January 1999 to July 2004, 1,487 adult patients with community-acquired pneumonia who were admitted to the pulmonary department via emergency center were examined. Early death was defined as those who died within 2 days of hospitalization. The clinical and laboratory aspects of the patients who died early (n = 30) were compared with those of an age and gender matched control population (n = 60). Results : In the early death group, respiratory rate, heart rate, and blood urea nitrogen (BUN) were significant higher (p < 0.05 for all), while the arterial pH, systolic pressure, and $PaO_2$ were significant lower (p < 0.05 for all) than the control. The independent factor significantly associated with early death was tachypnea (OR, 7.049). Conclusion : The importance of an early clinical assessment in emergency center with community-acquired pneumonia needs to be emphasized in order to recognize patients at risk of early death.

• Journal of Chest Surgery
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• v.38 no.2 s.247
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• pp.110-115
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• 2005

Background: The aims of this paper were to review the mid term clinical results and to analyze the preoperative risk factors of isolated aortic valve replacement (AVR). Material and Method: Between January 1992 and February 2003, 80 patients underwent isolated AVR. 58 were male and 22 were female patients, raging from 12 to 75 years of age (mean :$46.8{\pm}13.0$ years). 74 patients except one early death and 5 follow-up loss were contacted by OPD or by telephone. The mean duration of follow-up was $44.2{\pm}29.7$ months and the total cumulative period was 272.8 patient-year. Result: The complications in hospital occurred in 35 cases : 12 wound problems (11 superficial, 1 deep), 11 arrhythmias (9 temporary, 2 persistent), 3 low cardiac output, and so forth. The late deaths were 4 cases : the heart-related deaths were 2 cases ($0.7\%$ patient-year). Conclusion: The risk factors that influenced the early mortality and morbidity were older age (> 60 years)(p=0.04), poor preoperative NYHA functional class (> 3) (p=0.048), high preoperative serum creatinin level (> 1.2 mg/100 ml)(p=0.031), long operation time (aortic clamping time>90 min)(p=0.042). The same factors influenced the late mortality and morbidity. Freedom from valve-related complication was $86.4{\pm}5.3\%,$ actuarial survival rate were $96.8{\pm}2.3\%$ at 3 years and $90.8{\pm}4.6\%$ at 10 years.

• 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.