• Korean Journal of Clinical Pharmacy
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• v.12 no.1
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• pp.29-38
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• 2002

Hypertension is an important public health problem because it increases the risk of stroke, angina, myocardial infarction, heart failure, and end-stage renal disease. If it is not actively treated, morbidity and mortality increase with hypertension-induced complications and quality of life decreases. This study was to evaluate the use of antihypertensive drugs and blood pressure changes and to compare algorithms chosen (or the 1st and 2nd line therapy of hypertension based on the JNC VI recommendations. The medical charts of 222 patients with essential hypertension at St. Vincent's Hospital in Suwon from January 1997 to January 2000 were reviewed retrospectively. Data collection and analysis included baseline BP underlying diseases and complications, administered antihypertensives, BP changes, changes of antihypertensive regimen, and adverse effects with treatments. As results, the higher BP the patients had, the more frequent they had target organ damages and clinical cardiovascular diseases. Mean duration to reduce blood pressure less than 140/90 mmHg was 8 weeks in $85.3\%$ of the patients. The rate of control in BP was $82.4\%$ at 6 months. The major antihypertensive drugs prescribed were calcium channel blockers $(61.8\%)$ , ACE inhibitors $(19.1\%),\;\beta-blockers\;(13.7\%)$ and diuretics $(5.3\%)$ as the 1st-line monotherapy. The methods of treatment used as the 1st-line therapy were monotherapy$(59\%)$ and combination therapy $(41\%)$. Blood pressure change was significantly greater for combination therapy than monotherapy$(-26.2\pm21.4\;vs.\;-18.56\pm16.7$ mmHg for systolic blood pressure; P<0.003, $-16.9\pm13.2\;vs.\;-9.2\pm12.8$ mmHg for diastolic blood pressure; p<0.001). When blood pressure was not completely controlled with the first antihypertensive selected, the 2nd line therapy had 4 options: addition of 2nd agent from different class; $66.2\%$, substitution with another drug, $21.9\%$ increase dose $11.9\%$ continue first regimen $27.9\%$ Calcium channel blockers were the most frequently prescribed agents. This was not comparable to the JNC VI guideline which recommended diuretics and $\beta-blockers$ for the 1st-line therapy. Most of patients achieved the goal BP and maintained it until 6 months, but the remaining patients should be controlled more tightly to improve their BP with combination of life style modification, patient education, and pharmacotherapy.

• Journal of Chest Surgery
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• v.39 no.6 s.263
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• pp.462-469
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• 2006

Background: Pneumonectomy for inflammatory lung disease has been of major concern because of its associated morbidity and mortality, particularly with respect to pleuropneumonectomy. The purpose of this study is to evaluate the surgical outcomes, and identify the risk factors contributing to postoperative complications in patients undergoing pleuropneumonectomy. Material and Method: Ninety-eight patients underwent pneumonectomy for benign inflammatory lung disease were retrospectively analyzed. Pleuropneumonectomy (Group A) was done in 48 patients and standard pneumonectomy (Group B) was done in 50 patients. Clinical characteristics, postoperative complications were examined and compared between 2 groups. In pleuropneumonectomy group, postoperative risk factors affecting morbidity were evaluated. Result: There was one in-hospital death. Twenty-three major postoperative complications occurred in 21 patients (21.4%). The common complications were empyema and bronchopieural fistula (BPF) in 8 (8.4%), re-exploration due to bleeding in 8. At least one postoperative complication occurred in 14 of 48 patients from Group A (29.2%) and in 7 of 50 patients from Group B (14%). In Group A, empyema and BPF encountered in 6 and re-exploration for bleeding in 6 were the most common complication. In univariate analysis, right pneumonectomy, completion pneumonectomy, large amount of blood loss (>1,000 mL), and intrapleural spillage were risk factors contributing to postoperative complications in Group A. In multivariate analysis, intrapleural contamination during operation was a risk factor of postoperative complication. Conclusion: The morbidity and mortality rates of pneumonectomy for chronic inflammatory lung disease are acceptably. However, we confirm that pleuropneumonectomy is a real technical challenge and a high-risk procedure and technically demanding. Meticulous surgical techniques are very important in preventing serious and potentially lethal complications.

• Clinical and Experimental Pediatrics
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• v.50 no.11
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• pp.1055-1060
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• 2007

Right-sided heart failure is a major problem among patients with congenital heart diseases, due to the prevalence of congenital heart defects and the association of pulmonary hypertension. More attention is focused on the structure of the right heart particularly in association with congenital heart defects and chronic lung disease. The right ventricle (RV) may support the pulmonary circulation, and sometimes the systemic circulation (systemic RV) in congenital heart defects. Despite major progress being made, assessing the RV remains challenging, often requiring a multi-imaging approach and expertise (echocardiography, magnetic resonance imaging, nuclear and cineangiography). Evidence is accumulating that RV dysfunction develops in many of these patients and leads to considerable morbidity and mortality. While there is extensive literature on the pathophysiology and treatment of left heart failure, the data for right-sided heart failure is scarce. Therefore RV function in certain groups of congenital heart disease patients needs close surveillance and timely and appropriate intervention to optimise outcomes. An understanding of RV physiology and hemodynamics will lead to a better understanding of current and future treatment strategies for right heart failure. This will review right-sided heart failure with the implications of volume and pressure loading of the RV in congenital heart diseases.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.4
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• pp.2167-2172
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• 2013

Lung cancer remains a major cause of morbidity and mortality worldwide, accounting for more deaths than any other cause. All the clinical practice guidelines recommended against routine screening for lung cancer have cited lack of robust evidence, at least until a few years back. However, the potential to screen lung cancers has received renewed interest due to superior performance of low dose CT (LD-CT) in detecting early stage cancers. The incremental costs and risks involved due to the invasive procedures in the screened population due to a high false positivity rate questions the use of LD-CT scan as a reliable community based screening tool. There is therefore an urgent need to find a less invasive and a more reliable biomarker that is crucial to increase the probability of early lung cancer detection. This can truly make a difference in lung cancer survival and at the same time be more cost and resource utilization effective. Sampling blood serum being minimally invasive, low risk and providing an easy to obtain biofluid, needs to be explored for potential biomarkers. This review discusses the use of circulatory miRNAs that have been able to discriminate lung cancer patients from disease free controls. Several studies conducted recently suggest that circulating miRNAs may have promising future applications for screening and early detection of lung cancer.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.2
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• pp.533-538
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• 2012

Background: Tobacco cessation would provide the most immediate benefits of tobacco control to prevent tobacco related disease morbidity and mortality. Methods: A tobacco cessation program involving individual and group behavior therapy was implemented in three stages at a worksite. Tobacco quit rates were assessed at the end of each contact session. Results: Out of the 291 tobacco users identified, 224 participated in the tobacco cessation interventions. At the end of three interventions, 38 (17%) users had successfully quit tobacco use. Presence of clinical oral pre-cancer lesion was found to be associated with quitting (p=0.02). Also tobacco users with oral pre-cancer lesions were around three times more likely to quit than those with no lesions (OR= 2.70 95% C.I= 1.20 - 6.05). Conclusion: Cost effective multi-pronged tobacco cessation approaches, inbuilt into other occupational health and welfare activities, are acceptable and feasible to achieve long term sustainable tobacco cessation programs at worksites.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.6
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• pp.577-581
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• 2010

Descending necrotizing mediastinitis (DNM) is a complication of odontogenic or oropharyngeal infections that can spread to the mediastinum. Such infections is serious, leading to sepsis and frequently to death. Even in this era of antibiotics, the mortality rate associated with DNM is approximately 40%. It is difficult to diagnose early because clinical and radiologic findings appear in the late stage of the infection. Delayed diagnosis is the principal reason for the high mortality in DNM. Therefore, descending necrotizing mediastinitis requires an early and aggressive surgical approach to reduce the high morbidity and mortality associated with this disease. We experienced a case of odontogenic infection followed by acute mediastinitis, so present now with the review of literatures.

• Korean Journal of Head & Neck Oncology
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• v.11 no.2
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• pp.167-172
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• 1995

Pharyngocutaneous fistula(PCF) is one of the complications following total laryngectomy in laryngeal and hypopharyngeal cancer. Fistula lead to delayed wound healing, more serious complications such as carotid blow-out, prolonged hospitalization, significant patient morbidity and occasional mortality. Identification of patients at high risk for fistula formation, appropriate preventive measures, and appropriate management are the head and neck surgeon's responsibility. So we analyzed the clinical data of pharyngocutaneous fistula which was developed after total laryngectomy. Following results were obtained: 1) Occurrence of PCF increases with salvage surgery compared to curative surgery. 2) Early detection and effective management of PCF are the key factors to decreasing the hospitalization period. 3) Constructing a pharyngostoma seems to be an ideal method of preventing dangerous complications and ultimately closing the fistula. 4) Simultaneous reconstruction is necessary in the high risk group.

• Archives of Reconstructive Microsurgery
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• v.10 no.2
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• pp.124-130
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• 2001

Both of latissimus dorsi and rectus abdominis muscles are workhorse for various reconstructive surgeries. These muscle flaps have been used widely for soft tissue coverage, tissue augmentation, and functional muscle transfer. However, the traditional method for muscle harvest requires a long incision that often results in an unsightly scar and becomes the main concern of the patient. The purpose of this study is to introduce our clinical experience of endoscopic harvest of latissimus dorsi muscle and rectus abdominis muscle, and to make comparison with traditional harvest of these two muscle flaps. Of the 13 rectus abdominis muscles free flaps, 6 muscles were harvested traditionally and 7 muscles were harvested with endoscopic assistance. Of the 21 latissimus dorsi muscle free flaps, 12 muscles were harvested traditionally and 9 muscles were harvested with endoscopic assistence. Follow up period was between 6 months and 24 months. The patients age ranged from 7 to 70 years old. The result revealed no statistically significant differences in the amount of intraoperative bleeding, incidence of postoperative hematoma and seroma, and the incidence of donor-site wound infection. However, patients feel less pain and start earlier and better movement after the operation with endoscopically assisted harvest. This technique is easy to learn, is safe, and can reduce substantially the donor site morbidity comparing traditional harvesting technique.

• Childhood Kidney Diseases
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• v.19 no.2
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• pp.71-78
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• 2015

The incidence of acute kidney injury (AKI) in critically ill pediatric patients has been reported as increasing to 25 %, depending on population characteristics. The etiology of AKI has changed over the last 10-20 years from primary renal disease to the renal conditions associated with systemic illness. The AKI in pediatric population is associated with increased mortality and morbidity, and prevention is needed to reduce the consequence of AKI. It is known that the most important risk factors for AKI in critically ill pediatric patients are clinical conditions to be associated with decreased renal blood flow, direct renal injury, and illness severity. Renal hypoperfusion leads to neurohormonal activation including renin-angiotensin-aldosterone system, sympathetic nervous system, antidiuretic hormone, and prostaglandins. Prolonged renal hypoperfusion can result in acute tubular necrosis. The direct renal injury can be predisposed under the condition of renal hypoperfusion, and appropriate treatment of volume depletion is important to prevent AKI. The preventable causes of AKI include contrast-induced nephropathy, hemodynamic instability, inappropriate mediation use, and multiple nephrotoxic insults. Given the evidence of preventable factors for AKI, several actions such as the use of protocol for prevention of contrast-induced nephropathy, appropriate treatment of volume depletion, vigorous treatment of sepsis, avoidance of combinations of nephrotoxic medications, and monitoring of levels of drugs should be recommended.

• Archives of Plastic Surgery
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• v.37 no.3
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• pp.301-303
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• 2010

Purpose: The axillary web syndrome (AWS) is a selflimiting cause of morbidity in the early postoperative period after axillary surgery. This article presents a rare complication developed after surgical treatment for axillary osmidrosis. Methods: A 55-year-old male patient underwent surgical excision of skin and glandular tissue for axillary osmidrosis. Three weeks after the surgery, he visited our department due to a visible web of left axillary skin overlying palpable cord extends into the medial ipsilateral arm. There was a taut and tender cord of tissue under the skin and shoulder abduction was limited to less than 90 degrees. He was diagnosed with AWS and treated with conservative management. Results: Four months later, AWS resolved completely without any treatment and patient was free of pain or motion restriction. Conculsion: Axillary web syndrome has been described as frequent complication after axillary lymph node dissection or sentinel node biopsy, but not after surgical treatment of axillary osmidrosis. Surgeons must be aware of the risk of axillary web syndrome after treatment of axillary osmidrosis.