• Clinical and Experimental Pediatrics
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• v.50 no.1
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• pp.33-39
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• 2007

Purpose : In spite of medical advances, empyema is a serious complication of pneumonia in children. Vaccination practices and antibiotic prescribing practices promote the change of clinical manifestations of empyema and causative organisms. So we made a nationwide clinical observation of 122 cases of empyema in children from 32 hospitals during the 5 year period from September 1999 to August 2004. Methods : Demographic data, and clinical information on the course and management of empyema patients were collected retrospectively from medical records in secondary and tertiary hospitals in Korea. Results : One hundred twenty two patients were enrolled from 35 hospitals. The most frequent age group was 1-3 years, accounting for 48 percent of all cases. The male to female sex ratio was 1.2:1. The main symptoms were cough, fever, respiratory difficulty, lethargy and chest pain in order of frequency. Hematologic findings on admission revealed decreased hemoglobin levels ($10.4{\pm}1.6g/dL$) and increased leukocyte counts ($16,234.3{\pm}10,601.8/{\mu}L$). Pleural fluid obtained from patients showed high leukocyte counts ($30,365.8{\pm}64,073.0/{\mu}L$), high protein levels ($522.3{\pm}1582.3g/dL$), and low glucose levels ($88.1{\pm}523.5mg/dL$). Findings from pleural fluid cultures were positive in 80 cases(65.6 percent). The most common causative agent was Streptococcus pneumoniae. The majority of patients were treated with antibiotics and closed drainage. Some patients needed open drainage (16.4 percent) or decortication (3.3 percent). The mean duration of hospitalization was $28.6{\pm}15.3days$. Conclusion : We analyzed childhood empyema patients during a period of 5 years in Korean children. The most frequent age group was 1-3 years and the most common causative agent was Streptococcus pneumoniaeiae. The majority of patients were treated with antibiotics and close drainage.

• Journal of Preventive Medicine and Public Health
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• v.32 no.1
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• pp.30-39
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• 1999

Objectives. This study was carried out to evaluate hearing impairment judgement and to investigate the differences in various diagnostic criteria for noise-induced hearing loss (NIHL) among workers who required for close observation (C). Methods. Out of 731,029 workers who had taken the specific periodic health examination in 1994, we used the audiometric data on 37,999 workers (C) eliminating the employees who had previous otologic problems. Many investigators have being using different criteria for the evaluation of hearing impairment. In this study, we used the criteria of early (1989-1994), current, compensation for NIHL in Korea, 2-, 3-, 4-divided classification and hearing loss at 4,000 Hz and compared the evaluation results. Results. The prevalences of C and workers who had occupational disease $(D_1)$ diagnosed for NIHL were 11.1 % and 0.44 %. There were significant difference in the prevalences of C and $D_1$, depending on different province of Korea. Pure tone averages (PTAs) were not appropriately applied in their evaluation 97% of workers whom we studied on were below the level of mild hearing loss judged by ISO standard. However, there were wide variations in the prevalence rate of mild hearing loss by diagnostic criteria. Thus, there were different judgements in determining the degree of NIHL depending on which diagnostic criteria were utilized. PTAs were found 20.54 (Rt) and 20.74 (Lt) when the method of 3-divided classification was applied for audiometric data. The degree of hearing impairment of the left ear was more severe than that of right ear. The prevalence of normal hearing threshold below 20 dB was 75.4% and the range of difference in both ear was below 10 dB. Right sided hearing threshold levels were 21.08 dB (500 Hz), 18.44 dB (1,000 Hz), 22.09 (2,000 Hz) and 52.36 dB (4,000 Hz). There was typical high frequency loss (C5-dip at 4,000 Hz) above 30 - 40 dB in normal hearing level. The increasing trend in hearing threshold level was gradually decreased by the increase of PTAs. The difference between PTAs and threshold at 4,000 Hz was about 10 dB. Conclusions. We could found that PTAs in the previous examination were not appropriately evaluated. This study revealed that they did not use unique criteria for managing the workers of NIHL. For the prevention of NIHL, it was found that the quality control on diagnosis and comprehensive management program were required, especially for those of hearing loss (C).

• Journal of Chest Surgery
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• v.37 no.1
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• pp.27-34
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• 2004

Background: Infective endocarditis shows higher operative morbidity and mortality rates than other cardiac diseases. The vast majority of studies on infective endocarditis have been made on aortic endocarditis, with little attention having been paid to infective endocarditis on the mitral valve. This study attempts to investigate the clinical aspects and operative results of infective endocarditis on the mitral valve. Meterial and Method: The subjects of this study consist of 23 patients who underwent operations for infective endocariditis on the mitral valve from June 1995 to May 2003. Among them, 2 patients suffered from prosthetic valvular endocarditis and the other 21 from native valvular endocarditis. The subjects were evenly distributed age-wise with an average age of 44.8$\pm$15.7 (11∼66) years. Emergency operations were performed on seventeen patients (73.9%) due to large vegetation or instable hemodynamic status. In preoperative examinations, twelve patients exhibited congestive heart failure, four patients renal failure, two patients spleen and renal infarction, and two patients temporary neurological defects, while one patient had a brain abscess. Based on the NYHA functional classification, seven patients were determined to be at Grade II, 9 patients at Grade III, and 6 patients at Grade IV. Vegetations were detected in 20 patients while mitral regurgitation was dominant in 19 patients with 4 patients showing up as mitral stenosis dominant on the preoperative echocardiogram. Blood cultures for causative organisms were performed on all patients, and positive results were obtained from ten patients, with five cases of Streptococcus viridance, two cases of methicillin-sensitive Staphylococcus aureus, and one case each of Corynebacteriurn, Haemophillis, and Gernella. Operations were decided according to the AA/AHA guidelines (1988). The mean follow-up period was 27.6 $\pm$23.3 (1 ∼ 97) months. Result: Mitral valve replacements were performed on 43 patients, with mechanical valves being used on 9 patients and tissue valves on the other 4. Several kinds of mitral valve repair or mitral valvuloplasty were carried out on the remaining 10 patients. Associated procedures included six aortic valve replacements, two tricuspid annuloplasty, one modified Maze operation, and one direct closure of a ventricular septal defect. Postoperative complications included two cases of bleeding and one case each of mediastinitis, low cardiac output syndrome, and pneumonia. There were no cases of early deaths, or death within 30 days following the operation. No patient died in the hospital or experienced valve related complications. One patient, however, underwent mitral valvuloplasty 3 months after the operation. Another patient died from intra-cranial hemorrhage in the 31st month after the operation. Therefore, the valve-related death rate was 4.3%, and the valve-related complication rate 8.6% on mid-term follow-up. 1, 3-, and 5-year valve- related event free rates were 90.8%, 79.5%, and 79.5%, respectively, while 1, follow-up. 1, 3-, and 5-year valve- related event free rates were 90.8%, 79.5%, and 79.5%, respectively, while 1, 3-, and 5-year survival rates were 100%, 88.8%, and 88.8%, respectively. Conclusion: The findings suggest that a complete removal of infected tissues is essential in the operative treatment of infectious endocarditis of the mitral valve. It is also suggested that when infected tissues are completely removed, neither type of material nor method of operation has a significant effect on the operation result. The postoperative results also suggest the need for a close follow-up observation of the patients suspected of having brain damage, which is caused by preoperative blood contamination or emboli from vegetation, for a possible cerebral vascular injury such as mycotic aneurysm.

• (The)Study of the Eastern Classic
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• no.49
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• pp.73-107
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• 2012

Yeoheon Jang Hyeongwang(1554-1637), one of the greatest Mid-Joseon Confucianists did systematic studies on universe and nature. It can be considered that he inherited the academic tradition of Cho Sik (曺植) and Jeong Gu(鄭逑) and followed their steps of fengshui (風水) and compilation of geographical records. His living and thought and deserve researching with regard to geographical studies. This paper attempts to analyze Yeoheon's recognition of geography in general. In other words, I shall prove that his view of geography is Neo-Confucian. At the same time, I shall discuss how he named people's residence, how he understanded the Joseon territory, what he thought about fengshui, and what significance the complication of geographical records by his disciples had. Yeoheon considered that land is composed of water, fire, earth, and rock, and understanded the land according to the theory of Zhouyi (周易). He analyzed geographic environments by the system of Zhouyi. His study of geography is basically intended for practical use, and as a result is necessary for people to choose where to live and where to cultivate. In his opinion, it is essential to divide the land of the Joseon by means of geographical differences in order to help people to find a better place to live. We can see his Confucian view from the fact that he placed a greater emphasis on human beings over nature. Therefore, the practical use for humans is the first priority in his study of geography. Meanwhile, he considered nature itself as only the object of study. He realized the vitality of life by making a close observation of nature and attained the mind of the Heaven and Earth in a detached way. He, as a follower of Neo-Confucianism, enjoyed the land by feeling comfortable with his present status and by being satisfied with himself. He put his Confucian view of universe and world into practice in his life. As a part of his efforts, he named his residence and surrounding natural environments with the polar star and 28 stars, and accordingly they are reconstructed in a system of universe. The Confucian tradition of dongcheon gugok (洞天九曲) starting with Zhu Xi's administration of wuyi jiugu (武夷九曲) was widely prevalent during the Joseon period, but Yeoheon's system of organizing places is original. His sense of naming places reflects his ideas of following his predecessors, comparing natural objects to human emotions, and desiring to live in retirement. Yeoheon understanded the Joseon territory with comparison of the Chinese land. He expressed his knowledge in the form of changing geographical features of a district, appreciating natural beauty, locating towns, and being familiar with a region, and proposing his own climatology and view of the reality. His recognition of the Joseon territory resolves itself into the following several points. He regarded the Joseon territory as one organism, and considered the territory to be composed of ki (氣) as Neo-Confucianists usually do. In addition, he understanded not only natural environments but also towns from a perspective of the fengshui and adopted a comparative methodology in dividing regions. He also applied climatology to analyze persons and customs. He employed the methodology of fengshui from the comprehensive theory of the Yijing. It is because he was influenced by Cho Sik and Jeng Gu. Yeoheon chose dwelling places for people, or gave advice on several places of his hometown relying on his knowledge of fengshui. When it comes to his theory of fengshui, he agreed with the theory of topography with regards to the fengshui of tombs, but criticized the custom of delaying funerals in order to turn fortune in one's favor. In addition, he accepted that it is necessary to complement a town by creating forests around it. We need to pay attention to the fact that Yeoheon's disciples complied several geographical records. It proves that they inherited the tradition of "valuing practical use and governing on behalf of the people" from Cho Sik and Jeong Gu. Yeoheon put a great emphasis on geographical records and encouraged his disciples to compile them. In other words, he emphasized that they, as administrator or intellectual, need to be erudite in the history and custom of a region where they have lived, and have to establish a standard to encourage or warn people in the region while considering the geographical records. His opinion functioned as a guideline for his successors to compile geographical records later. This paper only analyzed several facts with regard to Yeoheon's knowledge of geography and an academic tradition concerning the study of geography. In the future, I shall discuss how his predecessors and successors understanded geography and how the tradition of compiling geographical records was transferred and developed between them. I believe that this study will contribute to establishing the history of geography, which the Joseon Confucianists researched for a long time but we have not paid an enough attention to until now.