• Journal of Preventive Medicine and Public Health
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• 제39권2호
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• pp.141-148
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• 2006

Objectives : We wanted to evaluate the medical underutilization for benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) among Korean elderly men and we wanted to determine their associated factors. Methods : This study was conducted on 239 men with LUTS and 116 men with BPH who were compatible with the diagnostic criteria from a total of 641 participants. These participants were over 50 years old and they were randomly chosen in a community-based study for estimating the prevalence of BPH. Using a self-reported questionnaire, we surveyed the sociodemographics, health status, quality of life, lower urinary tract symptoms, medical utilization and reasons for not seeking treatment. Results : Only 27.6% of the men with LUTS and 31.0% of the men with BPH reported having visited a doctor for urinary symptoms. The reasons for not visiting a doctor were, in order of responses from the group with LUTS: 'considered the symptoms as a part of the normal ageing process', 'not enough time to visit a doctor', 'financial difficulty' and 'the symptoms were not severe or bothersome'. Regarding BPH, the responses were the same as those of the group with LUTS however, 'financial difficulty' placed second. Among the men with experience of visiting a doctor for urinary symptoms, 33.3% of those with LUTS and 28.1% of those with BPH were not treated. The most common reason in both groups was 'the symptoms were not severe to be treated'. On a multiple logistic regression analysis, the larger size household (odds ratio (OR) 3.03, 95% confidence interval (CI)=1.40-6.54) and an unsatisfactory quality of life related with urinary symptoms (OR 2.98, 95% CI=1.23-7.21) were associated with medical utilization in the group of LUTS. For BPH, the current employment status was related with the medical utilization (OR 2.80, 95% CI=1.10-7.11), in addition to the larger size household (OR 3.24, 95% CI=1.14-9.21). Conclusions : Many men with urinary symptoms do not visit a doctor. This medical underutilization for people with LUTS and BPH may be associated with economic status in Korea.

• Journal of Nutrition and Health
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• 제52권6호
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• pp.552-558
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• 2019

본 연구는 2008 ~ 2014년까지 수행된 국민건강영양조사 자료를 활용하였다. 본 분석 대상자는 12 ~ 29세 여자 청소년 및 젊은 여성이며, 이들을 대상으로 비타민 D 결핍 여부에 따른 빈혈 및 철 결핍성 빈혈과의 연관성 분석을 실시하였다. 그 결과, 교란인자를 보정한 다중 로지스틱 회귀분석 모델에서 비타민 D 결핍군이 충분군보다 빈혈 및 철 결핍성 빈혈의 유병률이 유의적으로 높았다. 또한 혈청 25(OH)D 농도가 증가함에 따라 빈혈 및 철 결핍성 빈혈의 유병률이 낮아지는 선형 관계가 나타났다. 본 연구의 결과는 청소년 및 젊은 여성에서 문제가 되고 있는 비타민 D 결핍과 빈혈에 대한 예방 및 관리에 기초자료를 제공할 수 있다고 기대된다. 추후 전향적인 코호트 연구 및 임상시험 연구 설계를 이용한 후속 연구를 수행하여 비타민 D와 빈혈 사이의 명확한 인과관계를 확인할 필요가 있다고 사료된다.

• 대한임상독성학회지
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• 제12권2호
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• pp.77-84
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• 2014

Purpose: Carbamate insecticides are potent cholinesterase inhibitors capable of causing severe cholinergic toxicity. Use of carbamate rather than organophosphate insecticides has been increasing. Compared with organophosphate poisoning, relatively few studies have investigated carbamate-associated acute pancreatitis. We investigated general characteristics and pancreatitis of carbamate poisoning and the predictors, among those readily assessed in the emergency department. Methods: We performed a retrospective review of consecutive patients, aged over 18 years, who were admitted between January 2008 and April 2012 to an emergency department (ED) of an academic tertiary care center for treatment of carbamate poisoning. Patients who exhibited poisoning by any other material, except alcohol, were excluded. After application of exclusion criteria, patients were divided according to carbamate-induced pancreatitis and non-pancreatitis groups. Results: A total of 41 patients were included in this study. Among these 41 patients, the prevalence of acute pancreatitis was 36.6% (15 patients). Initial blood chemistry tests showed a statistically higher glucose level in the pancreatitis group, compared with the non-pancreatitis group (222, IQR 189-284 vs. 137, IQR 122-175 mg/dL, P<0.05). Regarding clinical courses and outcomes, a significantly higher proportion of patients developed pneumonia [10 (66.7%) vs. 6 (23.1%), P<0.05] and had a longer hospital stay (7 days, IQR 6-12 vs. 5 days, IQR 2-11, P<0.05), but no difference in mortality, in the pancreatitis group vs. the non-pancreatitis group. In multivariate analysis, the initial glucose was showing significant association with the presentation of carbamate-induced acute pancreatitis (odds ratio 1.018, 95% confidence interval 1.001-1.035, P<0.05). Conclusion: Carbamate-induced acute pancreatitis is common, but not fatal. Initial serum glucose level is associated with acute pancreatitis.

• 정신신체의학
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• 제24권2호
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• pp.217-226
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• 2016

연구목적 본 연구는 대사증후군의 예방과 회복을 위해 5년 동안 추적이 가능한 만성 조현병 환자에서 대사증후군의 변화와 예측인자를 조사하였다. 방 법 2011년부터 2016년까지 추적이 가능하며 동의서에 동의한 107명의 환자가 본 연구에 포함되었다. Revised National Cholesterol Education Program-Adult Treatment Panel III(NCEP-ATP III)를 이용하여 대사증후군을 정의하였다. 결 과 추적 관찰 기간 동안 22명(20.5%)의 환자가 새롭게 대사증후군에 진단되었고 14명(13.1%)는 대사증후군에서 회복되었다. 77명(66.4%)은 변화가 없었다(대사증후군이 있는 환자:34명[31.8%], 대사증후군이 없는 환자 : 37명[34.6%]). 복부둘레와 중성 지방이 대사증후군의 유무가 변화된 환자들에서 중요한 인자였다. 다른 변수를 통제한 다변량 회귀분석에서 여성(OR=2.846, 95% C.I. 1.020-7.942), 1달에 1회 이상 외래 방문(OR=3.155, 95% C.I. 1.188-8.379), 항우울제 병합치료(OR=3.991, 95% C.I. 1.048-15.205)가 대사증후군의 유병률에 유의한 영향을 주었다. 반면에 항정신병 약물의 종류나 용량은 대사증후군의 유병률에 영향을 주지 못했다. 결 론 만성 조현병 환자에서 약제의 변경 및 용량조절보다 증상에서의 회복과 건강한 생활 습관이 대사증후군에 중요하다.

• Investigative and Clinical Urology
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• 제59권6호
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• pp.357-362
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• 2018

Purpose: Classic angiomyolipoma (AML) is common benign kidney tumor. However, some studies have claimed that epithelioid angiomyolipoma (EAML) has malignant potential. We compared the patient characteristics and prognosis of EAML and classic AML to demonstrate predicting factors and poorer prognosis of EAML. Materials and Methods: The medical records of 231 patients who were diagnosed with EAML (n=27, 11.7%) or classic AML (n=204, 88.3%), were reviewed. All patients underwent computed tomography (CT) scans before operation or needle biopsy. We assessed the age, sex, tumor size, body mass index, comorbidities, and Hounsfield unit (HU) according to each CT phase. We defined the unfavorable group as patients with recurrence, metastasis and death due to tumor progression. Logistic regression analysis was used to predict EAML. Results: EAML patients were younger (41.2 years vs. 49.1 years, p=0.001), predominantly male (55.6% vs. 28.4%, p=0.005), and had a larger tumor (7.5 cm vs. 4.2 cm, p<0.001). The median pre-contrast HU was not significantly different between EAML and classic AML ($29.9{\pm}23.7$ vs. $14.7{\pm}41.0$, p=0.071). In multivariable analysis, younger age (odds ratio [OR], 0.96; p=0.032), male sex (OR, 3.33; p=0.013), and tumor larger than 4 cm (OR, 3.8; p=0.009) were significant predictive factors. Five patients (18.5%) had unfavorable outcomes, two patients had lymph node metastasis, and three patients had lung metastasis. Conclusions: Patient and tumor characteristics can be helpful in determining the type of AML preoperatively. Younger age, male sex, and larger tumor mass may increase the possibility of diagnosing EAML. EAML has malignant potential and requires careful follow-up.

• 정신신체의학
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• 제27권1호
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• pp.69-76
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• 2019

연구목적 본 연구에서는 우울감을 주소로 내원한 청소년을 대상으로 비자살성 자해행동(Non-suicidal Self-Injury, 이하 NSSI) 의 빈도와, NSSI유무에 따른 사회인구학적, 임상적 특성을 비교하고, 이와 연관된 자살시도의 예측인자를 밝히고자 한다. 방 법 총 113명의 우울감을 주소로 내원한 12세에서 18세 청소년을 대상으로, 사회인구학적 특징, 자살행동과 NSSI, 심리상태에 대해 자기보고식 검사도구를 이용하여 평가하였고, 반구조화된 면담도구를 이용하여 정신과적 진단을 하였다. NSSI의 유무에 따라 두 군으로 나누어 이들의 사회인구학적 특징과 임상적 특징을 비교하였고, 로지스틱 회귀분석을 이용하여 유의한 변수 중 자살시도의 예측인자를 분석하였다. 결 과 분석에 포함된 113명의 청소년 중 42.1%에서 NSSI를 보고하였다. NSSI 가 있는 군은 없는 군에 비해 여성이 더 많았고, 우울, 불안 및 자살사고점수가 더 높았다. 자살 시도의 가장 연관성이 높은 예측인자는 NSSI, 가족이나 친구 중 자살/자해 경험, 총 상태불안점수였다[Odds Ratio (OR)=0.05, 95% Confidence Interval (CI)=0.01~0.20, p<0.001 ; OR=0.07, 95% CI=0.01~0.45, p=0.005; OR=1.10, 95% CI=1.02~1.19, p=0.013]. 결 론 본 연구를 통해 우울감을 주소로 병원에 방문한 청소년은 일반인구에 비해 NSSI의 빈도가 3배 정도 더 높고, NSSI가 동반된 경우 자살사고와 불안이 높며 자살시도와도 연관성이 매우 높음을 확인하였다. 본 연구 결과를 통해 병원에 방문한 우울한 청소년의 경우, NSSI에 대한 평가의 반드시 포함해야 하며 청소년 대상 자살예방프로그램 개발 시 NSSI에 대한 평가 및 접근을 반드시 포함해야 할 것으로 생각된다.

• Archives of Plastic Surgery
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• 제46권4호
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• pp.336-343
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• 2019

Background Sternal rigid plate fixation (RPF) has been adopted in recent years in high-risk cases to reduce complications associated with steel wire cerclage, the traditional approach to sternal closure. While sternal RPF has been associated with lower complication rates than wire cerclage, it has its own complication profile that requires evaluation, necessitating a critical examination from a national perspective. This study will report the outcomes and associated risk factors of sternal RPF using a national database. Methods Patients undergoing sternal RPF from 2005 to 2016 in the American College of Surgeons-National Surgical Quality Improvement Program were identified. Demographics, perioperative information, and complication rates were reviewed. Logistic regression analysis was performed to identify risk factors for postoperative complications. Results There were 381 patient cases of RPF identified. The most common complications included bleeding (28.9%), mechanical ventilation >48 hours (16.5%), and reoperation/readmission (15.2%). Top risk factors for complications included dyspnea (odds ratio [OR], 2.672; P<0.001), nonelective procedure (OR, 2.164; P=0.010), congestive heart failure (OR, 2.152; P=0.048), open wound (OR, 1.977; P=0.024), and operating time (OR, 1.005; P<0.001). Conclusions Sternal RPF is associated with increased rates of three primary complications: blood loss requiring transfusion, ventilation >48 hours, and reoperation/readmission, each of which affected over 15% of the study population. Smokers remain at an increased risk for surgical site infection and sternal dehiscence despite RPF's purported benefit to minimize these outcomes. Complications of primary versus delayed sternal RPF are roughly equivalent, but individual patients may perform better with one versus the other based on identified risk factors.

• Journal of Korean Neurosurgical Society
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• 제64권2호
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• pp.297-308
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• 2021

Objective : Shunt infection is a common complication while treating hydrocephalus. The antibiotic-impregnated shunt catheter (AISC) was designed to reduce shunt infection rate. A meta-analysis was conducted to study the effectiveness of AISCs in reduction of shunt infection in terms of age, follow-up time and high-risk patient population. Methods : This study reviewed literature from three databases including PubMed, EMBASE, and Cochrane Library (from 2000 to March 2019). Clinical studies from controlled trials for shunt operation were included in this analysis. A subgroup analysis was performed based on the patient's age, follow-up time and high-risk population. The fixed effect in RevMan 5.3 software (Cochrane Collaboration) was used for this meta-analysis. Results : This study included 19 controlled clinical trials including 10105 operations. The analysis demonstrated that AISC could reduce the infection rate in shunt surgery compared to standard shunt catheter (non-AISC) from 8.13% to 4.09% (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.40-0.58; p=0.01; I2=46%). Subgroup analysis of different age groups showed that AISC had significant antimicrobial effects in all three groups (adult, infant, and adolescent). Follow-up time analysis showed that AISC was effective in preventing early shunt infections (within 6 months after implant). AISC is more effective in high-risk population (OR, 0.24;95% CI, 0.14-0.40; p=0.60; I2=0%) than in general patient population. Conclusion : The results of meta-analysis indicated that AISC is an effective method for reducing shunt infection. We recommend that AISC should be considered for use in infants and high-risk groups. For adult patients, the choice for AISC could be determined based on the treatment cost.

• Journal of Trauma and Injury
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• 제35권2호
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• pp.84-91
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• 2022

Purpose: The aim of this study was to analyze by age group the characteristics of patients with dog bite injuries, as well as determine which factors were associated with wound infections in those patients. Methods: We reviewed patients with dog bite injuries who presented to Gachon University Gil Medical Center in Incheon, Korea from January 1, 2014 to December 31, 2018. They were classified by age group: children (0-18 years), adults (19-59 years), or elderly (≥60 years). Event profiles, wound characteristics, and infections were compared across these age groups. Multivariable logistic regression was used to identify factors associated with wound infections. Results: Of the total 972 dog bite injuries, 272 (28.0%) were in children, 606 (62.3%) were in adults, and 94 (9.7%) were in the elderly. The median age was 30 years (interquartile range, 16-48 years) and the majority of patients (60.5%) were female. The most common place of injury was at home (73.8%) and indoors (77.0%). In children, the head and neck were the most frequent sites of injury (43%), while the most frequent site in adults and the elderly (50.8% and 59.6%, respectively) was the upper extremity. The odds ratio (OR) for wound infection was 3.997 (95% confidence interval [CI], 1.279-12.491; P=0.017) for head and neck injuries and 3.881 (95% CI, 1.488-10.122; P=0.006) for lower extremity injuries. The OR for wound infection was 4.769 (95% CI, 2.167-10.494; P<0.001) for significant injuries. Elderly patients had a higher risk for wound infection than other age groups (OR, 2.586; 95% CI, 1.221-5.475; P=0.013). Conclusions: When analyzing patients with dog bite injuries, differences across age groups were found, with the elderly at the highest risk for significant injury and wound infection. It is recommended that age-specific approaches and strategies be used to prevent dog bite wound infections.

• Journal of Korean Neurosurgical Society
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• 제66권5호
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• pp.536-542
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• 2023

Objective : Surgical site infection is the most detrimental complication following cranioplasty. In other surgical fields, intrawound vancomycin powder application has been introduced to prevent surgical site infection and is widely used based on results in multiple studies. This study evaluated the effect of intrawound vancomycin powder in cranioplasty compared with the conventional method without topical antibiotics. Methods : This retrospective study included 580 patients with skull defects who underwent cranioplasty between August 1, 1998 and December 31, 2021. The conventional method was used in 475 (81.9%; conventional group) and vancomycin powder (1 g) was applied on the dura mater and bone flap in 105 patients (18.1%; vancomycin powder group). Surgical site infection was defined as infection of the incision, organ, or space that occurred after cranioplasty. Surgical site infection within 1-year surveillance period was compared between the conventional and vancomycin powder groups with logistic regression analysis. Penalized likelihood estimation method was used in logistic regression to deal with zero events. All local and systemic adverse events associated with topical vancomycin application were also evaluated. Results : Surgical site infection occurred in 31 patients (5.3%) and all were observed in the conventional group. The median time between cranioplasty and detection of surgical site infection was 13 days (range, 4-333). Staphylococci were the most common organisms and identified in 25 (80.6%) of 31 cases with surgical site infections. The surgical site infection rate in the vancomycin powder group (0/105, 0.0%) was significantly lower than that in the conventional group (31/475, 6.5%; crude odds ratio [OR], 0.067; 95% confidence interval [CI], 0.006-0.762; adjusted OR, 0.068; 95% CI, 0.006-0.731; p=0.026). No adverse events associated with intrawound vancomycin powder were observed during the follow-up. Conclusion : Intrawound vancomycin powder effectively prevented surgical site infections following cranioplasty without local or systemic adverse events. Our results suggest that intrawound vancomycin powder is an effective and safe strategy for patients undergoing cranioplasty.