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The National Survey of Open Lung Biopsy and Thoracoscopic Lung Biopsy in Korea (개흉 및 흉강경항폐생검의 전국실태조사)

  • 대한결핵 및 호흡기학회 학술위원회
    • Tuberculosis and Respiratory Diseases
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    • v.45 no.1
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    • pp.5-19
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    • 1998
  • Introduction: Direct histologic and bacteriologic examination of a representative specimen of lung tissue is the only certain method of providing an accurate diagnosis in various pulmonary diseases including diffuse pulmonary diseases. The purpose of national survey was to define the indication, incidence, effectiveness, safety and complication of open and thoracoscopic lung biopsy in korea. Methods: A multicenter registry of 37 university or general hospitals equipped more than 400 patient's bed were retrospectively collected and analyzed for 3 years from the January 1994 to December 1996 using the same registry protocol. Results: 1) There were 511 cases from the 37 hospitals during 3 years. The mean age was 50.2 years(${\pm}15.1$ years) and men was more prevalent than women(54.9% vs 45.9%). 2) The open lung biopsy was performed in 313 cases(62%) and thoracoscopic lung biopsy was performed in 192 cases(38%). The incidence of lung biopsy was more higher in diffuse lung disease(305 cases, 59.7%) than in localized lung disease(206 cases, 40.3%) 3) The duration after abnormalities was found in chest X-ray until lung biopsy was 82.4 days(open lung biopsy: 72.8 days, thoracoscopic lung biopsy: 99.4 days). The bronchoscopy was performed in 272 cases(53.2%), bronchoalveolar lavage was performed in 123 cases(24.1%) and percutaneous lung biopsy was performed in 72 cases(14.1%) before open or thoracoscopic lung biopsy. 4) There were 230 cases(45.0%) of interstitial lung disease, 133 cases(26.0%) of thoracic malignancies, 118 cases(23.1%) of infectious lung disease including tuberculosis and 30 cases (5.9 %) of other lung diseases including congenital anomalies. No significant differences were noted in diagnostic rate and disease characteristics between open lung biopsy and thoracoscopic lung biopsy. 5) The final diagnosis through an open or thoracoscopic lung biopsy was as same as the presumptive diagnosis before the biopsy in 302 cases(59.2%). The identical diagnostic rate was 66.5% in interstitial lung diseases, 58.7% in thoracic malignancies, 32.7% in lung infections, 55.1 % in pulmonary tuberculosis, 62.5% in other lung diseases including congenital anomalies. 6) One days after lung biopsy, $PaCO_2$ was increased from the prebiopsy level of $38.9{\pm}5.8mmHg$ to the $40.2{\pm}7.1mmHg$(P<0.05) and $PaO_2/FiO_2$ was decreased from the prebiopsy level of $380.3{\pm}109.3mmHg$ to the $339.2{\pm}138.2mmHg$(P=0.01). 7) There was a 10.1 % of complication after lung biopsy. The complication rate in open lung biopsy was much higher than in thoracoscopic lung biopsy(12.4% vs 5.8%, P<0.05). The incidence of complication was pneumothorax(23 cases, 4.6%), hemothorax(7 cases, 1.4%), death(6 cases, 1.2%) and others(15 cases, 2.9%). 8) The 5 cases of death due to lung biopsy were associated with open lung biopsy and one fatal case did not describe the method of lung biopsy. The underlying disease was 3 cases of thoracic malignancies(2 cases of bronchoalveolar cell cancer and one malignant mesothelioma), 2 cases of metastatic lung cancer, and one interstitial lung disease. The duration between open lung biopsy and death was $15.5{\pm}9.9$ days. 9) Despite the lung biopsy, 19 cases (3.7%) could not diagnosed. These findings were caused by biopsy was taken other than target lesion(5 cases), too small size to interpretate(3 cases), pathologic inability(11 cases). 10) The contribution of open or thoracoscopic lung biopsy to the final diagnosis was defininitely helpful(334 cases, 66.5%), moderately helpful(140 cases, 27.9%), not helpful or impossible to judge(28 cases, 5.6%). Overall, open or thoracoscopic lung biopsy were helpful to diagnose the lung lesion in 94.4 % of total cases. Conclusions: The open or thoracoscopic lung biopsy were relatively safe and reliable diagnostic method of lung lesion which could not diagnosed by other diagnostic approaches such as bronchoscopy. We recommend the thoracoscopic lung biopsy when the patients were in critical condition because the thoracoscopic biopsy was more safe and have equal diagnostic results compared with the open lung biopsy.

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Territorial Expansion the King Võ (Võ Vương, 1738-1765) in the Mekong Delta: Variation of Tám Thực Chi Kế (strategy of silkworm nibbling) and Dĩ Man Công Man (to strike barbarians by barbarians) in the Way to Build a New World Order (무왕(武王, 1738-1765) 시기 메콩 델타에서의 영토 확장 추이: 제국으로 가는 길, '잠식지계(蠶食之計)'와 '이만공만(以蠻攻蠻)'의 변주)

  • CHOI, Byung Wook
    • The Southeast Asian review
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    • v.27 no.2
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    • pp.37-76
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    • 2017
  • $Nguy{\tilde{\hat{e}}}n$ Cư Trinh has two faces in the history of territorial expansion of Vietnam into the Mekong delta. One is his heroic contribution to the $Nguy{\tilde{\hat{e}}}n$ family gaining control over the large part of the Mekong delta. The other is his role to make the eyes of readers of Vietnamese history be fixed only to the present territory of Vietnam. To the readers, $Nguy{\tilde{\hat{e}}}n$ Cư Trinh's achievement of territorial expansion was the final stage of the nam $ti{\acute{\hat{e}}n$ of Vietnam. In fact, however, his achievement was partial. This study pays attention to the King $V{\tilde{o}}$ instead of $Nguy{\tilde{\hat{e}}}n$ Cư Trinh in the history of the territorial expansion in the Mekong delta. King's goal was more ambitious. And the ambition was propelled by his dream to build a new world, and its order, in which his new capital, $Ph{\acute{u}}$ $Xu{\hat{a}}n$ was to be the center with his status as an emperor. To improve my assertion, three elements were examined in this article. First is the nature of $V{\tilde{o}}$ Vương's new kingship. Second is the preparation and the background of the military operation in the Mekong Delta. The nature of the new territory is the third element of the discussion. In 1744, six years after this ascending to the throne, $V{\tilde{o}}$ Vương declared he was a king. Author points out this event as the departure of the southern kingdom from the traditional dynasties based on the Red River delta. Besides, the government system, northern custom and way of dressings were abandoned and new southern modes were adopted. $V{\tilde{o}}$ Vương had enough tributary kingdoms such as Cambodia, Champa, Thủy $X{\tilde{a}}$, Hoả $X{\tilde{a}}$, Vạn Tượng, and Nam Chưởng. Compared with the $L{\hat{e}}$ empire, the number of the tributary kingdoms was higher and the number was equivalent to that of the Đại Nam empire of the 19th century. In reality, author claims, the King $V{\tilde{o}}^{\prime}s$ real intention was to become an emperor. Though he failed in using the title of emperor, he distinguished himself by claiming himself as the Heaven King, $Thi{\hat{e}}n$ Vương. Cambodian king's attack on the thousands of Cham ethnics in Cambodian territory was an enough reason to the King $V{\tilde{o}}^{\prime}s$ military intervention. He considered these Cham men and women as his amicable subjects, and he saw them a branch of the Cham communities in his realm. He declared war against Cambodia in 1750. At the same time he sent a lengthy letter to the Siamese king claiming that the Cambodia was his exclusive tributary kingdom. Before he launched a fatal strike on the Mekong delta which had been the southern part of Cambodia, $V{\tilde{o}}$ Vương renovated his capital $Ph{\acute{u}}$ $Xu{\hat{a}}n$ to the level of the new center of power equivalent to that of empire for his sake. Inflation, famine, economic distortion were also the features of this time. But this study pays attention more to the active policy of the King $V{\tilde{o}}$ as an empire builder than to the economic situation that has been told as the main reason for King $V{\tilde{o}}^{\prime}s$ annexation of the large part of the Mekong delta. From the year of 1754, by the initiative of $Nguy{\tilde{\hat{e}}}n$ Cư Trinh, almost whole region of the Mekong delta within the current border line was incorporated into the territory of $V{\tilde{o}}$ Vương within three years, though the intention of the king was to extend his land to the right side of the Mekong Basin beyond the current border such as Kampong Cham, Prey Vieng, and Svai Rieng. The main reason was $V{\tilde{o}}$ Vương's need to expand his territory to be matched with that of his potential empire with the large number of the tributary kingdoms. King $V{\tilde{o}}^{\prime}s$ strategy was the variation of 'silkworm nibbling' and 'to strike barbarians by barbarians.' He ate the land of Lower Cambodia, the region of the Mekong delta step by step as silkworm nibbles mulberry leave(general meaning of $t{\acute{a}}m$ thực), but his final goal was to eat all(another meaning of $t{\acute{a}}m$ thực) the part of the Mekong delta including the three provinces of Cambodia mentioned above. He used Cham to strike Cambodian in the process of getting land from Long An area to $Ch{\hat{a}}u$ Đốc. This is a faithful application of the Dĩ Man $C{\hat{o}}ng$ Man (to strike barbarians by barbarians). In addition he used Chinese refugees led by the Mạc family or their quasi kingdom to gain land in the region of $H{\grave{a}}$ $Ti{\hat{e}}n$ and its environs from the hand of Cambodian king. This is another application of Dĩ Man $C{\hat{o}}ng$ Man. In sum, author claims a new way of looking at the origin of the imperial world order which emerged during the first half of the 19th century. It was not the result of the long history of Đại Việt empires based on the Red River delta, but the succession of the King $V{\tilde{o}}^{\prime}s$ new world based on $Ph{\acute{u}}$ $Xu{\hat{a}}n$. The same ways of Dĩ Man $C{\hat{o}}ng$ Man and $T{\acute{a}}m$ Thực Chi $K{\acute{\hat{e}}}$ were still used by $V{\tilde{o}}^{\prime}s$ descendents. His grandson Gia Long used man such as Thai, Khmer, Lao, Chinese, and European to win another man the '$T{\hat{a}}y$ Sơn bandits' that included many of Chinese pirates, Cham, and other mountain peoples. His great grand son Minh Mạng constructed a splendid empire. At the same time, however, Minh Mạng kept expanding the size of his empire by eating all the part of Cambodia and Cham territories.