• Childhood Kidney Diseases
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• v.5 no.2
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• pp.136-146
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• 2001

Purpose : One of the most difficult problems in the care of children with nephrotic syndrome remains the occurrence of relapses, despite initial response to steroids. Constantinescu reported that rapidity of initial response to steroid therapy could predict fewer relapses in the first year. So we evaluated the changes in serum lipid abnormalities in children with corticosensitive nephrotic syndrome before steroid treatment and the correlation between serum lipid levels and renal function, days to remission. Methods . We analyzed the Medical records of children who were managed by us between October 1994 and August 2000. In 33 patients with corticosensitive nephrotic syndrome, we evaluated the correlation between serum lipid levels and renal function [Creatinine clearance(Ccr)] and proteinuria before steroid treatment, and days to remission defined as the third day when the patient's urine becomes protein free. Results : There were 21 males and 12 females. Median age at presentation was 6.4 years (range: 1.8-17.3 years). Median days to remission were 15.4 days (range 4-42 days) on Prednisolone $60mg/m^2$ daily. The increased levels of triglyceride, total cholesterol, LDL cholesterol, apolipoprotein B, total cholesterol/HDL cholesterol, Lipoprotein(a) were observed. But the level of HDL cholesterol was not increased. Serum albumin was decreased a]id proteinuria was increased before steroid treatment. But Ccr was not decreased. There were negative correlation between serum albumin and total cholesterol (r = -0.5157, P<0.005), LDL cholesterol (r = -0.5543, P<0.005), total cholesterol/HDL cholesterol (r = -0.4506, P<0.01), lipoprotein(a) (r = -0.4570, P<0.025), apolipoprotein B (r = -0.5297, P<0.025), apolipoprotein B/apolipoprotein Al (r = -0.5851, P<0.01), apolipoprotein B/HDL cholesterol (r = -0.4961, P<0.05) before steroid treatment. There was no correlation between proteinuria and serum lipid profiles. Also Ccr and serum lipid profiles were not correlated. There was positive correlation between days to remission and HDL cholesterol (r = +0.4511, P<0.05), apolipoprotein B (r = +0.5190, P<0.05), apolipoprotein B/HDL cholesterol (r = +0.7169, P<0.005). Conclusions : This results reveal that HDL cholesterol, apolipoprotein B and apolipoprotein B/HDL cholesterol can be used as a predictive factor in corticosensitive nephrotic syndrome. We could not determine the significant level of these lipids for insufficient patients number, but these level may predict future relapses of corticosensitive nephrotic syndrome patients and thus may allow to better management and treatment protocols. More data and long term follow up studies should be needed. (J Korean Soc Pediatr Nephrol 2001;5 : 136-46)

• Journal of Chest Surgery
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• v.39 no.5 s.262
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• pp.359-365
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• 2006

Background: Arterial grafts have been used to achieve better long-term results for coronary revascularization. Bilateral internal thoracic artery (ITA) grafts have a better results, but it may be not used in some situations such as diabetes and chronic obstructive pulmonary disease (COPD). We evaluated the clinical and angiographic results of composite left internal thoracic artery-radial artery (LITA-RA) Y graft. Material and Method: Between April 2002 and September 2004, 119 patients were enrolled in composite Y graft for coronary bypass surgery. The mean age was $62.6{\pm}8.8$ years old and female was 34.5%. Preoperative cardiac risk factors were as follows: hypertension 43.7%, diabetes 33.6%, smoker 41.2%, and hyperlipidemia 22.7%, There were emergency operation (14), cardiogenic shock (6), left ventricle ejection fraction (LVEF) less than 40% (17), and 17 cases of left main disease. Coronary angiography was done in 35 patients before the hospital discharge. Result: The number of distal anastomoses was $3.1{\pm}0.91$ and three patients (2.52%) died during hospital stay. The off-pump coronary artery bypass (OPCAB) was applied to 79 patients (66.4%). The LITA was anastomosed to left anterior descending system except three cases which was to lateral wall. The radial Y grafts were anastomosed to diagonal branches (4), ramus intermedius (21), obtuse marginal branches (109), posterolateral branches (12), and posterior descending coronary artery (8). Postoperative coronary angiography in 35 patients showed excellent patency rates (LITA 100%, and RA 88.5%; 3 RA grafts which anastomosed to coronary arteries <70% stenosed showed string sign with competitive flow). Conclusion: The LITA-RA Y composite graft provided good early clinical and angiographic results in multivessel coronary revascularization. But it should be cautiously used in selected patients.

• Journal of the Korean Society of Food Culture
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• v.14 no.4
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• pp.371-383
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• 1999

This report gave analysis of food demand both in Korea and Japan through introducing the concept of cohort analysis to the conventional demand model. This research was done to clarify the factors which determine food demand of the household. The traits of the new model for demand analysis are to consider and quantify those effects on food demand not only of economic factors such as expenditure and price but also of non-economic factors such as the age and birth cohort of the householder. The results of the analysis can be summarized as follows: 1) The comparison of the item-wise elasticities of food demand demonstrates that the expenditure elasticity is higher in Korea than in Japan and that the expenditure elasticity is -0.1 for cereal and more than 1 for eating-out in both countries. In respect to price elasticity, the absolute values of all the items except alcohol and cooked food are higher in the Korea than in Japan, and especially the price elasticities of beverages, dairy products and fruit are predominantly higher in Japan. In this way, both expenditure and price elasticities of a large number of items are higher in Korea than in Japan, which may be explained from the fact that the level of expenditure is higher in Japan than in Korea. 2) In both of Korea and Japan, as the householder grows older, the expenditure for each item increases and the composition of expenditure changes in such a way that these moves may be regarded as due to the age effect. However, there are both similarities and differences in the details of such moves between Korea and Japan. Those two countries have this trait in common that the young age groups of the householder spend more on dairy products and middle age groups spend more on cake than other age groups. In the Korea, however, there can be seen a certain trend that higher age groups spend more on a large number of items, reflecting the fact that there are more two-generation families in higher age groups. Japan differs from Korea in that expenditure in Japan is diversified, depending upon the age group. For example, in Japan, middle age groups spend more on cake, cereal, high-caloric food like meat and eating-out while older age groups spend more for Japanese-style food like fish/shellfish and vegetable/seaweed, and cooked food. 3) The effect of the birth cohort effect was also demonstrated. The birth cohort effect was introduced under the supposition that the food circumstances under which the householder was born and brought up would determine the current expenditure. Thus, the following was made clear: older generations in both countries placed more emphasis upon stable food in their composition of food consumption; the share of livestock products, oil/fats and externalized food was higher in the food composition of younger generation; differences in food composition among generations were extremely large in Korea while they were relatively small in Japan; and Westernization and externalization of diet made rapid increases simultaneously with generation changes in Korea while they made any gradual increases in Japan during the same time period. 4) The four major factors which impact the long-term change of food demand of the household are expenditure, price, the age of the householder, and the birth cohort of the householder. Investigations were made as to which factor had the largest impact. As a result, it was found that the price effect was the smallest in both countries, and that the relative importance of the factor-by-factor effects differed among the two countries: in Korea the expenditure effect was greater than the effects of age and birth cohort while in Japan the effects of non-economic factors such as the age and birth cohort of householder were greater than those of economic factors such as expenditures.

• Journal of Nutrition and Health
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• v.42 no.1
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• pp.78-96
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• 2009

The purpose of this study was to analyze and evaluate the menu served in government offices foodservice by using Kasavana & Smith's Menu-Engineering. Sales and food costs were collected from the daily sales reports for a year from Jan 2 to Dec 31 in 2007. Calculation for menu analysis and customer's data were done by computer using the MS 2003 Excel spreadsheet program and SPSS 12.0 package program. Menu mix% (MM%) and unit contribution margin were used as variables by Kasavana & Smith. Four possible classifications by Menu-Engineering technique were turned out as 'STAR', 'PLOWHORSE', 'PUZZLE', 'DOG'. The main menus served during a year were 128 dishes and about 141 peoples visited this restaurant daily. The mean age of the men was $44.1\;{\pm}\;6.3$, women were $32.7\;{\pm}\;6.4$ and showed that was statistically higher than that of women (p < .0001). The rates of STAR menus were 'Western style (75.0%)', 'guk/tang-ryu (48.1%)', 'jjigae/ jeongol-ryu (23.1%)', 'bap-ryu (17.2%)' in sequence. There were no STAR menus in gui/jorim/jjim-ryu. PLOWHORSE menus were 'gui-ryu (75.0%)', 'guk/tang-ryu (29.6%)', 'bap-ryu (27.6%)' in sequence. There were no PUZZLE or DOG menus in 'jjigae/jeongol-ryu'. PUZZLE menus were 'jorim/jjim-ryu and Myeonryu (each 33.3%)', 'bap-ryu (31.0%)' in sequence. PUZZLE menus were a lots of 'Chinese food (75.0%)' and 'myeonryu (55.6%)'. This study provides the basic data based on regularly menu analysis method applied the scientific menu analysis techniques in government offices food services, I'd like to suggest that the menu management must be done based on the necessity and result of menu analysis according to the seasonal and middle, long-term plans.

• Journal of Distribution Research
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• v.16 no.3
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• pp.1-32
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• 2011

I. Introduction: In Chinese electronics industry, the local wholesalers are still dominant but power is rapidly swifting from wholesalers to retailers because in recent foreign big retailers and local mass merchandisers are growing fast. During such transient period, conflicts among channel members emerge important issues. For example, when wholesalers who have more power exercise influence strategies to maintain status, conflicts among manufacturer, wholesaler, and retailer will be intensified. Korean electronics companies in China need differentiated channel strategies by dealing with wholesalers and retailers simultaneously to sell more Korean products in competition with foreign firms. For example, Korean electronics firms should utilize 'guanxi' or relational quality to form long-term relationships with whloesalers instead of power and conflict issues. The major purpose of this study is to investigate the impact of conflict, dependency, and influence strategies between local Korean-products-selling retailers and wholesalers on performance in Chinese electronics distribution channels. In particular, this paper proposes effective distribution strategies for Korean electronics companies in China by analyzing moderating effects of 'Guanxi'. II. Literature Review and Hypotheses: The specific purposes of this study are as follows. First, causes of conflicts between local Korean-products-selling retailers and wholesalers are examined from the perspectives of goal incongruence and role ambiguity and then effects of these causes are found out on perceived conflicts of local retailers. Second, the effects of dependency of local retailers upon wholesalers are investigated on local retailers' perceived conflicts. Third, the effects of non-coercive influence strategies such as information exchange and recommendation and coercive strategies such as threats and legalistic pleas exercised by wholesalers are explored on perceived conflicts by local retailers. Fourth, the effects of level of conflicts perceived by local retailers are verified on local retailers' financial performance and satisfaction. Fifth, moderating effects of relational qualities, say, 'quanxi' between wholesalers and retailers are analyzed on the impact of wholesalers' influence strategies on retailers' performances. Finally, moderating effects of relational qualities are examined on the relationship between conflicts and performance. To accomplish above-mentioned research objectives, Figure 1 and the following research hypotheses are proposed and verified. III. Measurement and Data Analysis: To verify the proposed research model and hypotheses, data were collected from 97 retailers who are selling Korean electronic products located around Central and Southern regions in China. Covariance analysis and moderated regression analysis were employed to validate hypotheses. IV. Conclusion: The following results were drawn using structural equation modeling and hierarchical moderated regression. First, goal incongruence perceived by local retailers significantly affected conflict but role ambiguity did not. Second, consistent with conflict spiral theory, the level of conflict decreased when retailers' dependency increased toward wholesalers. Third, noncoercive influence strategies such as information exchange and recommendation implemented by wholesalers had significant effects on retailers' performance such as sales and satisfaction without conflict. On the other hand, coercive influence strategies such as threat and legalistic plea had insignificant effects on performance in spite of increasing the level of conflict. Fourth, 'guanxi', namely, relational quality between local retailers and wholesalers showed unique effects on performance. In case of noncoercive influence strategies, 'guanxi' did not play a role of moderator. Rather, relational quality and noncoercive influence strategies can serve as independent variables to enhance performance. On the other hand, when 'guanxi' was well built due to mutual trust and commitment, relational quality as a moderator can positively function to improve performance even though hostile, coercive influence strategies were implemented. Fifth, 'guanxi' significantly moderated the effects of conflict on performance. Even if conflict arises, local retailers who form solid relational quality can increase performance by dealing with dysfunctional conflict synergistically compared with low 'quanxi' retailers. In conclusion, this study verified the importance of relational quality via 'quanxi' between local retailers and wholesalers in Chinese electronic industry because relational quality could cross out the adverse effects of coercive influence strategies and conflict on performance.

• Journal of Distribution Science
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• v.9 no.2
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• pp.111-122
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• 2011

The purpose of this study is to survey the successful cases of small and medium Business Systematization Cognition by examining their entrepreneurial characteristics and analysing the factors affecting their success. To that end, previous studies on the association types of small businesses were studied. A research model was developed, and research hypotheses for an empirical analysis were established upon it. Suh et al. (2010) insist on the importance of Small Business Systematization in Korea but also show that small business performance is suffering: they are too small to stand alone. That is why association is so crucial for them: they must stand together. Unfortunately, association is difficult, as they have few specific links and little motivation. Even in franchising networks, association tends to be initiated by big franchisers, not small ones. In that sense, association among small businesses is crucial for their long-term survival. With this in mind, this study examines how they think and feel about the issue of 'Industrial Classification', how important Industrial Classification is to their business success, and what kinds of problems it raises in the markets. This study seeks the different cognitions among the association types of small businesses from the perspectives of participation motivation, systematization expectation, policy demand level, and management performance. We assume that different industrial classification types of small businesses will have different cognitions concerning these factors. There are four basic industrial classification types of small businesses: retail sales, restaurant, service, and manufacturing. To date, most of the studies in this area have focused on collecting data on the external environments of small businesses or performing statistical analyses on their status. In this study, we surveyed 4 market areas in Busan, Masan, and Changwon in Korea, where business associations consist of merchants, shop owners, and traders. We surveyed 330 shops and merchants by sending a questionnaire or visiting. Finally, 268 questionnaires were collected and used for the analysis. An ANOVA, T-test, and regression analyses were conducted to test the research hypotheses. The results demonstrate that there are differences in cognition depending upon the industrial classification type. Restaurants generally have a higher cognition concerning job offer problems and a lower cognition concerning their competitiveness. Restaurants also depend more on systematization expectation than do the other industrial classification types. On the policy demand level, restaurants have a higher cognition. This study identifies several factors that are contributing to management performance through differences in cognition that depend upon association type: systematization expectation and policy demand level have positive effects on management performance; participation motivation has a negative effect on management performance. We confirm also that the image factors of different cognitions are linked to an awareness of the value of systematization and that these factors show sequential and continual patterns in the course of generating performances. In conclusion, this study carries significant implications in its classifying of small businesses into the four different associational types (retail sales, restaurant, services, and manufacturing). We believe our study to be the first one to conduct an empirical survey in this subject area. More studies in this area will likely use our research frameworks. The data show that regionally based industrial classification associations such as those in rural cities or less developed areas tend to suffer more problems than those in urban areas. Moreover, restaurants suffer more problems than the norm. Most of the problems raised in this study concern the act of 'associating itself'. Most associations have serious difficulties in associating. On the other hand, the area where they have the least policy demand is that of service types. This study contributes to the argument that associating, rather than financial assistance or management consulting, promotes the start-up and managerial performance of small businesses. This study also has some limitations. The main limitation is the number of questionnaires. We could not survey all the industrial classification types across the country because of budget and time limitations. If we had, we could have produced many more useful results and enhanced the precision of our analysis. The history of systemization is very short and the number of industrial classification associations is relatively low in Korea. We should keep in mind, though, that this is very crucial to systemization entrepreneurs starting their businesses, as it can heavily affect their chances of success. Being strongly associated with each other might be critical to the business success of industrial classification members. Thus, the government needs to put more effort and resources into supporting the drive of industrial classification members to become more strongly associated.

• Journal of the Korean Institute of Traditional Landscape Architecture
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• v.32 no.2
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• pp.68-81
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• 2014

This study was conducted to identify the spacialty, to illuminate the existence and values of Myeongwoldae(明月臺) and Forest Myeongwol, and to suggest the sustainable usage, preservation and management plans with the purpose of ecological and cultural landscaping characteristic and value identification. The result of the study is as follows. Castle Myeongwol and Port Myeongwol shows the status of Hallim-eup Myeongwol District which is the administrative center of western Jeju as well as is the fortress. Building Wolgyejeongsa and School Woohakdang, the head temple of education and culture, located in Myeongwol District represents the spaciality of Myeonwol-ri which was the center of education. Stand Myeongwol is one of the most representative Confucian cultural landscapes in Jeju Island and the field of communion with nature where scholars enjoy poetries, nature, changgi(Korean chess), and go in the Joseon Dynasty period. It was found that the current relics of Myeongwoldae was recovered through the maintenance project conducted by Youth Group Myeongwol composed with Hongjong-si(洪鍾時) as the center during the Japanese colonial era in 1931. It seems that the stonework of Myeongwoldae composed of three levels in the order of square, octagon, and circle based on the heaven-man unity theory of Confucianism and the octagon in the middle is the messenger of Cheonwonjibang(天圓地方), in other words, between the square-shaped earth and the circle-shaped sky. It is assumed that both Grand Bridge Myeongwol and Bridge Myeongwol were constructed as arched bridges in early days. Bridge Myeongwol is the only arched bridge remaining in Jeju Island now, which has the modern cultural heritage value. In Forest Myeongwol, 97 taxa of plants were confirmed and in accordance with 'Taxonomic Group and Class Criteria of Floristic Specific Plants', eight taxa were found; Arachniodes aristata of FD IV and Ilex cornuta, Piper kadsura, Litsea japonica, Melia azedarach, Xylosma congestum, Richosanthes kirilowii var. japonica, Dichondra repens, Viburnum odoratissimum var. awabuki of FD III. Otherwise, 14 taxa of naturalized plants including Apium leptophylihum which is imported to Jeju Island only were confirmed. In Forest Myeongwol, 77 trees including 41 Celtis sinensis, 30 Aphananthe aspera, two Wylosma congestum, a Pinus densiflora, a Camellia japonica, a Melia azedarach, and an Ilex cornuta form a colony. Based on the researched data, the preservation and plans of Myeongwoldae and Forest Myeongwol is suggested as follows. Myeongwoldae, Bridge Myeongwol, and Forest Myeongwol should be managed as one integrated division. Bridge Myeongwol, an arched bridge which is hard to be found in Jeju Island is a high-standard stonework requiring long-term preservation plans. Otherwise, Grand Bridge Myeongwol that is exposed to accident risks because of deterioration and needs safety diagnosis requires measures according to the result of precise safety diagnosis. It is desirable to restore it to a two-sluice arched bridge as its initial shape and to preserve and use it as a representative local landmark with Stand Myeongwol. In addition, considering the topophsis based on the analysis result, the current name of Jeju Special Self-Governing Province Monument No. 19 'Myoengwol Hackberry Colony' should change to 'Myeongwol Hackberry-Muku Tree Colony'. In addition, the serial number system which is composed without distinction of hackberry and muku tree should be improved and the regular monitoring of big and old trees, specific plants, and naturalized species is required.

• Journal of Intelligence and Information Systems
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• v.21 no.2
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• pp.191-204
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• 2015

According to the '2013 Performance Assessment Report on the Financial Program' from the National Assembly Budget Office, the unfilled recruitment ratio of Software(SW) Developers in South Korea was 25% in the 2012 fiscal year. Moreover, the unfilled recruitment ratio of highly-qualified SW developers reaches almost 80%. This phenomenon is intensified in small and medium enterprises consisting of less than 300 employees. Young job-seekers in South Korea are increasingly avoiding becoming a SW developer and even the current SW developers want to change careers, which hinders the national development of IT industries. The Korean government has recently realized the problem and implemented policies to foster young SW developers. Due to this effort, it has become easier to find young SW developers at the beginning-level. However, it is still hard to recruit highly-qualified SW developers for many IT companies. This is because in order to become a SW developing expert, having a long term experiences are important. Thus, improving job continuity intentions of current SW developers is more important than fostering new SW developers. Therefore, this study surveyed the job continuity intentions of SW developers and analyzed the factors associated with them. As a method, we carried out a survey from September 2014 to October 2014, which was targeted on 130 SW developers who were working in IT industries in South Korea. We gathered the demographic information and characteristics of the respondents, work environments of a SW industry, and social positions for SW developers. Afterward, a regression analysis and a decision tree method were performed to analyze the data. These two methods are widely used data mining techniques, which have explanation ability and are mutually complementary. We first performed a linear regression method to find the important factors assaociated with a job continuity intension of SW developers. The result showed that an 'expected age' to work as a SW developer were the most significant factor associated with the job continuity intention. We supposed that the major cause of this phenomenon is the structural problem of IT industries in South Korea, which requires SW developers to change the work field from developing area to management as they are promoted. Also, a 'motivation' to become a SW developer and a 'personality (introverted tendency)' of a SW developer are highly importantly factors associated with the job continuity intention. Next, the decision tree method was performed to extract the characteristics of highly motivated developers and the low motivated ones. We used well-known C4.5 algorithm for decision tree analysis. The results showed that 'motivation', 'personality', and 'expected age' were also important factors influencing the job continuity intentions, which was similar to the results of the regression analysis. In addition to that, the 'ability to learn' new technology was a crucial factor for the decision rules of job continuity. In other words, a person with high ability to learn new technology tends to work as a SW developer for a longer period of time. The decision rule also showed that a 'social position' of SW developers and a 'prospect' of SW industry were minor factors influencing job continuity intensions. On the other hand, 'type of an employment (regular position/ non-regular position)' and 'type of company (ordering company/ service providing company)' did not affect the job continuity intension in both methods. In this research, we demonstrated the job continuity intentions of SW developers, who were actually working at IT companies in South Korea, and we analyzed the factors associated with them. These results can be used for human resource management in many IT companies when recruiting or fostering highly-qualified SW experts. It can also help to build SW developer fostering policy and to solve the problem of unfilled recruitment of SW Developers in South Korea.

• The Journal of Korean Society for Radiation Therapy
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• v.31 no.2
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• pp.43-49
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• 2019

Purpose: This study examined changes in the position of the heat and lungs depending on the patient's breathing method during left breast cancer radiotherapy and used treatment plans to compare the resulting radiation dose. Materials and methods: The participants consisted of 10 patients with left breast cancer. A CT simulator(SIMENS SOMATOM AS, Germany) was used to obtain images when using three different breathing methods: free breathing(FB), deep inspiration breath hold(DIBH with Abches, DIBH), inspiration breath hold(IBH with CPAP, CPAP). A Ray Station(5.0.2.35, Sweden) was used for treatment planning, the treatment method was volumetric modulated arc therapy (VMAT) with one partial arc of the same angle, and the prescribed dose to the planning target volume (PTV) was a total dose of 50Gy(2Gy/day). In treatment plan analysis, the 95% dose (D95) to the PTV, the conformity index(CI), and the homogeneity index (HI) were compared. The lungs, heart, and left anterior descending artery (LAD) were selected as the organs at risk(OARs). Results: The mean volume of the ipsilateral lung for FB, DIBH, and CPAP was 1245.58±301.31㎤, 1790.09±362.43 ㎤, 1775.44±476.71 ㎤. The mean D95 for the PTV was 46.67±1.89Gy, 46.85±1.72Gy, 46.97±23.4Gy, and the mean CI and HI were 0.95±0.02, 0.96±0.02, 0.95±0.02 and 0.91±0.01, 0.90±0.01, 0.92±0.02. The V20 of Whole Lung was 10.74±4.50%, 8.29±3.14%, 9.12±3.29% and The V20 of the ipsilateral lung was 20.45±8.65%, 17.18±7.04%, 18.85±7.85%, the Dmean of the heart was 7.82±1.27Gy, 6.10±1.27Gy, 5.67±1.56Gy, and the Dmax of the LAD was 20.41±7.56Gy, 14.88±3.57Gy, 14.96±2.81Gy. The distance from the thoracic wall to the LAD was measured to be 11.33±4.70mm, 22.40±6.01mm, 20.14±6.23mm. Conclusion: During left breast cancer radiotherapy, the lung volume was 46.24% larger for DIBH than for FB, and 43.11% larger for CPAP than FB. The larger lung volume increases the distance between the thoracic wall and the heart. In this way, the LAD, which is one of the nearby OARs, can be more effectively protected while still satisfying the treatment plan. The lung volume was largest for DIBH, and the distance between the LAD and thoracic wall was also the greatest. However, when performing treatment with DIBH, the intra-fraction error cannot be ignored. Moreover, communication between the patient and the radiotherapist is also an important factor in DIBH treatment. When communication is problematic, or if the patient has difficulty holding their breath, we believe that CPAP could be used as an alternative to DIBH. In order to verify the clinical efficacy of CPAP, it will be necessary to perform long-term follow-up of a greater number of patients.

• Journal of Chest Surgery
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• v.41 no.6
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• pp.703-709
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• 2008

Background: Diagnosis and treatment are often successful in the setting of cardiac myxomas. However, cardiac myxomas can lead to catastrophic complications, due to intracardiac obstruction and embolism preoperatively, and can recur postoperatively. Material and Method: We retrospectively reviewed the clinical characteristics, surgical treatment, and recurrence data of 85 patients who underwent cardiac myxoma surgery at Asan Medical Center between November 1994 and June 2007. We analyzed the morphologic characteristics of 58 patients with left atrial myxomas and determined the development of functional mitral valve stenosis and systemic embolism through reviewing the results of preoperative echo-cardiograms to find potential preoperative risk factors. Result: Twenty-seven (31.8%) patients were men, and 58 (68.2%) were women. The mean patient age was $54.5{\pm}14.3$ years. Preoperative symptoms included obstructive symptoms in 41 (48.2%) patients, signs of embolism in 19 (22.4%), constitutional symptoms in 8 (9.4%), and no symptoms in 19 (20.0%). Among the 58 patients with left atrial myxomas, the mean maximal tumor diameter was $4.3{\pm}1.8$ (range $1.1{\sim}8\;cm$)cm. Twenty-six (44.8%) patients had a prolapsing type, defined as a tumor mobile enough to move down. to the mitral. annular plane during diastole, and 32 (55.2%) had villous type, defined as a tumor consisting of multiple fine villous extensions on the surface. Twelve (20.7%) patients had severe functional mitral valve stenosis, and 15 (25.9%) had systemic embolism preoperatively. The incidence of severe functional mitral valve stenosis was significantly higher in patients with the prolapsing type than in those with the non-prolapsing type (p=0.001). The mean maximal tumor diameter in patients with severe functional mitral valve stenosis was $5.1{\pm}1.0\;cm$, significantly larger than that seen in patients without severe functional mitral valve stenosis (p=0.041). The incidence of systemic embolism was significantly higher in patients with the villous type than in those with the smooth type (p=0.006). Postoperative complications were noted in 6 (7.1%) patients, and early mortality was noted in 1 (1.2%). The mean postoperative follow-up duration was $36.2{\pm}37.5$ months, with recurrence reported in 2(2.4%) patients during the follow-up period. The disease free interval were 48, 12 months, respectively. Conclusion: Surgical treatment for cardiac myxomas was performed safely, and long-term prognosis was good. In patients with left atrial myxoma, close attention should be maintained and surgery should be performed promptly in those of prolapsing type, those with large maximal diameter in order to prevent severe functional mitral valve stenosis, and those of villous type in order to prevent systemic embolism. Echocardiography should be followed serially in order to detect recurrence.