• Journal of Chest Surgery
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• 제21권2호
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• pp.211-222
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• 1988

Tetralogy of Fallot is a cyanotic congenital heart disease characterized by large ventricular septal defect[VSD] and stenosis of right ventricular outflow tract[RVOT] and the degree of RVOT stenosis and the state of pulmonary arteries are the major determinant of prognosis of this anomaly after operation. The sum of blood flow through RVOT and collateral flow from systemic arteries determine the total pulmonary blood flow and it is drained to left atrium and left ventricle. Therefore the degree of development of left ventricle not only reflects pulmonary blood flow and the status of peripheral pulmonary arteries but also affects postoperative prognosis as a systemic ventricle. In this article, left ventricular volume and its influence on postoperative cardiac function in tetralogy of Fallot were studied in 34 patients operated on at Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital in 1985. Mean age of the patients was 5 1/12*3 9/12 years[range 9/12 - 14 8/12 years], mean body surface area[BSA] 0.65*0.20m2[range 0.38 - 1.22m2], mean body weight 15.6k6.48kg[range 7.0 - 36kg]and mean hematocrit 50.6*9.77%[range 32.0 - 73.5%]. Left ventricular end-diastolic volume[LVEDV] of them were from 11.2 to 113cc and there was a good linear correlation between BSA[m2, X]and LVEDV[cc, Y][Y= - 20.0+923x, r= 0.84, p < 0.005]. Mean LVEDV/m2 was [57.6 * 18.3 cc / m2[range 28.7 - 95.8 cc / m2] and there was a significant reduction of volume compared with normal value. As body surface increases, there was a increasing tendency in LVEDV/m2 but there was no statistical significance. Mean total amount of postoperatively infused dopamine in these 33 patients[except one who expired postoperatively] was 65.6*74.5mg / kg and it was 40.6*44.0mg / kg in routine RVOT widening group [Group I] and 205*49.3mg / kg in transannular RVOT widening group[Group II]. There was a statistically significant difference between two groups. In group I patients there was a good linear inverse correlation between dopamine total amount[mg / kg, Y] and LV volume[cc / m2, X] [Y = 150 - 1.89 X, r = - 0. 77, p < 0.005]. But there were no correlations between dopamine total amount and Hct, cardiopulmonary bypass time and aorta cross clamp time. In conclusion, the patient with small preoperative left ventricular volume required more amount of dopamine as an inotropic agent for the maintenance of a cardiac function in postoperative period. But this is a result of immediate postoperative period and does not reflect the long term effect of left ventricular volume in tetralogy of Fallot. There must be more study for the evaluation of its long term effect.

• Tuberculosis and Respiratory Diseases
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• 제62권5호
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• pp.398-405
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• 2007

연구배경: 내과계중환자실에서 72시간 이상 장기간 기계 환기를 받은 환자들의 자료가 부족하여 기저질환별, 기계 환기가 필요했던 원인질환별로 장기 예후를 관찰하며, 또한 1년째에는 삶의 질 평가를 같이 수행하여 이 환자들의 삶의 질 상태를 평가 하고자 하였다. 방 법: 2003년 3월부터 2003년 7월까지 서울아산병원 내과계중환자실에서 72시간 이상 기계 환기치료를 받은 환자 73명을 대상으로 1, 3, 6, 12, 24, 36개월 생존율을 전향적으로 관찰하고 1년 생존자를 대상으로 Short Form 36(SF-36)을 이용하여 삶의 질을 측정하였다. 결 과: 대상 환자들의 1개월 생존율은 54.8%(40/73), 3개월 생존율은 39.7%(29/73), 6개월 생존율은 30.1%(22/73), 12개월 생존율은 20.5%(15/73), 24개월 생존율은 18.3%(13/71), 그리고 36개월 생존율은 16.9%(12/71)이었다. 3년간 생존율은 기계 환기가 필요했던 원인질환별로는 차이가 없었고, 기저질환별로는 신생물 또는 만성간질환이 만성폐질환이나 만성신장질환에 비해 예후가 불량하였다(p<0.05). SF-36을 이용한 삶의 질 평가에서 정상 대조군과 비교 시 정신적 건강영역에서 Role limiting due to emotional problem을 제외하고 모두 낮은 값을 보였다. 결 론: 한 대학병원 내과계중환자실에서 72시간이상 장기간 기계 환기를 받은 환자들의 3년간 생존율은 낮았으며, 12개월까지 지속적으로 낮아지나 12개월부터 36개월까지는 유지되었다. 1년 시점에서 삶의 질 평가 시 이 환자들의 삶의 질 상태가 낮음을 보여주었다.

• Asian Pacific Journal of Cancer Prevention
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• 제13권2호
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• pp.725-729
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• 2012

Background: The management of hepatolithiasis combined with intrahepatic cholangicarcinoma (IHHCC) remains a challenge due to poor prognosis. The aim of this study was to summarize our diagnosis and cure experience of IHHCC over the recent 10 years. Methods: From January 1996 to January 2006, 66 patients with IHHCC were reviewed retrospectively. Results: Of the 66 patients, 52 underwent surgical resection (radical resection in 38 and palliative in 14) and 8 patients abdominal exploration, while the other 6 cases received endoscopic retrograde biliary internal drainage and stent implantation. In this series, correct diagnosis of advanced stage was made during operation in 8 cases (8/60, 13.3%) and all of them (underwent unnecessary abdominal exploration, among them the positive rate of CA19-9 was 100%, and the positive rate of CEA was 87.6% (7/8), incidence rate of ascites was 100% and short-term significant weight loss was 100%, with median overall survival of only 4 months. Conclusion: Radical resection is mandatory for IHHCC patient to achieve long-term survival, the CT and MR imaging features of IHHCC being concentric enhancement. Patients with IHHCC have significant higher CA199 and significant higher CEA and short-term significant weight loss and ascites should be considered with advanced stage of IHHCC and unnecessary non-therapeutic laparotomies should be avoided.

• Annals of Clinical Neurophysiology
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• 제8권1호
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• pp.40-43
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• 2006

Background: Benign paroxysmal positional vertigo (BPPV) is a relatively common disorder, and is characterized by episodic vertigo and nystagmus which was provoked by head motion. However, little is known about the short and long-term outcome and the prognostic factors for recurrence of BPPV. In this pilot study, we tried to identify the prognostic factors of BPPV for short-term outcome. Methods: We analyzed clinical features of 32 patients (men=21, mean $age=60.4^{\circ}{\pm}12.6y$) with BPPV that was diagnosed by typical nystagmus induced by positioning maneuver. The induced nystagmus was recorded using video-oculography (VOG). According to the semicircular canal involved, BPPV patients were classified into horizontal, posterior, or anterior canal type. Univariate analysis for age, sex, and history of vertigo, and Kaplan-Meier analysis for each canal type were performed. Results: Horizontal (n=21, 65.6%) semicircular canal type BPPV was more common than the posterior one (n=11, 34.4%). Median follow-up period was 113 day (from 34 to 216 days). Four patients with horizontal canal type BPPV had recurrent attacks. Age, history of vertigo, and days prior to diagnosis were not different between canal type. Overall recurrence rate of horizontal canal type BPPV by Kaplan-Meier estimation was 19% at 60 days (p=0.13). Conclusions: Horizontal canal type BPPV was more common and recurred more frequently than posterior canal type in the present study. However, we did not find prognostic factors for recurrence of BPPV.

• Clinical and Experimental Pediatrics
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• 제50권12호
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• pp.1231-1240
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• 2007

목 적 : Bartter 증후군은 신장 내 전해질 수송 장애로 인해 저칼륨혈증 및 대사성 알칼리증을 보이는 질환으로 이에 따른 여러 증상이 나타난다. 저자들은 Bartter 증후군의 임상 양상과 장단기 치료 결과에 대해 보고하고자 한다. 방 법 : Bartter 증후군으로 서울아산병원 소아과에서 치료하였던 다섯 명의 환아를 대상으로 진단시 병력, 혈액 검사 및 소변 검사, 신장 초음파, 청력 검사 등의 결과를 후향적으로 분석하고, 치료 후 변화와 성장 발달에 관해 조사하였다. 결 과 : 다섯 명의 환아 중 양수 과다증을 보인 3례는 모두 조산아로 출생하였다. 진단 당시 나이는 평균 11.8개월로 모든 예에서 식욕 부진, 성장 부진 및 다뇨의 증상을 보였다. 진단시 저칼륨혈증, 대사성 알칼리증 및 고레닌혈증을 보였고, 혈압은 모두 정상이었다. 신석회화는 1례에서 있었고, 청력은 모두 정상이었다. 인도메타신과 그 외의 프로스타글란딘 생성 억제제, 경구 칼륨 제제 등을 사용한 후 단기적으로 임상 증상이 호전되었고, 장기적으로 성장 발달이 정상화되었다. 결 론 : Bartter 증후군은 조기에 발견하여 적절한 치료를 하면 예후가 양호한 질환이므로 조기 진단이 중요하다고 판단된다.

• Journal of Gastric Cancer
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• 제18권1호
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• pp.69-81
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• 2018

Purpose: It has been reported that the survival of patients with locally advanced gastric cancer (LAGC) is better in East Asia countries than in developed western countries; however, the prognosis of LAGC remains poor. This study aimed to evaluate the effects of perioperative chemotherapy on the long-term survival of East Asia patients with LAGC. Materials and Methods: From October 2006 through August 2008, 43 patients with LAGC received perioperative S-1 combined with weekly docetaxel in a phase II study (neoadjuvant group). These patients were matched using propensity scores to patients who underwent surgery without neoadjuvant chemotherapy during the same period (surgery group). The surgical outcomes and long-term survivals were compared between the 2 groups. Results: After matching, 43 and 86 patients were included in the neoadjuvant and surgery groups, respectively, and there was no significant difference in their baseline characteristics. Although the operating time was longer in the neoadjuvant group, there was no significant difference in postoperative complications between the 2 groups. The neoadjuvant group had a significantly higher 5-year overall survival (OS) rate (73.3% vs. 51.1%, P=0.005) and a trend towards higher 5-year progression-free survival (PFS) (62.8% vs. 49.9%, P=0.145). In the multivariate analysis, perioperative chemotherapy was an independent factor for OS, with a hazard ratio of 0.4 (P=0.005) and a marginal effect on the PFS (P=0.054). Conclusions: Perioperative chemotherapy was associated with better long-term survival without increasing postoperative complications in the setting of D2 surgery for patients with LAGC, suggesting that perioperative chemotherapy can be a therapeutic option in East Asia countries.

• Asian Pacific Journal of Cancer Prevention
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• 제15권8호
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• pp.3435-3441
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• 2014

Background: Axillary lymph node status at diagnosis remains the strongest predictor of long-term survival in breast cancer. Patients with more than ten axillary lymph nodes at diagnosis have a poor long-term survival. In this single institutional study, we set out to evaluate the prognosis of this high-risk group in the era of multimodality therapy. Materials and Methods: In this retrospective study, we looked at all breast cancer patients with greater than ten axillary lymph nodes diagnosed at Mount Sinai Medical Center (MSMC) from January 1st 1990 to December 31st 2007 (n=161). In the univariate analysis, descriptive frequencies, median survival, and 5- and 10-year survival rates were estimated for common prognostic factors. A multivariate prognostic analysis for time-to-event data, using the extended Cox regression model was carried out. Results: With a median and mean follow-up of 70 and 89.9 months, respectively, the overall median survival was estimated to be 99 months. The five-year disease-free survival (DFS) was 59.3% and the ten-year DFS was 37.9%, whereas the five- and ten-year overall survival (OS) was 66.6% and 43.9%, respectively. Multivariate analysis revealed a significant improvement in DFS among black patients compared to whites (p=0.05), improved DFS and OS among young patients (ages 21-45) compared to elderly patients (age greater than 70) (p=0.00176, p=0.0034, respectively), and improved DFS and OS among patients whose tumors were ER positive (p=0.049, p=0.0034). Conclusions: In this single institution study of patients with greater than 10 positive axillary nodes, black patients had a significantly improved DFS compared with white patients. Young age and ER tumor positivity was associated with improved outcomes. Using multivariate analysis, there were no other variables associated with statistically significant improvements in DFS or OS including date of diagnosis. Further work is needed to improve breast cancer survival in this subgroup of patients.

• Journal of Digestive Cancer Research
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• 제2권2호
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• pp.72-74
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• 2014

췌장암은 예후가 매우 불량한 대표적인 암이며, 특히 전이성 췌장암의 경우 생존기간이 3-6개월에 불과하다. 대부분의 췌장암 치료는 항암화학요법이 근간을 이루지만 수술적 치료 이외에 항암화학요법이나 방사선 치료에는 반응이 미미한 것으로 알려져 있다. 저자들은 다발성 혈관 침범과 복강 내 림프절 전이를 보이는 수술이 불가능한 진행성 췌장암에서 젬시타빈 단독 항암화학요법과 고식적 방사선 치료, 그리고 병행한 사이버나이프 추가 치료로 7년 이상의 장기 생존을 보인 증례를 경험하였다. 추적관찰 중 한 차례의 재발과 병발한 원발성 폐암이 확인되었으나, 이 역시 사이버나이프 치료 후 완전 관해를 보인 드문 증례기에 문헌고찰과 함께 보고하는 바이다.

• Korean Circulation Journal
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• 제52권6호
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• pp.429-440
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• 2022

Background and Objectives: Endovascular therapy (EVT) first strategy has been widely adopted for the treatment of chronic limb threatening ischemia (CLTI) patients in real-world practice. This study aimed to investigate long-term outcomes of CLTI patients who underwent EVT and identify prognostic factors. Methods: From the retrospective cohorts of a Korean multicenter endovascular therapy registry, 1,036 patients with CLTI (792 men, 68.8 ± 9.5 years) were included. The primary endpoint was amputation-free survival (AFS) defined as the absence of major amputation or death. Secondary endpoints were major adverse limb events (MALE; a composite of major amputation, minor amputation, and reintervention). Results: Five-year AFS and freedom from MALE were 69.8% and 61%, respectively. After multivariate analysis, age (hazard ratio [HR], 1.476; p<0.001), end-stage renal disease (ESRD; HR, 2.340; p<0.001), Rutherford category (RC) 6 (HR, 1.456; p=0.036), and suboptimal EVT (HR, 1.798; p=0.005) were identified as predictors of major amputation or death, whereas smoking (HR, 0.594; p=0.007) was protective. Low body mass index (HR, 1.505; p=0.046), ESRD (HR, 1.648; p=0.001), femoropopliteal lesion (HR, 1.877; p=0.004), RC-6 (HR, 1.471; p=0.008), and suboptimal EVT (HR, 1.847; p=0.001) were predictors of MALE. The highest hazard rates were observed during the first 6 months for both major amputation or death and MALE. After that, the hazard rate decreased and rose again after 3-4 years. Conclusions: In CLTI patients, long-term outcomes of EVT were acceptable. ESRD, RC-6, and suboptimal EVT were common predictors for poor clinical outcomes.

• Korean Circulation Journal
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• 제52권3호
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• pp.205-217
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• 2022

Background and Objectives: The prognostic value of left atrial (LA) function in terms of long-term clinical outcomes after mitral regurgitation (MR) surgery remains unclear. Therefore, we investigated the impact of preoperative LA global longitudinal strain (LAGLS) on the long-term postoperative clinical outcomes in chronic severe MR patients who underwent mitral valve (MV) repair surgery. Methods: From January 2012 to December 2017, we analyzed 338 patients (mean age, 51.9±12.5 years; 218 males [64.5%]) treated with MV repair surgery for severe MR. The primary outcome was cardiovascular events, defined as the composite of all-cause death, newly developed atrial fibrillation (AF), and re-hospitalization for cardiovascular causes. Results: During a median follow-up of 45 months (interquartile range, 26-65), 30 (8.9%) cardiovascular events, 5 (1.5%) all-cause death, 8 (2.4%) newly developed AF, and 26 (7.7%) re-hospitalizations occurred. On multivariable analysis, baseline LAGLS was an independent predictor of cardiovascular events (adjusted hazard ratio [HR], 0.91; 95% confidential interval [CI], 0.85-0.97; p=0.004) and re-hospitalization (adjusted HR, 0.93; 95% CI, 0.86-1.00; p=0.037). According to the optimal cutoff value of LAGLS, patients with low LAGLS (<23.6%) had a significantly higher risk of cardiovascular events (adjusted HR, 2.70; 95% CI, 1.04-7.00; p=0.041) than those with high LAGLS (≥23.6%). In a subgroup analysis, patients with high LAGLS had better clinical outcomes regardless of whether the patient had a LA volume index <60 mL/m². Conclusions: In patients with chronic severe MR who received successful MV repair surgery, preoperative LAGLS is an independent predictor of long-term postoperative outcomes.