• Journal of Yeungnam Medical Science
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• 제39권2호
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• pp.133-140
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• 2022

Background: Despite advances in surgery and intensive perioperative care, fecal peritonitis secondary to colonic perforation is associated with high rates of morbidity and mortality. This study was performed to review the outcomes of patients who underwent colonic perforation surgery and to evaluate the prognostic factors associated with mortality. Methods: A retrospective analysis was performed on 224 consecutive patients who underwent emergency colonic perforation surgery between January 2008 and May 2019. We divided the patients into survivor and non-survivor groups and compared their surgical outcomes. Results: The most common cause of colon perforation was malignancy in 54 patients (24.1%), followed by iatrogenic perforation in 41 (18.3%), stercoral perforation in 39 (17.4%), and diverticulitis in 37 (16.5%). The sigmoid colon (n=124, 55.4%) was the most common location of perforation, followed by the ascending colon, rectum, and cecum. Forty-five patients (20.1%) died within 1 month after surgery. Comparing the 179 survivors with the 45 non-survivors, the patient characteristics associated with mortality were advanced age, low systolic blood pressure, tachycardia, organ failure, high C-reactive protein, high creatinine, prolonged prothrombin time, and high lactate level. The presence of free or feculent fluid, diffuse peritonitis, and right-sided perforation were associated with mortality. In multivariate analysis, advanced age, organ failure, right-sided perforation, and diffuse peritonitis independently predicted mortality within 1 month after surgery. Conclusion: Age and organ failure were prognostic factors for mortality associated with colon perforation. Furthermore, right-sided perforation and diffuse peritonitis demonstrated a significant association with patient mortality.

• Journal of Korean Neurosurgical Society
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• 제66권3호
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• pp.258-262
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• 2023

Germinal matrix-intraventricular hemorrhage (GM-IVH) is among the devastating neurological complications with mortality and neurodevelopmental disability rates ranging from 14.7% to 44.7% in preterm infants. The medical techniques have improved throughout the years, as the morbidity-free survival rate of very-low-birth-weight infants has increased; however, the neonatal and long-term morbidity rates have not significantly improved. To this date, there is no strong evidence on pharmacological management on GM-IVH, due to the limitation of well-designed randomized controlled studies. However, recombinant human erythropoietin administration in preterm infants seems to be the only effective pharmacological management in limited situations. Hence, further high-quality collaborative research studies are warranted in the future to ensure better outcomes among preterm infants with GM-IVH.

• Tuberculosis and Respiratory Diseases
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• 제68권3호
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• pp.140-145
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• 2010

Background: Pulmonary embolism (PE) is a common clinical problem in the West that is associated with substantial morbidity and mortality. The diagnostic modality has been changed since 2001. This study retrospectively reviewed the PE mortality with the aim of identifying the risk factors associated with mortality since the multidetector computed tomography (MDCT) was introduced. Methods: We analyzed 105 patients with acute PE proven by multidetector CT or ventilation perfusion scan. The primary outcome measure was the all-cause mortality at 3 months. The prognostic effect of the baseline factors on survival was assessed by multivariate analysis. Results: The main risk factors were prolonged immobilization, stroke, cancer and obesity. Forty nine percent of patients had 3 or more risk factors. The overall mortality at 3 months was 18.1%. Multivariate analysis revealed low diastolic blood pressure and the existence of cancer to be independent factors significantly associated with mortality. Forty two PE patients were examined for the coagulation inhibitors. Four of these patients had a protein C deficiency (9.5%), and 11 had a protein S deficiency (26%). Conclusion: PE is an important clinical problem with a high mortality rate. Close monitoring may be necessary in patients with the risk factors.

• 한국임상약학회지
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• 제23권4호
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• pp.365-372
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• 2013

Background: Malnutrition of inpatients has been associated with higher morbidity, mortality, cost, and longer hospital stay. Total parenteral nutrition (TPN) therapy plays an important role in decreasing morbidity and mortality among critical inpatients in hospitals, and has been commonly used to improve clinical outcomes. However, only a few studies were conducted regarding patients' nutritional improvement by TPN. Method: This study therefore evaluated the changes in nutritional parameters by TPN therapy for early malnourished inpatients. Data from early malnourished inpatients who were treated with TPN therapy between January 2012 and June 2013 at the ${\bigcirc}{\bigcirc}$ university Hospital were studied retrospectively. Information regarding sex, age, underlying diseases, division, TPN (peripheral and central), and changes in nutritional parameters were collected by reviewing electronic medical records. The criteria for evaluation of the changes in nutritional parameters were included physical marker, body mass index (BMI), and biochemical markers, including albumin (Alb), total lymphocyte count (TLC), and cholesterol. Nutritional parameters were collected three times: pre-TPN, mid-TPN and end-TPN. A total of 149 patients (peripheral, 97; central, 52) was evaluated. Results: In all patients, the malnutrition number was significantly decreased following the complete TPN therapy (peripheral patients, pre-TPN: $3.33{\pm}0.12$, mid-TPN : $3.06{\pm}0.17$, and end-TPN: $2.85{\pm}0.21$ (p < 0.05); central patients, pre-TPN: $3.38{\pm}0.11$, mid-TPN: $3.06{\pm}0.13$, and end-TPN: $2.75{\pm}0.21$ (p < 0.05). The malnutrition number means number of nutrition parameters below normal range of malnutrition. In addition, all of the four nutritional parameters (BMI, Alb, TLC and cholesterol) were increased with duration of TPN periods for all patients, and the changes in the early stage were larger than in the late stage (p < 0.05). The nutritional parameters of non-cancer patients were increased to a greater extent compared to cancer patients with longer TPN therapy, but it was not significant. The nutritional parameters of younger patients (50-60 years) were also increased more than of older patients (70-80 years), but it was not significant. Conclusion: In conclusion, the TPN therapy decreases malnutritional status and improves nutritional parameters in malnourished patients, thereby decreasing morbidity and mortality. The combined evaluation of all four nutritional parameters is more accurate for nutritional assessment than a single one.

• Journal of Trauma and Injury
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• 제26권3호
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• pp.170-174
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• 2013

Purpose: A flail chest is one of most challenging problems for trauma surgeons. It is usually accompanied by significant underlying pulmonary parenchymal injuries and mayled to a life-threatening thoracic injury. In this study, we evaluated the treatment result for a flail chest to determine the effect of trauma localization on morbidity and mortality. Methods: Between 2004 and 2011, 46 patients(29 males/17 females) were treated for a flail chest. The patients were divided into two group based on the location of the trauma in the chest wall; Group I contained patients with an anterior flail chest due to a bilateral costochondral separation (n=27) and Group II contained patients with a single-side posterolateral flail chest due to a segmental rib fracture (n=19). The location of the trauma in the chest wall, other injuries, mechanical ventilation support, prognosis and ISS (injury severity score) were retrospectively examined in the two groups. Results: Mechanical ventilation support was given in 38 patients(82.6%), and 7 of these 38 patients required a subsequent tracheostomy. The mean ISS for all 46 patients was $19.08{\pm}10.57$. Between the two groups, there was a significant difference in mean ventilator time (p<0.048), but no significant difference in either trauma-related morbidity (p=0.369) or mortality (p=0.189). Conclusion: An anterior flail chest frequently affects the two underlying lung parenchyma and can cause a bilateral lung contusion, a hemopneumothorax and lung hemorrhage. Thus, it needs longer ventilator care than a lateral flail chest does and is more frequently associated with pulmonary complications with poor outcome than a lateral flail chest is. In a severe trauma patient with a flail chest, especially an anterior flail chest, we must pay more attention to the pulmonary care strategy and the bronchial toilet.

• 응용통계연구
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• 제30권3호
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• pp.475-486
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• 2017

국민 건강의 향상 및 복지의 선진화를 위해 객관적이고 정확한 건강기대수명의 필요성이 대두되었다. 또한 건강기대수명은 삶의 질을 평가하는 주요한 지표이기 때문에 기대수명 및 건강기대수명에 근거한 사회계층간의 삶의 질의 불평등에 대한 논의는 이미 여러 해외연구에서 계속되어 왔다. 이에 본 논문에서는 우리나라 유병률과 사망률에서 모집단에 대한 대표성을 갖고 있는 표본코호트DB를 통해 건강기대수명을 도출하였다. 본 논문에서는 건강기대수명의 산출을 위해 Sullivan (1971)의 단일상태 접근법을 이용하였다. 이때, 사망률과 유병률이 관측되지 않은 연령대의 경우에는 Greville (1945)의 9-order correction factor 방법과 Brass (1971)의 Brass-logit 모형을 통하여 보정하여 주었다. 그 결과 2013년 기준 한국여성의 기대수명은 87세, 남성은 80세 였으나 여성의 경우는 60년, 남성은 61년 동안만 질병이 없는 '건강한 삶'을 영위하는 것으로 나타났다. 본 연구에서는 또한 2003년부터 2013년까지 한국인의 특정 질병으로부터의 건강한 삶의 영위기간을 성별, 소득수준별, 건강보험가입 구분별로 산출하였다. 그 결과 건강기대수명 측면에서 한국의 성별, 소득수준별, 건강보험 가입 구분별 삶의 질의 불평등을 확인하였다.

• Journal of Trauma and Injury
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• 제22권1호
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• pp.57-64
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• 2009

Purpose: Computed tomography (CT) is an accurate test for evaluating hemodynamically stable patients with blunt abdominal trauma. Until now, there have been few studies concentrating on the diagnostic and prognostic significance of the intravenous contrast extravasation (CE) site. We investigated the site of CE on abdominopelvic CT (APCT) and its effect on treating trauma patients and predicting the clinical outcome. Methods: The 50 patients admitted to our emergency department with blunt abdominal trauma showing CE on APCT from January 2004 to September 2006 were included in this study. Patients were prospectively collected, and medical records were reviewed and analyzed. The patients'clinical and lab findings, Focused Assessment with Sonography for Trauma (FAST) findings, CT findings were analyzed. CE sites were classified as intraperitoneal, retroperitoneal, and pelvic cavity and were correlated with post-treatment complications, mortality, and morbidity. Results: Of the 50 patients (mean age : $45{\pm}18years$, 29 males, 21 females) included in our study, 33 patients died (66%). There was no correlation between CE site and ICU or total hospitalization duration (p=0.553, p=0.523). During the first 24 hours of resuscitation, the pelvic cavity group required a mean of 20 units more of packed red blood cell (pRBC) transfusion compared to other groups (p=0.003). In the intraperitoneal group, more patients received operative invasive intervention - either laparotomy or embolization (p=0.025). The intraperitoneal group had the highest mortality, with 13 deaths (11/33, 39%), and the highest early mortality rate (10/13, 76%) in the first 24 hours (p=0.001). Conclusion: Intraperitoneal CE on the CT scan in cases of blunt abdominal trauma is regarded as an indication of a need for invasive intervention (either angiography or laparotomy) and of a higher mortality rate in the first 24 hours. A pelvic cavity CE rquires more aggressive transfusion with pRBC. However, the CT findings themselves showed no significant correlation with overall mortality, morbidity, or hospitalization.

• Journal of Preventive Medicine and Public Health
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• 제34권2호
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• pp.103-108
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• 2001

대기분진의 영향을 분석한 역학적 연구들은 분석방법의 오류, 생물학적인 타당성, 혼란변수의 통제 등 여러 가지 제한점들을 갖고 있기 때문에 이를 해석할 때 주의를 요한다. 그러나 대기분진역학연구들이 여러 가지 다른 연구방법과 자료원, 그리고 분석기법 등을 적용하였는데도 불구하고 연구결과간에 일치성이 매우높기 때문에 대기분진의 인체효과에 대한 연구결과가 일정한 방법론적인 또는 분석상의 오류에 의해서 나타났을 가능성은 거의 없다. 역학적 연구들이 생물학적인 타당성에 대한 상세한 근거를 제시하기는 어렵지만 서로 다른 연구들의 결과가 호흡기질환 및 심혈관계질환에 대한 건강영향을 나타내고 있으나 기타 질환에 대해서는 의미있는 결과들이 거의 없다는 것은 대기분진이 호흡기질환 및 심혈관계질환에 미치는 생물학적인 기전의 근거를 강하게 나타낸다고 할 수 있다. 대기분진 역학연구의 또 다른 중요한 관심사는 혼란변수의 통제 문제이다. 혼란변수란 노출과 질병에 서로 연관되어 있는 다른 위험인자가 분석에서 적절하게 통제되지 못하였을 때 이로 인하여 대기분진과 건강영향의 관련성이 잘못 나타나는 것을 말한다. 그러나 역시 서로 다른 연구들에서 여러 가지 혼란변수가 관련성에 영향을 미쳤다면 여러 지역의 다양한 연구에서 일정한 결과를 제시하기는 어려웠을 것이므로 대기분진과 건강영향의 관련성이 혼란변수의 부적절한 처리 때문에 나타난 것이라고 보기는 어렵다. 물론 대기분진 이외의 가스상 오염 물질이 같이 존재하고 또 서로간의 상관성이 매우 높기 때문에 이러한 대기오염 물질의 영향을 완전히 통제한 상태에서 대기분진만의 영향을 관찰한다는 것은 매우 어려운 일이다. 따라서 다중 공선성의 문제나 교차효과의 문제 등이 앞으로 대기분진 역학연구의 과제일 것이다. 결론적으로, 대기분진이 사망률 및 병원 내원율 등에 미치는 영향은 확립되었다고 보아도 될 것이다. 또한 우리나라의 연구들을 통하여 대기분진의 건강영향은 예외 없이 우리에게도 나타나는 문제라는 것을 확인하였다. 그러나 이러한 역학적 관련성에 대한 성과에도 불구하고 발생기전의 평가, 감수성 인구집단의 확인, 예방 및 관리 대책 마련 등 앞으로 해야 할 과제가 많이 남아있다.

• 한국동물위생학회지
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• 제31권4호
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• pp.521-532
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• 2008

The prevalence of major calf disease was investigated in 117 Holstein dairy calves in Chonnam area. All of them were moved in the College experimental farm which is operated in intensive units. clinical signs were daily examined throughout two months after the introduction of the College farm. Among calves, 92 cases(78.6%) died in the two months after the introduction in it. Outbreaks of respiratory and alimentary diseases were their main causes of their fatality. The incidence of respiratory disorders during the full period of the experiment was up to 42.8%, and the alimentary diseases were occurred 35.9% of the herd. Most of the mortality was related with respiratory(59.9%) and alimentary(52.1%) pathogens. Also calf mortality by combined infection claimed 6.6% among 100 morbidity cases. Principle pathogens to cause mortality were Pasteurella spp(44.4%), E coli(29.9%), bovine viral diarrhea virus(16.2%), IBRV(12.0%), respectively. Viruses also played as an important role in increasing calf morbidity to secondary respiratory bacterial pathogens. Pasteurella infection combined with infectious bovine rhinotracheitis virus(11 cases), parainfluenza virus type-3(9 cases), or bovine respiratory syncytial virus(7 cases) was appeared as major pattern to mortality. colibacillosis in causing enteritis was concurrently infected with BVD(19 cases), bovine coronavirus infection(14 cases), salmonellosis(5 cases), coccidiosis(5 cases) and clostridial infection(4 cases). Ninty-two cases to death were appeared to have 100% neutralizing antibodies to BCV; Among them, 73.8% had the neutralizing antibody level higher than 64. Calves with neutralizing antibodies higher than 16 to BVDV were 50%. The cases with neutralizing antibody level lower than 8 to BEFV were 89.4% that means the necessity of appropriate vaccination.

• Neonatal Medicine
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• 제18권1호
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• pp.111-116
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• 2011

목적: 다태임신에서 지연 분만이 신생아 사망률과 이환율에 미치는 영향에 대하여 알아보고자 하였다. 방법: 2005년 6월부터 2010년 7월까지 서울대학교병원에서 지연 분만 방법으로 출생한 아기들을 대상으로 후향적 고찰을 하였다. 결과는 신생아 사망률과 이환율로 하였으며, 이환율을 조사한 질병에는 뇌실 내 출혈, 신생아 호흡 곤란 증후군, 기관지폐 형성 이상, 뇌실 주위 백색질연화증, 자궁 외 성장지연 등을 포함하였다. 다태아 중 이후에 출생한 아기들의 결과를 처음 출생한 아기들, 그리고 재태주령과 출생체중이 비슷한 아기들로 이루어진 대조군의 결과와 비교하였다. 결과: 총 4쌍의 쌍둥이, 5쌍의 세 쌍둥이가 있었으며, 처음 출생한 아기들(그룹 1)은 9명, 이후에 출생한 아기들(그룹 2)은 14명이었다. 그룹 1의 재태주령은 22주 6일-27주 5일, 그룹 2의 재태주령은 24주 6일-28주 0일이었다. 첫 분만과 지연 분만 사이간격의 평균은 10일이었으며, 모든 세 쌍둥이 가운데 둘째와 셋째 아기 사이의 지연 분만은 없었다. 부당 경량아는 그룹 2보다 그룹 1에서 많았다(그룹 1: 66.7%, 그룹 2: 21.4%, P=0.03). 그룹 1과 2 사이에 사망률의 차이가 있었지만 통계적으로는 유의하지 않았다(그룹 1: 33.3%, 그룹 2: 7.1%, P=0.106). 그룹 2에 대한 대조군은 28명이었고, 그룹 2와 대조군 사이에 신생아기 사망률과 이환율은 통계적으로 의미있는 차이는 없었다. 결론: 대상수가 적기는 하지만, 다태임신에서 지연 분만으로 남아 있는 태아의 부당경량아 빈도는 줄일 수 있으며 재태 기간연장으로 인해 출생 후에 나쁜 영향을 끼치지는 않을 것으로 생각된다.