• Tuberculosis and Respiratory Diseases
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• v.54 no.2
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• pp.199-209
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• 2003

Background : Unexplained weight loss, which commonly occurs in patients with chronic obstructive pulmonary disease(COPD), is important because weight loss is an independent risk factor of mortality and morbidity in these patients. Leptin is known to play an important role in regulating body weight. In addition, the tumor necrosis factor($TNF-{\alpha}$) might also play a potential role in the weight loss experienced in chronic wasting disease. The aim of this study was to determine the influence of plasma leptin and the circulating $TNF-{\alpha}$ system to the difference in the body compositions in patients with COPD. Methods : Spirometry, body composition analysis and the plasma concentrations of leptin, $TNF-{\alpha}$ and a soluble TNF receptor (STNF-R55, -R75) were measured in 31 patients with chronic bronchitis and 10 patients with emphysema. The COPD subtype was classified by the transfer coefficient of carbon monoxide, DLco/VA. Results : The circulating levels of leptin were significantly lower in those patients with emphysema($108.5{\pm}39.37pg/ml$) than those with chronic bronchitis($180.9{\pm}57.7pg/ml$). The circulating levels of sTNF-R55 were significantly higher in the emphysema patients($920.4{\pm}116.4pg/ml$) than in those with chronic bronchitis($803.2{\pm}80.8pg/ml$). There was no relationship between the circulating leptin levels and the activated TNF system in patients with chronic bronchitis and emphysema. However, the circulating leptin levels correlated well with the BMI and fat mass in both patient groups. Conclusion : These results suggest that the weight loss noted in emphysema patients may be associated with the activation of the $TNF-{\alpha}$ system rather than the plasma leptin level.

• Journal of Gastric Cancer
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• v.7 no.2
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• pp.74-81
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• 2007

Purpose: Routine pancreatico-splenectomy with total gastrectomy should no longer be considered as the standard surgical procedure for gastric cancer because of the lack of proven surgical benefit for survival. The aim of this study is to evaluate the clinicopathologic factors and the survival of patients with locally advanced gastric cancer and they had undergone combined pancreatico-splenectomy with a curative intent. Material and Methods: We retrospectively reviewed a total of 118 patients who had undergone total gastrectomy with distal pancreatico-splenectomy from 1990 to 2001. The patients were divided into 2 groups: 90 patients who were free from cancer invasion (group I), and 28 patients with histologically proven cancer invasion into the pancreas (group II). The various clinicopathologic factors that were presumed to influence survival and the survival rates were analyzed. Results: The rate of pathological pancreatic invasion was 23.7%. The tumor stage, depth of invasion, pancreas invasion, lymph node metastasis, lymph node ratio, curability and the hepatic and peritoneal metastasis were statistically significance on univariate analysis. Among these factors, the tumor stage, lymph node ratio and curability were found to be independent prognostic factor on multivariate analysis. The 5-years survival rates were 36.2% for group I and 13.9% for group II. The morbidity rate was 22.1%, and this included pancreatic fistula (5.1%), intra-abdominal abscess (4.2%) and bleeding (4.2%). The overall mortality rate was 0.8%. Conclusion: Combined distal pancreatico-splenectomy with total gastrectomy with a curative intent was selectively indicated for those patients with visible tumor invasion to the pancreas, a difficult complete lymph node dissection around the distal pancreas and spleen, and no evidence of liver metastasis or peritoneal dissemination.

• Clinical and Experimental Pediatrics
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• v.45 no.12
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• pp.1512-1518
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• 2002

Purpose : Twins have a higher mortality and morbidity than singletons. Co-twin with one fetal death is particularly at risk. We investigated the neonatal outcome of live co-twins when one fetus had died after the 20th gestational week, and associated risk factors. Methods : A retrospective study was performed in fifteen cases of twin pregnancy with single intrauterine fetal deaths after the 20th gestational week during the period from January 1996 to December 2000 at Chonnam University Hospital. Results : Gestational age was $33.7{\pm}3.2weeks$, birth weight was $1,992{\pm}592g$. Interval between one fetal death being detected and the delivery of a live co-twin was $32.4{\pm}29.5days$. There were 11 cases(73.3%) of premature babies less than 37 gestational weeks. Main causes of preterm delivery were preterm labor and premature rupture of membranes. Hematologic findings suggesting disseminated intravascular coagulopathy(DIC) were not found in all mothers before delivery, and was not associated with DIC and encephalomalacia of the live co-twin. Perinatal outcome of fifteen live co-twins was as follows : six were normal(40%), three were DIC(20.0%), three were encephalomalacia(20.0%), one suffered intrauterine growth retardation, there was one case of twin to twin transfusion syndrome, and one of congenital heart disease(atrial septal defect with pulmonary stenosis). The occurrence of DIC and encephalomalacia in live co-twins was not related to placental chorionicity, birth weight, gestational week, and the interval between the detection one fetal death and the delivery of a live co-twin. Conclusion : We could not find any maternal hematologic problems in twin pregnancies complicated by one fetal death. Twenty percent of live co-twins showed DIC and encephalomalacia. However, its associated risk factors were not found. We need to investigate more closely the cases of live co-twins with one intrauterine fetal death.

• Tuberculosis and Respiratory Diseases
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• v.45 no.2
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• pp.404-415
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• 1998

Background: Sleep apnea syndrome, which occurs in 1~4 % of the adult population, frequently has different cardiovascular complications such as hypertension, ischemic heart disease, cardiac arrythmia as well as sleep-wake disorder such as excessive daytime hypersomnolence or insomnia. Mortality and vascular morbidity are reported to be significantly higher in sleep apnea syndrome patients than in normal population. According to the recent studies, autonomic dysfunction as well as hypoxemia, hypercapneic acidosis, and increased respiratory effort, may playa role in the high prevalence of cardiovascular complications in patients with sleep apnea syndrome. However the cause and mechanism of autonomic neuropathy in patients with sleep apnea syndrome are not well understood. We studied the existence of autonomic neuropathy in patients with sleep apnea syndrome and factors which influence the pathogenesis of autonomic neuropathy. Method: We used the cardiovascular autonomic neuropathy(CAN) test as a method for evaluation of autonomic neuropathy. The subjects of this study were 20 patients who diagnosed sleep apnea syndrome by polysomnography and 15 persons who were normal by polysomnography. Results: Body mass index and resting systolic blood pressure were higher in sleep apnea group than control group. Apnea index(Al), respiratory disturbance index(RDI) and snoring time percentage were significantly higher in sleep apnea group compared with control group. But there were no significant differences in saturation of oxygen and sleep efficiency in two groups. In the cardiac autonomic neuropathy test, the valsalva ratio was significantly low in sleep apnea group compared with control group but other tests had no differences between two groups. The CAN scores and corrected QT(QTc) interval were calculated significantly higher in sleep apnea group, but there were no significant correlations between CAN scores and QTc interval. There were no significant data of polysomnography to correlate to the CAN score. It meant that the autonomic neuropathy in patients with sleep apnea was affected by other multiple factors. Conclusion: The cardiovascular autonomic neuropathy test was a useful method for the evaluation of autonomic neuropathy in patients with sleep apnea syndrome and abnormalities of cardiovascular autonomic neuropathy were observed in patients with sleep apnea syndrome. However, we failed to define the factors that influence the pathogenesis of autonomic neuropathy of sleep apnea syndrome. This study warrants futher investigations in order to define the pathogenesis of autonomic neuropathy in patients with sleep apnea syndrome.

• Clinical and Experimental Pediatrics
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• v.48 no.11
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• pp.1193-1200
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• 2005

Purpose : Invasive bacterial infection is a major cause of morbidity and mortality in children. Previously, we reported etiology of invasive infections in healthy children in 1985-1995. This study was performed to update etiology of invasive bacterial infections in the previously healthy children. Methods : We reviewed medical records of 98 episodes of invasive bacterial infections in immunocompetent children at the Seoul National University Children's Hospital in 1996-2004. Results : The frequent pathogens identified over all age groups were Streptococcus pneumoniae (33%) and Staphylococcus aureus(33%). The proportion of Salmonella species and Haemophilus influenzae has been declined to 4% each from 23% and 14%, respectively, compared to previous study. S. agalactiae was the most common isolate in the infants ${\leq}3$ months. Among the infants and children aged 3 months to 2 years and children of 2-5 years, S. pneumoniae(57%, 52%, respectively, in each group) was the most common isolates followed by S. aureus(17% and 24%, respectively). S. aureus was the most common isolates(73%) in children >5 years. Primary bacteremia was the most common clinical diagnosis(27%). S. pneumoniae was responsible for 42% of primary bacteremia, 50% of meningitis, and 69% of bacteremic pneumonia and empyema. S. aureus accounted for 80% of bone and joint infections. The case fatality rate was 8.1% for all invasive infections. Conclusion : We reviewed frequency of bacterial agents of invasive infections in children. The data may be useful for pediatricians to select adequate empirical antibiotics in the management of invasive bacterial infections.

• Tuberculosis and Respiratory Diseases
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• v.60 no.4
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• pp.397-403
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• 2006

Background: Chronic obstructive pulmonary disease(COPD) is categorized by the percentage of the predicted $FEV_1$(Forced expiratory volume in 1 second) result which is highly correlated with disease severity(morbidity and mortality). In COPD patients, dyspnea seems to be different from disease severity. We investigated whether dyspnea is correlated with disease severity, as measured by $FEV_1$, quality of life(QoL), occupation, and supporting level of family members and neighbors. Method: Thirty-six clinically stable patients with chronically irreversible airflow limitation were enrolled. We used the Medical Research Council(MRC) dyspnea scale to assess the level of dyspnea and the Korean St. Goerge's respiratory questionnaire(SGRQ) as measure the QoL. Result: The mean percentage of the predicted $FEV_1$ was 32.0%. Dyspnea was not correlated with GOLD stage using $FEV_1$(p=0.114). With deteriorating level of dyspnea the scores of symptoms(p=0.041), activity(p=0.004), impact(p=0.001), and total SGRQ score(p<0.001) were significantly increased. Dyspnea was not correlated with the level of occupation(p=0.259). The supporting level of family members and neighbors was significantly negatively correlated with dyspnea scale(p=0.011). Conclusion: In the management of COPD patients, we have to remember that the level of subjective dyspnea is correlated with QoL(symptom, activity and impact on society) and social supporting level as well as GOLD stage($FEV_1$).

• Journal of Chest Surgery
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• v.40 no.4 s.273
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• pp.247-255
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• 2007

Background: Lung injury that follows bypass has been well described. It is manifested as reduced oxygenation and lung compliance and, most importantly, increased pulmonary vascular resistance reactivity; this is a known cause of morbidity and mortality after repair of congenital heart disease. Injury to the pulmonary vascular endothelium, and its associated alterations of endothelin-1, is considered to be a major factor of bypass-induced lung injury. Removing endothelin-1 after bypass may attenuate this response. This study measured the concentration of serum and peritoneal effluent endothelin-1 after performing bypass to determine if endothelin-1 can be removed via peritoneal dialysis. Material and Method: From March 2005 to March 2006, 18 patients were enrolled in this study Peritoneal catheters were placed at the end of surgery. Serum samples were obtained before and after bypass, and peritoneal effluents were obtained after bypass. Endothelin-1 was measured by enzyme linked immunosorbent assay (ELISA). Result: In the patients with a severe increase of the pulmonary artery pressure or flow, the mean preoperative plasma endothelin-1 concentration was significantly higher than that in the patients who were without an increase of their pulmonary artery pressure or flow (4.2 vs 1.8 pg/mL, respectively, p<0.001). The mean concentration of plasma endothelin-1 increased from a preoperative value of $3.61{\pm}2.17\;to\;5.33{\pm}3.72 pg/ml$ immediately after bypass. After peritoneal dialysis, the mean plasma endothelin-1 concentration started to decrease. Its concentration at 18 hours after bypass was significantly lower than the value obtained immediately after bypass (p=0.036). Conclusion: Our data showed that the plasma endothelin-1 concentration became persistently decreased after starting peritoneal dialysis, and this suggests that peritoneal dialysis can remove the circulating plasma endothelin-1.

• Clinical and Experimental Pediatrics
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• v.53 no.2
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• pp.173-177
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• 2010

Purpose : Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen that causes nosocomial infection in NICU. It contributes to neonatal morbidity and mortality with variable complications. This study was conducted to identify the risk factors associated with complicated MRSA bacteremia in neonates. Methods : We reviewed the medical records of 44 neonates with positive blood culture for MRSA who were admitted to the NICU of Pusan National University Hospital from January 2002 to December 2007. We compared various factors of the complicated and uncomplicated MRSA bacteremia cases. Results : Of the 44 neonates, 31 were male and 13, female. The mean gestational age and birth weight were $33.2{\pm}4.9$ weeks and $1,859.9{\pm}962.2g$, respectively. Twenty-one of infants were treated with a mechanical ventilator during a mean of $8.8{\pm}13.8$ days. There were 13 cases of complicated and 31 cases of uncomplicated MRSA bacteremia. Between the 2 groups, we compared the following variables: gestational age, birth weight, ventilator use, umbilical catheter use and central catheter insertion, $O_2$ inhalation, first oral feeding day after birth, underlying disease, transfusion, and initial vancomycin use. The underlying disease and transfusion were the risk factors related to complicated MRSA bacteremia. Conclusion : Complicated MRSA bacteremia is related to underlying disease and transfusion. Since this was a retrospective study with a small sample size, it offered limited capacity to compare complicated and uncomplicated MRSA bacteremia. A prospective study with a larger population is needed to determine the exact characteristics of MRSA bacteremia in NICU.

• Clinical and Experimental Pediatrics
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• v.51 no.1
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• pp.67-72
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• 2008

Purpose : In this study, we retrospectively analyzed the clinical outcomes of patients who underwent allogeneic hematopoietic stem cell transplantation (HSCT) grafted from HLA-matched parents. Methods : Seven children with acute leukemia (4 acute lymphoblastic leukemia, 3 acute myeloid leukemia) in first complete remission received allogeneic HSCT from their respective parents at the St. Marys Hospital between April, 1999 and October, 2005. The median age of patients at transplantation was 5 years (range, 1-11 years; 2 male, 5 female) and the median age of donors was 35 years (range, 30-41 years; 5 male, 2 female). We investigated the clinical outcomes such as engraftment, acute and chronic graft-versus-host disease (GVHD), transplant-related morbidity and mortality, relapse and survival. Results : Median time from transplantation to last follow-up was 69.5 months (range, 18.8-96.5 months). All patients were successfully engrafted, with a median time of 11 days (range, 10-16 days) and 26 days (range, 13-39 days) for neutrophil and platelet recovery, respectively. Grade II acute GVHD occurred in 3, and grade III acute GVHD in 1 of 7 recipients. Extensive chronic GVHD developed in 2, and limited chronic GVHD in 1 of 7 recipients. Death from transplant-related complications occurred in 1, and relapse occurred in 1 of 7 recipients. Estimated 5-year overall survival was $83{\pm}15%$. Conclusion : The clinical outcomes of recipients who underwent HSCT from HLA-matched parents were comparable to those of patients who received HSCT grafted from HLA-matched sibling donors in childhood leukemia. HLA typing of parents, as well as siblings will increase the likelihood of finding an HLA-matched family donor for patients who need HSCT.

• Korean Journal of Health Education and Promotion
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• v.25 no.5
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• pp.79-92
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• 2008

Purpose: Recommendation for regular Pap test in the past 3 years as a cue to action affects on an increased likelihood of receiving a cervical cancer screening in that period. This study performed to estimate the association with healthcare access, healthcare provider status, and physician recommendation for Pap test in the past 3 years among Korean American women. Method: Korean Health survey was carried out in 2002. These population-based telephone surveys were conducted with Korean American women who resided in Alameda and Santa Clara Counties, California (n=865). We preformed multiple logistic regression analyses to estimate predictors of physician recommendation for Pap test by SAS 8.2. Results: Korean women in two California Counties were 37.9% who received physician recommendation for Pap test in the past 3 years. The predictors on physician recommendation for Pap test in the past 3 years were health insurance coverage, visiting number to doctor in the past year, and healthcare provider status. For healthcare access, no matter who had enrolled in public or private health insurances, the women were more likely to get the recommendation for Pap test from their regular healthcare provider. Particularly, for ethnicity of healthcare provider, the women were more likely to get the recommendation for Pap test from non-Korean female doctors (OR=6.21, 95% CI=2.63, 14.66), Korean male doctors (OR=2.19, 95% CI=1.30, 3.68), and non-Korean male doctors (OR=2.07, 95% CI=1.15, 3.71). Conclusion: (삭제) Effect of healthcare access and healthcare provider status on recommendation for Pap test among Korean American women in two California Counties would contribute to our understanding of developing strategies to promote adherence of Pap test and reduce morbidity and mortality far cervical cancer among Korean American women in the U.S.