• Journal of Chest Surgery
• /
• v.34 no.9
• /
• pp.680-685
• /
• 2001

Background: Tricuspid valve replacement is very rarely performed procedure and its long-term result is not yet satisfactory. Moreover, it is not well known whether bioprosthesis or mechanical prosthesis is the best selection for artificial valve. We reviewed 72 cases of tricuspid valve replacements in 71 patients between January 1989 and December 1998, trying to analyze the overall results and risk factors for mortality and morbidity. Material and Method: Average age of the patients at the time of operation was 42$\pm$13 years(range 16 to 65 years) and the sex ratio of male versus female was 32/39. Primary diagnosis consisted of 50 cases of aquired valvular heart disease and 18 cases of congenital heart disease, such as Ebstein’s anomaly. 4 cases had isolated tricuspid valve regurgitation. Implanted valves were 69 mechanical prosthesis and 3 bioprosthesis. Concomitant mitral or aortic valve replacements were performed in 50 cases. One patient received concomittant pulmonary valve replacement. Result: There were 7(9.72%) operative deaths and 7(13.0%) late deaths. Actuarial survival at 10 years was 59.2$\pm$7.2%. Prosthetic tricuspid valve thrombosis occurred 11 times in 5 patients. Reoperation for prosthetic tricuspid valve failure was performed in 1 patient. In this case, examination of the explanted prostheses showed that the tricuspid stenosis was the result of valve thrombosis. Among the 47 survivors, 46 patients(98%) were in functional class I or II. Conclusion: In our ten-year experience of tricuspid valve replacement, mortality and morbidity were satisfactory. Mechanical prosthesis in tricuspid position showed comparable clinical results as bioprosthesis.

• Asian Pacific Journal of Cancer Prevention
• /
• v.16 no.13
• /
• pp.5385-5388
• /
• 2015

Background: Gastric cancer is the most common gastrointestinal cancer and a leading cause of cancer mortality in Nepal. Survival of gastric cancer patients depends on the stage at which diagnosis is made. The aim of this study was to analyze the presentation and outcomes of gastric cancer patients treated at a tertiary care hospital in Nepal. Materials and Methods: A retrospective analysis of 140 consecutive histologically proven gastric adenocarcinoma cases managed at the Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal for the period of January 2009 to December 2013 was carried out. Results: One hundred forty out of the total 186 patients with histologically proven gastric adenocarcinoma, were admitted for surgery. The mean age was $59.6{\pm}12.4yrs$ (range 29 to 78 yrs) and the male: female ratio was 2:1. Sixty three (45%) patients featured Tibeto-Burman descent though this ethnic group accounts for only 18% of the Nepalese population. Two-thirds or more patients presented with abdominal pain, anorexia, weight loss and/or vomiting. In 86 (61.5%) of the patients the tumor was located in the lower $3^{rd}$ of the stomach and in only 15% of the patients the tumor was located at the upper $3^{rd}$. Early gastric cancer was diagnosed postoperatively in only 4%. In 54%, the disease was locally advanced and metastatic lesions were found in 14% of the patients. Subtotal (73) or total (11) curative gastrectomies (D1, D1+ or D2) were performed in 84 (60%) patients with average lymph node retrieval of $16.6{\pm}8.2$. Palliative gastrectomies or procedures were performed in 23% of the patients and no intervention (open & close/biopsy) was employed in 15% of the patients. Perioperative morbidity was seen in 10% and mortality in 4%. Three, four and five year survival rates up to the recent follow-up were 17.9%, 11.9% and 8.3%, respectively. Conclusions: Gastric cancer in Nepal is usually diagnosed at an advanced stage and has a poor prognosis. Thus, early detection is the key to improve the survival of gastric cancer patients.

• Journal of Preventive Medicine and Public Health
• /
• v.1 no.1
• /
• pp.79-86
• /
• 1968

This paper describes the incidence and some epidemiological features of drowning accident out of a series of our study on the epidemiology of various accidents in Korea. By the daily press it is apparent from the frequent reporting of swimming accidents that the incidence would be high. In the rural areas, there are, at present, about 1,250 artificial lakes and farm ponds to be utlized for rice production. The reservoirs, irrigation ditches and riversides are also used for recreation. In most places facilities for aquatic activities is meager, and safety measures for the prevention of drowning is not sufficiently enforced. In the survey crude data on drownings were collected from the concerned governmental statistic books for the period 1955 to 1967 which were compiled not in a uniform way. Drownings were classfied into two categories, one is accidental drowning, E 929 and the other is due to cataclysm, E 934, according to the WHO international classification of diseases. Epidemiological variables in relation to drowning accident were obtained through qualitative analysis of informations from the popular news papers. The following summary may be drawn; 1. The average number of deaths due to accidental drowning totaled 1,088 annually and the mortality rate per 100,000 population was 3.4, The 42.0% of all drownings were rescued and the remaining were not saved. 2. The sex ratio (M/F) of the victims for all ages was 5 to 1, which had a wide range of difference among the age groups. The young ages less than 20 years occupied 68.0% of all deaths. 3. The percentage distribution of the causes of accidents revealed 31.9% for careless swimming, 45.5% for unskilled, 10.6% for swimmer's cramp and 6.0% for drunked. The distribution of places where accidents occurred showed 88.0% for rivers, water reservoirs, irrigation ditches and 12.0% for regular swimming pools. The seasonal distribution of cases indicated 85.0% of the total were seen during the summer months, June-August, and 50.0% of them occurred on Sundays, 4. The average annual deaths due to cataclysm were 402 and mortality rate per 100,000 population was 1.6, but the number of victims due to cataclysm varied greatly each year. 5. The accident cases due to cataclysm were classified into 60.0% for injuries, 40.0% for deaths. The 26.8% of all deaths were missing cases. 6. The deaths due to either accidental drowning or cataclysm totaled 1,490, and the death rate per 100,000 for the whole country was 5.0.

• Journal of Chest Surgery
• /
• v.35 no.2
• /
• pp.113-117
• /
• 2002

With an increasing awareness of the limitations of both mechanical prostheses and bioprostheses, aortic valvuloplasty has gained attention as an alternative procedure for aortic valve disease. Material and Method: Eight consecutive patients underwent aortic valvuloplasty caused by leaflet prolapse between June 1799 to June 2000. Mean age of the patients was 18.4$\pm$12.6 year. Four paitents(50%) were male. Six patients had tricuspid valves and ventricular septal defect and two patients had bicuspid valves. The extent of aortic insufficiency was 3.5$\pm$0.5 by preoperative Doppler echocardiography. The technique involved triangular resection of the free edge of the prolapsed leaflet, annular plication at the commissure, and resection of a raphe when present in bicuspid valves. Result: There was no in-hospital mortality or morbidity. Mean follow-up was complete at 11.973.6months. There was no late mortality or morbidity. The amount of the severity of aortic insufficiency, as assessed by echocardiography preoperatively, postoperatively and at late follow-up was 3.5$\pm$0.5, 0.6$\pm$0.5 and 0.8$\pm$0.6, respectively(p value : 0.01). There was one patient with grade 2/4 aortic insufficiency and in the other patients, grade 1/2 or trivial aortic insufficiency were detected with late echocardiograms. Conclusion: Triangular resection in the patients with aortic leaflet prolapse offers a good early clinical result, but long-term follow-up is necessary.

• Journal of Cerebrovascular and Endovascular Neurosurgery
• /
• v.26 no.2
• /
• pp.152-162
• /
• 2024

Objective: Stroke is the second-leading cause of death globally. Intracranial atherosclerotic stenosis (ICAS) represents 10-15% of ischemic strokes in Western countries and up to 47% in Asian countries. Patients with ICAS have an especially high risk of stroke recurrence. The aim of this meta-analysis is to reassess recurrent stroke, transient ischemic attack (TIA), and other outcomes with stenting versus best medical management for symptomatic ICAS. Methods: The search protocol was developed a priori according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The OVID Medline, Embase, Web of Science, and Cochrane Library databases were searched from inception to August 14th, 2022. Results: This meta-analysis included four randomized controlled trials (RCTs), with a total number of 991 patients. The mean age of participants was 57 years. The total number of intracranial stenting patients was 495, and the number of medical treatment patients was 496. The included studies were published between 2011 and 2022. Two studies were conducted in the USA, and the other two in China. All included studies compared intracranial stenting to medical treatment for ICAS. Conclusions: In patients with ischemic stroke due to symptomatic severe intracranial atherosclerosis, the rate of 30-day ischemic stroke, 30-day intracerebral hemorrhage, one-year stroke in territory or mortality favored the medical treatment alone without intracranial stenting. The risk of same-territory stroke at last follow-up, disabling stroke at last follow-up, and mortality did not significantly favor either group. Intracranial stenting for atherosclerosis did not result in significant benefit over medical treatment.

• Clinical and Experimental Reproductive Medicine
• /
• v.33 no.1
• /
• pp.69-69
• /
• 2006

Heterotopic pregnancy is the coexistency of intrauterine and extrauterine pregnancy. The incidence of heterotopic pregnancy is about 1 to 30,000 pregnancy in a natural cycle. However, the frequency of heterotopic pregnancy has steadily increased because of rising incidence of pelvic inflammatory disease, pelvic surgery and the development of ovulation induction and assisted reproduction. Because heterotopic pregnancy is difficult due to diagnose and it has high morbidity and mortality rate, one should always take this into consideration and should conduct careful and thorough gynecologic evaluation. We have experienced a case of heterotopic pregnancy in a 29-year old woman who presented with acute abdominal pain in a natural cycle and report this case with a brief review of literature.

• Korea Journal of Hospital Management
• /
• v.24 no.4
• /
• pp.1-12
• /
• 2019

Purposes: The purpose of this study, was to identify similar factors between reasons for unscreening and unmet health care needs through prior research, and based on this, we wanted to figure out the relevance between the medical screening and unmet health care needs. Methodology: The analysis was conducted using data from 9,640 adults aged 19 or older who don't have a missing value from 16,277 participants in the 7th, 1st&2nd Year (2016&2017) of the National Health and Nutrition Examination Survey (KNHANES). Unmet health care needs were investigated as a self-reported questionnaire of whether medical service was required but not received. And the analysis was performed through the Chi-Square Test and Multi-logistic Regression analysis. Findings: As a result of the analysis, unmet healthcare needs were higher who received only one type of screening comparative to who screened both. and were highest who screened neither. Practical Implications: Unmet health care needs are the center of a vicious cycle, such as morbidity and mortality, which is detrimental to the quality of life, and continues to increase. Therefore, it is necessary to find ways of realizing health care that guarantees the health rights of all citizens by policy guarantee and support for the subjects to recognize the importance of thorough education of screenings rather than only health screening or cancer screening.

• Asian Pacific Journal of Cancer Prevention
• /
• v.15 no.10
• /
• pp.4289-4294
• /
• 2014

Background: One of the most important reasons for the high mortality rates of cancer is the low level of awareness, which can lead to a late diagnosis and treatments starting too late. Therefore, it is necessary for individuals, especially at younger age, to gain awareness and integrate taking the necessary precautions into their lifestyle in order to prevent cancer and ensure early diagnosis. The aim of this study was to assess the levels of awareness of factors for major cancers among students studying in two different campuses of a university in the Western Black Sea Region. Materials and Methods: This descriptive/cross-sectional study was performed between January-March 2014. Students studying in the 2013-2014 academic year in a university in the Western Black Sea Region in two separate campuses were the subjects. Results: The mean age was $21.01{\pm}3.63$. While female students (51.2%) were the majority in the health sciences campus (74.8%), male students (48.8%) were the majority in the social sciences campus (76.5%). Some 9.6% of the students from the health sciences campus and 12.4% of the students from the social sciences campus thought that cancer was communicable, while most of the students from both campuses knew that smoking caused cancer. It can also be seen that the rate of answering questions regarding cancer correctly was higher among students studying in the health sciences campus. Conclusions: It was determined that students who do not study at the health sciences campus have insufficient information on cancer, cancer symptoms, and the possibility of breast cancer in males and approximately half of them regarded obesity as a risk factor for cancer.

• Tuberculosis and Respiratory Diseases
• /
• v.66 no.5
• /
• pp.370-373
• /
• 2009

Crohn's disease, a major form of inflammatory bowel disease (IBD), is a chronic inflammatory condition that is characterized by microvascular and macrovascular involvement. Some extraintestinal complications can occur due to chronic systemic inflammation in IBD. Among them, a pulmonary thromboembolism is a rare manifestation of IBD but is associated with a high morbidity and mortality. To our best of knowledge, there is only one case report of a pulmonary thromboembolism as a complication of Crohn's disease in Korea. We present another rare case of pulmonary thromboembolism as complication in a 25-year-old man with underlying Crohn's disease.

• Archives of Plastic Surgery
• /
• v.38 no.1
• /
• pp.93-95
• /
• 2011

Purpose: Mucormycosis generally occurs in patients with uncontrolled diabetes mellitus and immunocompromised conditions. It is rare, but once a patient is infected with it, it can occur as a rapidly extending, aggressive, and life-threatening rhinocerebral infection with a high mortality rate. Methods: A 70-year-old female patient had a 40 years of history of adult onset diabetes mellitus. She presented herself with severe right hemifacial pain, swelling, and weakness for 3 days and was admitted to ENT. On a facial computed tomography (CT) scan, it was found that her infection extended from her inferior temporal scalp to her submental area and involved her submandibular, masseter, prevertebral, parapharyngeal, retropharyngeal, and pharyngeal mucosal space and pansinusitis. Through endoscopic sinus surgery, mucormycosis was confirmed via histologic examination. Results: Despite empiric antibiotics and amphotericin B administration, the patient was in a septic condition and in a coma. The patient's family wanted to withdraw her life support, and the patient expired. Conclusion: Mucormycosis is very rare, but is one of the disastrous complications of uncontrolled diabetes mellitus. Suspicion of its occurrence, based on identified risk factors, and its rapid diagnosis can enhance the chance of its cure.