• Archives of Plastic Surgery
• /
• v.42 no.5
• /
• pp.601-607
• /
• 2015

Background Autologous or implant-based breast reconstruction after nipple-sparing mastectomy is increasingly preferred worldwide as a breast cancer treatment option. However, postoperative nipple-areola complex (NAC) necrosis is the most significant complication of nipple-sparing mastectomy. The purpose of our study was to identify the risk factors for NAC necrosis, and to describe the use of our skin-banking technique as a solution. Methods We reviewed cases of immediate autologous breast reconstruction after nipple-sparing mastectomy at our institution between June 2005 and January 2014. The patients' data were reviewed and the risk of NAC necrosis was analyzed based on correlations between patient variables and NAC necrosis. Moreover, data pertaining to five high-risk patients who underwent the donor skin-banking procedure were included in the analysis. Results Eighty-five patients underwent immediate autologous breast reconstruction after nipple-sparing mastectomy during the study period. Partial or total NAC necrosis occurred in 36 patients (43.4%). Univariate analysis and binary regression modeling found that body mass index, smoking history, radiation therapy, and mastectomy volume were significantly associated with NAC necrosis. Of the 36 cases of NAC necrosis, 31 were resolved with dressing changes, debridement, or skin grafting. The other five high-risk patients underwent our prophylactic skin-banking technique during breast reconstruction surgery. Conclusions NAC necrosis is common in patients with multiple risk factors. The use of the skin-banking technique in immediate autologous breast reconstruction is an attractive option for high-risk patients. Banked skin can be used in such cases without requiring additional donor tissue, with good results in terms of aesthetic and reconstructive outcomes.

• Journal of Korean Academy of Nursing
• /
• v.33 no.1
• /
• pp.122-129
• /
• 2003

Purpose: The purpose of this study is to examine the difference of direct nursing activity and patient outcomes as mortality rate, complication rate, readmission rate and length of stay related to graded fee of nursing management for inpatient. Method: The subjects of this study were 44 general hospitals with more than 500 beds. Data totaled to 86,044 claims provided to inpatients in Jan. 2001 requested by an electronic data interchange from a Health Insurance Review Agency. The data was analyzed by SPSS win(ver.10.0) and statistical methods used were frequency, one-way ANOVA, $X^2$-Test and regression. Result: Synthetic judgment through performance index and 95% confidence interval, direct nursing activity showed to provided adequate quality of nursing care on 2nd, 3rd, 4th and 6th nursing degree. Also, patient outcomes showed difference by graded fee of nursing management for inpatient. Mortality rate of 2nd was the lowest with P.I. 67.9, 3rd, 5th, 6th, 4th in order. In case of complication rate, 2nd, 3rd and 4th were lower than other nursing degree. Readmission rate of 4th and 5th was the lowest. Length of stay of 2nd was the shortest with P.I. 88.3, 3rd, 4th, 5th, 4th, 6th in order. Conclusion: The findings from this study showed that, the higher nurse-to-patient ratio, the greater amount of direct nursing care activity for the patient. Also, the more direct nursing activities influenced a lower mortality rate, complication rate and readmission rate, shorter length of stay.

• Journal of the East Asian Society of Dietary Life
• /
• v.15 no.6
• /
• pp.717-727
• /
• 2005

The purpose of this study was to measure the effects of counseling for hypertension patients. the subjects were 44 hypertension patients who visited the general, hospital, located in Daegu, to receive medical treatments. Among 44 hypertension patient, 22 patients received the nutrition counseling three times for 8 weeks and the rest of the patients didn't as a non-counseling group(control group). The lifestyle, food habit, nutrient intakes, anthropometric measurements, and body fat and blood pressure as a main index were analysed before and after the nutrition counseling. The result after the nutrition counseling are as follows: 1) Body mass index(BMI), systolic blood pressure(SBP) and diastolic blood pressure(DBP) were significantly decreased in women(p<0.05). 2) The food habit score and nutrition knowledge score were dramatically increased(p<0.001). 3) The calcium intake was significantly increased in women(p<0.01). And energy, carbohydrate and fat intakes were decreased both men and women but there were no significant differences. The calcium intake as an Index of nutrition quality(INQ) and nutrient adequacy ratio(NAR) were significantly increased 5) Fat and cholesterol intakes in a group whose blood pressure reduced were significantly decreased compared with a group that had the same or higher blood pressure. These results showed that a well-planned nutrition counseling program would reduce the risk of cardiovascular disease.

• Journal of Gastric Cancer
• /
• v.4 no.3
• /
• pp.164-168
• /
• 2004

Purpose: The most feared complication of gastrointestinal tract operations is anastomotic leakage, not only because of the presumed individual surgeon's culpability but also because of the assumption that this event is often fatal. We have experienced 32 cases of anastomotic leakage after elective gastric resection during 8 years. The purpose of this study was to evaluate the result of their treatment. Materials and Methods: We evaluated the records of 1335 patients who had undergone elective gastric resection for an adenocarcinoma of stomach from January 1995 to October 2003 and conducted a retrospective, multivariate analysis. Results: Of the 1335 patients, 32 ($2.4\%$) sustained an anastomotic leakage. Anastomotic leakages usually developed on mean postoperative day $9.1\pm3.2$ (range:$1\∼18$ days).Overall, $31.3\%$ (10/32) of patients who sustained an anastomotic leakage died. The anastomotic leakages were identifed by radiological study or by operative finding at the site of the duodenal stump (20 patients), the esophagojejunostomy (7), the gastroduodenostomy (4), and the gastrojejunostomy (1). Fourteen patients ($43.8\%$) underwent a relaparotomy, a drainage procedure in the main, and 18 patients ($56.3\%$) were treated conservatively. The mortality rates were $42.9\%$ (6/14) and $22.2\%$ (4/18), respectively, but this difference was not statistically significant. A cox's proportional hazard analysis showed that a body-mass Index < 24 kg/m2 (odds ratio 5.55, $95\%$ CI: $0.69\∼44.82$) and non-enteral feeding (odds ratio 18.27, $95\%$ CI 2.22.150.69) were independent factors of mortality due to anastomotic leakage. Conclusion: Our observations show that anastomotic leakage after an elective gastric resection has a high risk of being fatal. Moreover, for a patient with a body-mass index lower than $24\;kg/m^{2}$ and/or non-enteral feeding, an anastomotic leakage after an elective gastric resection has a higher risk of being fatal.

• Journal of The Korean Society of Integrative Medicine
• /
• v.4 no.3
• /
• pp.39-47
• /
• 2016

PURPOSE : This study attempts to find the effects of water perturbation exercise performed on stroke patients in their physiological cost index and gait ability tests. METHOD : The subjects were 30 stroke patients, water perturbation exercise group was performed 3 day per week, for 40 minutes a day, for a period of eight weeks. The physiological cost index and gait of all subjects were assessed by using the polar, 6 Minute Walk Test (6MWT), and 10 meter Walk Test(10mWT) at pre training and post training. Paired t-test was used to analyze change before and after intervention in group. Pearson's correlation was used to analyze correlation of all variables. RESULT : Water perturbation exercise group showed increased physiological cost index. Water perturbation exercise increased gait ability, showing a significant difference. Showing the correlation between the relatively high amount between physiological cost index and 6 minutes walking test. CONCLUSION : From the result of the study, we found that water perturbation exercise was effective in improving physiological cost index and gait ability. The patient is considered to be used by itself to involve the treatment and the risk of falling from the lowered state into the treatment method for the intensive treatment of stroke patients to be useful in improving the cardiovascular system and ability to walk. Through underwater training for stroke patients in the future on the basis of this study it is considered to require additional clinical studies on the impact on daily living and quality of life of stroke patients.

• Tuberculosis and Respiratory Diseases
• /
• v.82 no.3
• /
• pp.217-226
• /
• 2019

Background: Depression is a recognized complication of lung cancer underreported in developing countries such as Malaysia. Treating and identifying depression in cancer patients increases survival and quality of life. Our objectives are to study prevalence of depressive symptoms in newly diagnosed lung carcinoma, and examine the relationship of depressive symptoms with other influencing risk factors. Methods: A 2-year, cross sectional study February 2015-February 2017, was conducted at Hospital Tengku Ampuan Afzan, and Penang General Hospital. One hundred and three patients with newly diagnosed, biopsy confirmed primary lung carcinoma were recruited. Self-rated patient's identification sheet, validated Center for Epidemiologic Studies Depression (CES-D), and Dukes University Religion Index score from three different main languages were used. Results: Prevalence of current depressive symptoms (CES-D total score ${\geq}16$) is 37.9%. The result suggests prevalence of those at high risk of moderate to major depression, may need treatment. Multivariate analysis reveals those with good Eastern Cooperation Oncology Group factor (${\eta}2=0.24$, p<0.001) married (${\eta}2=0.14$, p<0.001) with intrinsic religiosity (IR) (${\eta}2=0.07$, p<0.02) are more resistant to depression. Conclusion: One in three of lung carcinoma patients, are at increased risk for depression. Clinicians should be aware that risk is highest in those with poor performance status, single, and with poor IR. We suggest routine screening of depression symptoms as it is feasible, to be performed during a regular clinic visit with immediate referral to psychiatrist when indicated.

• International Journal of Clinical Preventive Dentistry
• /
• v.14 no.4
• /
• pp.264-270
• /
• 2018

Objective: This study performed a quantitative analysis using the real-time polymerase chain reaction technique to examine the oral microbial prevalence in adults and intended to examine the correlations between risk factors of periodontal disease and oral bacteria and correlation between oral test scores and oral microorganisms. Methods: We examined papillary marginal attached (PMA) index, modified patient hygiene performance (M-PHP) index, probing depth (PD), modified gingival index, and oral bacteria counts and surveyed 117, 20 years or older adult males and females who visited dental clinics in the Daejeon region to analyze the prevalence and oral health. Results: The prevalence was 100% for Fusobacterium nucleatum, meaning it was observed in all examined subject, 85.5% for Parvimonas micra, 76.1% for Prevotella intermedia, and 72.6% for Tannerella forsythia. The averages of P. gingivalis and T. forsythia increased as the examined subjects were older, and there was a statistically significant difference between T. forsythia and E. nodatum in relation to medical history, between P. intermedia and P. micra in relation to gender, and between P. intermedia and E. corrodens in relation to smoking (p<0.05). For a correlation between the oral test scores and oral microorganisms, P. gingivalis and F. nucleatum was highly correlated with PD (correlation coefficient of 0.51 and 0.41) (p<0.01) while P. gingivalis, P. micra, C. rectus, and E. nodatum were significantly correlated with M-PHP index, gingival index, PD, and PMA index (p<0.01, p<0.05). Conclusion: For oral health management of adults, the age, systemic disease, and smoking are closely related to oral bacteria, and P. gingivalis, T. forsythia, F. nucleatum, P. intermedia, P. micra, C. rectus, E. corrodens, and E. nodatum are considered to be the oral microorganisms that indicate periodontal health.

• Journal of Preventive Medicine and Public Health
• /
• v.28 no.3 s.51
• /
• pp.609-622
• /
• 1995

Until now there are few available epidemiologic data of osteoporosis in Korea, and the severity of osteoporosis-related health problem has not been widely recognized yet. But the numbers of the old people are increasing in Korea, and in 2000, the proportion of people over 65 will be up to about 6.8% of total population. Therefore, osteoporosis, one of the most common metabolic bone disease among the old people, will be one of the most important public health problem. On this background this study was performed to find out risk factors of the development of osteoporosis in Korean women through case-control approach. The subject of this study were selected among the women who visited menopause clinic in one general hospital in Seoul and were checked bone density from Sep. 1988 to Sep. 1993. Those who were diagnosed to have hypertension, diabetes mellitus, thyroid disease, breast disease, or liver disease, which are thought to influnce bone density, were excluded. Also excluded those who are age-unknown. Finally the subjects were 2,139 women aged between 18 and 79. We operatively defined patient group as those whose bone density is below $1.039/cm^2$, 90% of average bone density of women of 4th decade who visited the same hospital. And we defined control group as whose bone dendity is above $1.15g/cm^2$. We randomly selected 201 women from the patient group and 202 from the control. As independent variables we chose age, menarche age, menopause age, menopause type, the number of siblings, the number of pregnancies, body mass index, taking oral pill or not, feeding type, and educational state. Multiple logistic regression analysis was done to see the influence of these variables on the risk of osteoporosis. Results are as follows; 1. menopausal status was statistically significant risk factor to all women irrespective of her age, while obesity and later menopause age were found to be statistically significant protective factors. 2. The more siblings and pregnancies, the greater tile risk of osteoporosis, but these factors were not statistically significant. This result is not consistent with other studies. Further studies are strongly needed.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.16 no.4
• /
• pp.273-281
• /
• 2016

Background: Postoperative nausea and vomiting (PONV) is one of the most common postoperative complications. Despite this, few papers have reported the incidence and independent risk factors associated with PONV in the context of oral and maxillofacial surgery (OMFS). Therefore, we sought to determine the incidence of PONV, as well as to identify risk factors for the condition in patients who had undergone OMFS under general anesthesia. Methods: A total of 372 patients' charts were reviewed, and the following potential risk factors for PONV were analyzed: age, sex, body mass index, smoking status, history of PONV and/or motion sickness, duration of anesthesia, amount of blood loss, nasogastric tube insertion and retention and postoperative opioid used. Univariate analysis was performed, and variables with a P-value less than 0.1 were entered into a multiple logistic regression analysis, wherein P-values < 0.05 were considered significant. Results: The overall incidence of PONV was 25.26%. In the multiple logistic regression analysis, the following variables were independent predictors of PONV: age < 30 years, history of PONV and/or motion sickness, and anesthesia duration > 4 h. Furthermore, the number of risk factors was proportional to the incidence of PONV. Conclusions: The incidence of PONV in patients who have undergone OMFS varies from center to center depending on patient characteristics, as well as on anesthetic and surgical practice. Identifying the independent risk factors for PONV will allow physicians to optimize prophylactic, antiemetic regimens.

• Korean Journal of Adult Nursing
• /
• v.19 no.2
• /
• pp.283-294
• /
• 2007

Purpose: The purpose of this study was to identify predictors of cardiovascular risk factors of type 2 diabetic patients. Methods: Diabetic patients (N=160) were interviewed from November, 2003 to June, 2004. The 24 hour dietary recall, the International Physical Activity Questionnaire, the Diabetes Management Self-Efficacy Scale for patient with Type 2 diabetes, the Revised Summary of Diabetes Self-Care Activities Measure Scale and Parma Cardiovascular Risk Index were used to measure the predictors. Data were analyzed by descriptive analyses, Pearson correlation coefficients, and stepwise multiple regression using the SPSS WIN 10.0. Results: Mean dietary intakes of the participants were protein(P) of 64.5g, carbohydrate(C) of 280.74g, fat(F) of 30g, and calcium of 511.45mg. The ratio of CPF was 75:17:8. About 45% of the participants didn't exercise on a regular basis. The levels of self-efficacy, self-care, and cardiovascular risk factors of the participants were moderate. Self-efficacy was the most important predictor of cardiovascular risk factors along with self-care, exercising for more than 6 months, carbohydrate intakes and levels of physical activities. Conclusion: The findings of the study suggest that intervention programs increasing self-efficacy on diabetic management would be more beneficial than the fractional approach focusing only on diet or physical activities.