• Clinical and Experimental Pediatrics
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• v.58 no.10
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• pp.386-391
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• 2015

Purpose: To evaluate the outcomes and prognostic factors in children with extracranial germ cell tumors (GCTs) treated at a single institution. Methods: Sixty-six children diagnosed with extracranial GCTs between 1996 and 2012 were included in the study. Primary treatment was surgical excision, followed by six cycles of cisplatin-based chemotherapy. The survival rates were compared according to the International Germ Cell Cancer Cooperative Group classification used for GCTs in adults to validate the classification guidelines for GCTs in children. Results: The median patient age was 4.4 years. In 34 patients (51.5%), the primary tumor site was the gonad. Extragonadal GCTs were detected in 32 patients. The 5-year overall survival and event-free survival (EFS) were $92.0%{\pm}3.5%$ and $90.4%{\pm}3.7%$, respectively. In univariate analysis, tumor histology, metastasis, and elevated alpha-fetoprotein were not prognostic factors in children with extracranial GCTs. However, EFS was poorer in patients with mediastinal disease (n=12, $66.7%{\pm}13.6%$) than in those with nonmediastinal disease (n=54, $96.0%{\pm}2.8%$) (P=0.001). The 5-year EFS was lower in patients older than 10 years, (n=21, $80.0%{\pm}8.9%$) compared with those younger than 10 years (n=45, $95.2%{\pm}3.3%$) (P=0.04). Multivariate analysis identified the mediastinal tumor site as the only independent prognostic factor. Conclusion: The prognosis of children with extracranial GCTs was favorable. However, nongerminomatous mediastinal tumors were associated with poor survival in children. Further research is needed to improve the prognosis of children with malignant mediastinal GCTs.

• Journal of Gastric Cancer
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• v.23 no.3
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• pp.499-508
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• 2023

Purpose: Despite scientific evidence regarding laparoscopic gastrectomy (LG) for advanced gastric cancer treatment, its application in patients receiving neoadjuvant chemotherapy remains uncertain. Materials and Methods: We used the 2019 Korean Gastric Cancer Association nationwide survey database to extract data from 489 patients with primary gastric cancer who received neoadjuvant chemotherapy. After propensity score matching analysis, we compared the surgical outcomes of 97 patients who underwent LG and 97 patients who underwent open gastrectomy (OG). We investigated the risk factors for postoperative complications using multivariate analysis. Results: The operative time was significantly shorter in the OG group. Patients in the LG group had significantly less blood loss than those in the OG group. Hospital stay and overall postoperative complications were similar between the two groups. The incidence of Clavien-Dindo grade ≥3 complications in the LG group was comparable with that in the OG group (1.03% vs. 4.12%, P=0.215). No statistically significant difference was observed in the number of harvested lymph nodes between the two groups (38.60 vs. 35.79, P=0.182). Multivariate analysis identified body mass index (odds ratio [OR], 1.824; 95% confidence interval [CI], 1.029-3.234; P=0.040) and extent of resection (OR, 3.154; 95% CI, 1.084-9.174; P=0.035) as independent risk factors for overall postoperative complications. Conclusions: Using a large nationwide multicenter survey database, we demonstrated that LG and OG had comparable short-term outcomes in patients with gastric cancer who received neoadjuvant chemotherapy.

• Advances in pediatric surgery
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• v.20 no.2
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• pp.38-42
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• 2014

Purpose: Gastroschisis and omphalocele are major anterior abdominal wall defects. The purpose of this study was to analyze the clinical differences and mortalities of gastroschisis and omphalocele in Asan Medical Center. Methods: A retrospective review of the medical records was conducted of 103 cases of gastroschisis and omphalocele from September 1989 to February 2013 in Asan Medical Center in Korea. Results: There were 43 cases (41.7%) of gastroschisis and 60 cases (58.3%) of omphalocele. There was a female predominance in both gastroschisis (60.5%) and omphalocele (58.3%). The average gestational age at delivery was $36.7{\pm}0.4$ weeks for both groups. The mean birth weights were $2,381.9{\pm}80.6g$ for gastroschisis and $2,779.4{\pm}82.8g$ for omphalocele (p=0.001). Mean maternal ages in the gastroschisis and omphalocele groups were $27.5{\pm}0.7$ years and $30.5{\pm}0.7$ years, respectively (p=0.002). Associated malformations were documented in 13 infants (30.2%) with gastroschisis and 46 infants (76.7%) with omphalocele (p<0.001). All of gastroschisis patients except one underwent surgery including 31 primary repairs and 11 staged repairs. Fifty-two infants with omphalocele underwent surgery-primary repair in 41 infants and staged repair in 11 infants. Among 103 cases, 19 cases (18.4%) expired. Mortality rates of gastroschisis and omphalocele were 23.3% (10/43 cases) and 15.0% (9/60 cases), respectively (p=0.287). The main causes of death were abdominal compartment syndrome (6/10 cases) in gastroschisis, respiratory failure (4/9 cases) and discharge against medical advice (4/9 cases) in omphalocele. Conclusion: Gastroschisisis was associated with younger maternal age and lower birth weight than omphalocele. Associated malformations were more common in omphalocele. The mortality rates did not make a statistical significance. This might be the improvement of treatment of cardiac anomalies, because no patient died from cardiac dysfunction in our study. Furthermore, abdominal compartment syndrome might be the main cause of death in gastroschisis.

• Parasites, Hosts and Diseases
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• v.55 no.3
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• pp.313-317
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• 2017

Paragonimiasis is a parasitic disease caused by Paragnonimus species. The primary site of infection is the lung, and extrapulmonary involvement is also reported. When infected with Paragonimus westermani, which is the dominant species in Korea, the central nervous system is frequently involved along with the liver, intestine, peritoneal cavity, retroperitoneum, and abdominal wall. Ectopic paragonimiasis raises diagnostic challenge since it is uncommon and may be confused with malignancy or other inflammatory diseases. Here, we report an ectopic paragonimiasis case initially presented with recurrent abdominal pain. The patient developed abdominal pain 3 times for the previous 3 years and the computed tomography (CT) of the abdomen revealed fluid collection with wall enhancement. Recurrent diverticulitis was initially suspected and part of the ascending colon was resected. However, the specimen showed intact colon wall without evidence of diverticulitis and multiple parasite eggs and granulomas were found instead. The size of about $70{\mu}m$, the presence of an operculum and relatively thick egg shell suggested eggs of Paragonimus species. With appropriate exposure history and a positive antibody test, the definitive diagnosis was made as peritoneal paragonimiasis.

• Journal of Yeungnam Medical Science
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• v.34 no.2
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• pp.260-264
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• 2017

Klinefelter's syndrome is the most common congenital abnormality that causes primary hypogonadism. It is associated with diseases that predominantly affect women, such as systemic lupus erythematosus (SLE), and it can sometimes cause veno-occlusive disease. We experienced a case of Budd-Chiari syndrome (BCS) in a 33-year-old man with Klinefelter's syndrome presented with hematemesis and edema in both lower extremities. The clinical and laboratory findings were compatible with SLE, antiphospholipid syndrome, and BCS. To the best of our knowledge, this is the first case report to describe a simultaneous presentation of these four clinical syndromes in a single patient.

• Journal of Chest Surgery
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• v.27 no.12
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• pp.1002-1007
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• 1994

The spontaneous pneumothorax occurs subsequent to a disruption in the continuity of the visceral pleura with escape of free air into the pleural space included primary & secondary pneumothorax that is unrelated to identifiable etiologies such as trauma. In. the 33 year period 1960 to 1993, the 230 cases of open thoracotomy were carried out for definitive treatment of spontaneous pneumothorax, at the Dept. of Thoracic & Cardiovascular Surgery, National Medical Center, Seoul, Korea. There were 193 men & 37 women. They ranged in age from 15 years old to 72 years old. The lesion site was on the right side in 117 and on the left in 97, the 16 cases were in bilateral lesions.Surgical indications included recurrence in 98 cases, persistent air leak in 68 cases, nonexpansion of the lung 37 cases, roentgenologically apparent bullae & blebs in 23 cases, bilateral lesions in 16 cases,combined hemothorax & prevent for recurrence in each 2 cases. The types of operation were bullectomy in 207 cases, wedge resection in 13 cases, decortication & B.P.F. closure in 6 cases,lobectomy in 2 cases, pneumonectomy, plication in each I case. The post operative complication developed in 18 cases[7.8 %], there was I case of death due to sepsis. We believed that open thoracotomy with resection or obliteration of blebs & pleurodes is provided the best protection against recurrence.

• Korean Journal of Radiology
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• v.1 no.1
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• pp.43-50
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• 2000

Objective: To evaluate the usefulness of MR imaging for diseases of the small intestine, emphasizing a comparison with CT. Materials and Methods: Thirty-four patients who underwent both CT and MR imaging using FLASH 2D and HASTE sequences were analyzed. All patients had various small bowel diseases with variable association of peritoneal lesions. We compared the detectabilities of CT and MR imaging using different MR pulse sequences. The capability for analyzing the characteristics of small intestinal disease was also compared. Results: MR imaging was nearly equal to CT for detecting intraluminal or peritoneal masses, lesions in the bowel and mesentery, and small bowel obstruction, but was definitely inferior for detecting omental lesions. The most successful MR imaging sequence was HASTE for demonstrating bowel wall thickening, coronal FLASH 2D for mesenteric lesions, and axial FLASH 2D for omental lesions. MR imaging yielded greater information than CT in six of 12 inflammatory bowel diseases, while it was equal to CT in six of seven neoplasms and inferior in five of seven mesenteric ischemia. In determining the primary causes of 15 intestinal obstructions, MR imaging was correct in 11 (73%) and CT in nine (60%) patients. Conclusion: MR imaging can serve as an alternative diagnostic tool for patients with suspected inflammatory bowel disease, small intestinal neoplasm or obstruction.

• Korea Journal of Hospital Management
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• v.12 no.4
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• pp.1-21
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• 2007

The relaxation of the regulation in selection of medical institution allows patients to use their own judgement in choosing proper institution for their diseases. Since the change of the regulation, there should have been many changes in medical institution selection behavior. The analysis of the change in disease specific selection pattern is critical because there be an optimal selection criteria that ensure the efficient and effective utilization of medical resources. This study analysis the institution selection factors by comparing the choice among the cases of acute diseases, the cases of chronic diseases, inpatient services, outpatient services, and emergency medical service. The comparisons performed in terms of size, class and other characteristics of medical institutions. For the study the nationally surveyed database was used and the data were analyzed using logistic regression procedure. The results indicates that the primary care facilities were not properly utilized. This study speculates that the reason for the undesirable pattern of utilization is that the roles of primary care facilities in the healthcare delivery system was not clearly defined. Based on the results, the medical policy implications are discussed.

• Journal of The Korea Institute of Healthcare Architecture
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• v.30 no.3
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• pp.7-16
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• 2024

Purpose: Medical center has consumed the energy about twice the average value of building types. So, many countries have tried sustainability and energy reduction for building types through eco friendly certificate. This study investigate the eco friendly building certificate and energy performance certificate focusing in UK and Korea, and search the characteristics of status and services of certificates. Methods: BREEAM openbook and EPC open data have been studied in UK, and green building performance certificate and EPC data in korea have been analyzed. Results: UK has eco friendly building certificate focusing on healthcare, and EPC shows the standard, benchmark reference value, so lead to the CO₂ emission reduction. Primary health center and hospital show the higher value due to the dwelling unit. like a patient bed. Korea doesn't have green building certificate yet on healthcare, and EPC shows not the reference data, but the primary energy consumption. Korean cases just like in UK, clinic, public health, and outpatient center show the lower value compared to medical center, nursing home and general hospital. Implications: In Korea, it is needed for energy efficiency to have reference data information like a standard and benchmarking value for new design and construction.

• Journal of Chest Surgery
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• v.41 no.4
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• pp.520-522
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• 2008

Aortoesophageal fistula that causes massive bleeding from the esophagus is a rare and fatal disease. The most common cause of aortoesophageal fistula is an aortic aneurysm, and the other causes are inflammatory disease and neoplasm. The treatment of choice for aortoesophageal fistula is surgery, and this surgery carries a high rate of mortality and morbidity. Stent-graft treatment is now being applied for this malady. Herein we report on a case of primary aortoesophageal fistula that was treated with primary repair of the fistula openings, and we include a review of the relevant literature.