• Journal of The Korean Society of Clinical Toxicology
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• v.14 no.1
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• pp.37-46
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• 2016

Purpose: This study was designed to determine the factors hindering psychiatric intervention for suicide attempters in the emergency room (ER). Methods: Participants were 299 patients aged 18 years or older admitted to the ER for suicidal drug overdose between July 2012 and June 2014. Patients were divided into two groups according to whether they had received psychiatric treatment in the ER. Medical histories and follow-up treatments were determined by examining patients' medical records and through phone surveys, and were then compared using ${\chi}^2$-test and Fisher's exact test. In addition, the rate of satisfaction of the treatment group and the reasons for their dissatisfaction were also determined. Results: The treatment and non-treatment groups comprised 135 (45%) and 164 patients (55%), respectively. Factors influencing participation in psychiatric intervention were previous history of suicide attempts (p=0.004), history of psychiatric disorder (p<0.001), time of day (p=0.039), and day of the week (p=0.040) of arrival in the ER. Whether or not the patient received follow-up psychiatric treatment was not significantly relevant (p=0.300). Of the 82 patients who participated in the treatment satisfaction survey, 50.2% reported being unsatisfied, mainly because of unfriendly medical personnel (36.6%), discomfort regarding other people's perceptions (24.4%), and cursory care (14.6%). Conclusion: To raise the participation rate of psychiatric consult, cooperation with psychiatry at night and on weekends is required, and incorporation of patients without previous history of suicidal attempt or other psychiatric disorder is important. Resolution of complaints toward psychiatric consult in suicide attempt survivors is also required.

• Journal of Physiology & Pathology in Korean Medicine
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• v.20 no.2
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• pp.442-448
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• 2006

To obtain the 50% lethal dose (LD50), approximated lethal dose (ALD) and approximated target organs of 'Mahwangyounpae-tang' for further study like repeat dose toxicity, genotoxicity and reproductive toxicity, single dose toxicity was tested in male ICR mouse according to KFDA Guideline 1999-61 [KFDA, 1999] at a dosage level of 2,000, 1,000, 500, 250 and $125\;mg/kg/10m{\ell}$. In this study, mortalities, clinical signs, body weight changes and body weight gains, gross findings and weight of principal organs were detected during and/or after 14 days of single dosing. After 2 or 3 days of dosing, 1 or 2 animals in 2,000 and 1,000 mg/kg-dosing groups were died. Excitation and leaping response were observed as test article-treatment related clinical signs. These abnormal signs were restricted to 2,000 and 1,000 mg/kg-dosing groups and they were recovered to normal within 4 days after dosing in case of survivors. A significant decrease of body weight were observed in some periods of observation in 2,000 and 1,000 mg/kg-dosing group from 1 days after dosing compared to those of vehicle control group. A significant decrease of body weight gains were observed in observation periods in 2,000 and 1,000 mg/kg-dosing group compared to those of vehicle control group. Hypertrophy of heart and decoloration of kidney were observed as test article-treatment related gross findings. These abnormal findings were restricted to 2,000 and 1,000 mg/kg-dosing groups. A significant increase of absolute and relative heart and kidney weight were demonstrated in 2,000 mg/kg-dosing groups. LD50 in this study was detected as 2,242.42 mg/kg. ALD in this study was detected as 1,000 mg/kg and the target organ was considered as the heart and kidney.

• Pediatric Infection and Vaccine
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• v.15 no.1
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• pp.30-35
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• 2008

Purpose : We evaluated clinical presentations of brain abscesses, including predisposing factors, causative organisms, and mortality rate in neonates and children. Methods : We retrospectively reviewed the medical charts of neonates and children with brain abscesses treated at Severance Hospital from January 1997 through December 2006. Results : Among 27 neonates and children with brain abscesses, overall mortality was 22 % and 38% of survivors developed neurologic sequelae. The mortality rate was 38% in 8 infants with brain abscesses. The most common location of brain abscesses were frontal and parietal lobes, followed by temporal lobe. There were 7 cases with multiple brain abscesses. Streptococci (33%), Staphylococci (27%), and Gram-negative enterics (20%) were commonly isolated. The common predisposing conditions were neurosurgical procedure (30 %), cyanotic congenital heart disease (15%), and sinusitis/otitis (7%). Fever (74%), headache (37%), nausea/vomiting (33%), and altered mental status (33%) occurred commonly. Compared with children older than 1 year of age, infants were associated with multiple brain abscesses (63%, P=0.011) and high rates of death or neurologic sequelae (88%, P= 0.033). Conclusion : We should have a high index of suspicion in order to recognize the condition as early as possible, especially in infancy with brain abscesses who presents vague or nonspecific symptoms and signs.

• Radiation Oncology Journal
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• v.7 no.1
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• pp.29-36
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• 1989

One hundred and ten patients with carcinoma of the nasopharynx were treated by radiation therapy in Department of Therapeutic Radiology, Seoul National University Hospital between 1979 and 1985. Among these, one hundred and five patients were treated with curative intent and 5 patients with palliative aim. Excluding 16 patients who did not receive a full course of radiation therapy, the remaining 89 patients were reviewed for this analysis. Minimum follow-up period of survivors was 36 months. Forty-three percent of the patients had T4 primary lesions and $72\%$ had stage IV disease. The histology was squamous cell carcinoma in $46\%$ of the patients. undifferentiated carcinoma in $49\%$, and lymphoepithelioma in $5\%$. Total radiation dose to the primary site averaged 6,500cCY for T1, T2 lesions and 7500cCY for T3, T4 lesions. Neck node were given boost treatment to a maximum 7,500cCY depending on the extent of disease. Early primary lesion (T1, T2) and neck nodes were successfully controlled in most cases when dose of greater than 6,500cCY was delievered. Forty two patients $(47\%)$ had recurred, 16 of whom $(38\%)$ed at the primary site and $24(57\%)$ developed distant metastases. Of these. 9 patients received re-irradiation with or without chemotherapy and local control was obtained in 2 patients$(22\%)$. Actuarial overall survival and disease-free survival rate was $42\%\;and\;38\%$ at 5 years. T-stage and histologic subtype were not correlated with survival. However, N-stage was related to survival significantly (p=0.043).

• Journal of Chest Surgery
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• v.37 no.2
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• pp.139-145
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• 2004

This study describes our surgical results of transventricular complete repair of tetralogy of Fallot in infants. Material and Method: Eight hundred and forty children underwent complete repair of TOF between January 1990 and April 2002 in our institute. One hundred sixty infants of them were included to this survey. Mean age at repair was 8.1$\pm$2.6 months (3∼12). Correction was accomplished through a short right ventriculotomy less than 30% of ventricular height in all patients. A transannular patch was necessary in 78 patients (49%). Result: There were four early deaths. There were no late deaths. Follow-up with mean duration of 66 months was completed in all survivors, All patients are currently in New York Heart Association functional class I or II. Twenty patients required late reoperations. Actuarial freedom from reoperation at 1 and 10 years were 94% and 87% respectively. Two-dimensional and Doppler echocardiographic follow-up studies showed good right ventricular function in all patients except three. Conclusion: Our results suggested that early complete repair of TOF yield the acceptable results with low mortality and morbidity. Transventricular repair of intracardiac pathology can be safely applied to these patient population, yielding good postoperative right ventricular function.

• Journal of Chest Surgery
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• v.33 no.6
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• pp.476-486
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• 2000

Background: Pulmonary atresia with intact ventricular septum(PA/IVS) is an anatomically heterogenous anomaly with a variety of surgical strategies possible. The purpose of the study is to evaluate the influence of right ventricular size on the early and midterm results of surgical repair of PA/IVS. Material and method: Medical records of 20 consecutive patients with PA/IVS operated on between January 1993 and August 1999 were retrospectively reviewed. There were 12 boys and 8 girls whose ages ranged from 2 days to 14.5 months (median 6 days). Their body weight ranged from 2.52kg to 9.35 kg(median 3.18kg). The preoperative Z-value of the diameter of the tricuspid valve(T-valve) was less than or -4 in 5 patients, between -4 and -2 in 1, between -2 and 0 in 7, between 0 and 2 in 6, and greater than or 2 in 1. All patients who had z-value of tricuspid valve greater than -2.05 were attempted biventricular repair(n=15) and all patients who had it smaller than -4.4 underwent systemic-pulmonary shunt operation only(n=3) or bidirectinal cavopulmonary shunt with right ventricular reconstruction(n=2). Result: Two early deaths(2/20, 10%) occurred. Both were infants who underwent transannular patch with shunt. One of these two had huge right ventricle(Z-value of tricuspid valve = 5). There were 2 late non-cardiac deaths 3 and 7 months after operations respectively. Follow-up was completed in all children at a mean of 35.3 months(range, 5 to 54 months). 10 of 11 survivors who underwent transannular patch or valvotomy with or without shunt procedure were in NYHA functional class I even though some of them had small interatrial communication or patent shunt. All three patients who had shunt procedure only at initial palliation completed Fontan procedures with no death. Two patients who underwent right ventricular outflow reconstruction with bidirectional cavopulmonary shunt were also in good condition. Conclusion: The transanular RVOT patch or valvotomy with or without systemic-pumonary shunt as an initial palliative procedure to achieve biventricular repair for the patients who had neither too small nor too large right ventricle(-2.05$\leq$Z-value of T-value of T-valve$\leq$2) could be performed at low operative risk(1/14 7.1%). Systemic-pulmonary shunt procedure and bidirectional cavopulmonary shunt procedure for the patients who had small right ventricle(Z-value of T-valve$\leq$4.4) could be also performed with low risk. But a patient with huge right atrium and ventricle(Z-value of t-valve=5) had poor operative result.

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

• The Journal of Korean society of community based occupational therapy
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• v.6 no.2
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• pp.21-30
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• 2016

Objective : In October 2016, the most powerful earthquake, magnitude 5.1 and 5.8 struck the city of Gyeongju in Korea. Although it did not take a toll, this implicates potential disaster in the future. Taking this earthquake, this paper considers the healthcare system responding to disaster in non-government organization and other countries, and investigates the roles of occupational therapist in disaster management. Methods : This paper reviews literature related to healthcare system and roles of occupational therapist in disaster response. Results : Humanitarian recovery mission of Red Cross impacted and facilitated the recovery of vulnerable population including children, elderly and people with disabilities in disaster response. It was also emphasized by occurring large population with disabilities after disasters so that the concept of rehabilitation and occupational therapist's role was required. Occupational therapy practitioners play an important role in the stage of disaster preparedness, response and recovery and their target population is children, elderly and people with disabilities. Conclusion : The most of NGO and counties take the concept of rehabilitation into healthcare system responding to disaster. However, the system in Korea stays in emergency level. It is important to take the humanitarian recovery and rehabilitation concept to disaster relief. the survivors would be able to return to their normalcy and health life.

• The Korean Journal of Rehabilitation Nursing
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• v.6 no.1
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• pp.79-89
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• 2003

Purpose: This research with one group pre-post design was carried out to test the practical feasibility to administrate the Music Movement program developed for the stroke patients. Subjects: 12 stroke survivors at "J" Public Health Center in Seoul. were participated in. The average age was 68 years old, the ratio of sex was almost 5.8:4.2, the duration of was almost over 1 year. Method: Music Movement program was conducted for 2 hours ${\times}$ 1day ${\times}$ 6 weeks. The contents of Music Movement program were consisted of the preparatory activities, main activities and the wrap up activities. The preparatory activities are ice braking, greeting, explanation of the aims of music movement program, and introduction of stroke disease and ROM exercise. The main activities are the body motions with singing and playing musical instruments. The wrap up activities are stretching and joints and discussion of home activities. Data Collection: The outcome variables are muscle strength, finger pinch power, ROMs, flexibility, depression, and life satisfaction. Depression was measured by CES-D(Kim, I. J., 1999), life satisfaction by ladder scale(McDowell & Newell, 1996), and ADL state(Holbrook & Skilbeck, 1983). Data Analysis: SPSS/PC 10.0 for Window was used. Wilcoxon Signed Ranks Test was used to analyze outcome measures. The level of statistical significance was set at p<.05. Results: This program was effective to decrease the depression level of subjects(p<.05). The muscle strength, hand grip power, ROMs, life satisfaction, and rehabilitation state of the subjects were slightly increased but no significant differences were found between the pre and post test. Additionally every patient replied that they were very satisfied and expressed their appreciation for this program very much. Of course they strongly want to continue to participate in and meet the peer group again. Conclusion: Considering these results, the practical feasibility of Music Movement program can be supported. Therefore, this Music Movement program can be examined with the quasi-experimental design with control group and ongoing reviews. After that, this program would be applied in public health centers, medical institutes, and welfare centers for the rehabilitation of stroke patients.

• Radiation Oncology Journal
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• v.12 no.1
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• pp.43-50
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• 1994

A retrospective analysis was performed on 55 patients with malignant parotid tumor who were treated with radiation therapy between March, 1979 and July, 1989. Of these patients, 8 patients received radiation therapy(RT) alone and 47 patients were treated with combined operation and radiation therapy(OP + RT). The follow-up period of the survivors ranged from 1 to 129 months with a median of 48 months. The common histologic types were mucoepidermoid carcinoma (25 cases), malignant mixed tumor(12 cases), adenoid cystic carcinoma(6 cases). The 5 and 10 year local control rate were 69.8% and 65.7% in all patients. In OP+RT group, prognostic factors related to local control were histologic grade, tumor size, lymph node metastasis. Resection of facial nerve did not affect the local control rate significantly(p=0.129). Distant metastasis developed in 23.6% of patients, mostly to the lung. Actuarial overall survival rate was 72.2% at 10 years and formed plateau after 5 years. Disease-free (NED) survival rate was 49.4% at 10 years and was better achieved in OP+RT group and low grade lesions. Based on our result, a well planned postoperative RT following parotidectomy is highly efficacious in controlling malignant tumors of the parotid gland and preservation of facial nerve.