Background: Occlusive complications after arterial revascularization are difficult to treat and have high recurrence rate. This study was performed to establish an effective treatment modality and to evaluate the factors affecting the occlusive complications by analysis of clinical data. Material and Method: During the period of 5 years. 33 patients (55 reoperations) were studied at the Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital following 173 arterial revascularization surgeries. The clinical characteristics, operating methods, the time intervals of reoperation, used graft, and the results of treatment were evaluated retrospectively. Result: All the patients were men except one and the mean age was 63.5 years old. The mean time internal from first operation to reoperation was 11.9 months. The cause of arterial occlusive diseases were 28 atherosclerosis and 5 Burger's diseases, Associated diseases were Hypertension $(57.6\%)$, Diabetes mellitus $(33.3\%)$, heart failure $(18.2\%)$, and so on. The mean rate of reoperation was 1.67 times and the most common type of first operation was femoro-popliteal bypass grafting $(57.6\%)$. The graft that used revascularization surgery were 25 cases of PTFE and 6 case were Dacron. There was no statistical difference between two groups. The kinds of reoperations were thrombectomy in 20 cases, angioplasty 18 cases, re-bypass surgery in 13 cases, and lumbar sympathectomy in 4 cases. The results of reoperation were 15 cases of functional recovery, 7 cases of limb salvage, 5 cases of above-knee amputation. 3 cases of below-knee amputation and 3 deaths. Conclusion: The main cause of occlusive complications are occlusion of inflow or outflow artery. Treatments were different according to the first operation methods and graft used. The most frequent time of reoperation was within one year after the first operation. We believe that graft surveillance especially during the first year is very important factor in observing the patient. We can look forward to improving limb salvage rate to perform additional treatment such as radiological interventions and lumbar sympathectomy.
Song Suk-Won;Lee Hyun-Sung;Kim Moon Soo;Lee Jong Mog;Zo Zae Ill
Journal of Chest Surgery
/
v.38
no.6
s.251
/
pp.428-433
/
2005
Advanced age in Esophagectomy increases the risk of postoperative morbidity and mortality. However, the recent development of operative technique and perioperative care might have decreased the postoperative morbidity and mortality after esophagectomy. Material and Method: From March 2001 to July 2004, 174 patients underwent esophageal resection for esophageal cancer in the Center for Lung Cancer, National Cancer Center. The patients were divided into two groups : group 1 consisted of 27 patients aged 70 years or more, and group 2 consisted of 147 patients under 70 years of age. The two groups were compared according to preoperative risk factors, postoperative morbidity, operative mortality and survival. Result: The mean age was 63_4. There were 159 men. On histopathological examination, $93.1\%$ had squamous cell carcinoma. On the locations, $78.7\%$ were in mid and lower esophagus. Curative resections for esophageal cancer were possible in $162(93.1\%)$ patients. Mean hospital stay was 19.4 days with out difference between the groups. The overall postoperative morbidity were occurred in 61 patients $(35.1\%)$. The most frequent morbidity was pulmonary complication in $30(17.2\%)$. Preoperative incidence of hypertension, cardiac and pulmonary dysfunction were more common in Group I. However, there was no difference in overall postoperative morbidity, operative mortality and survival rate between the two groups. Conclusion: Esophagectomy for esophageal cancer could be carried out safely in patients over 70 years of age with satisfactory short-term results. Advanced age is no longer a risk factor for esophagectomy.
Purpose : Renal abscess is very rare in children and its diagnosis is difficult because symptoms are often nonspecific. In previous studies, on]y 15% to 25% of patients were reported to be diagnosed at the time of admission. Early diagnosis and treatment are important be cause mortality rate correlates positively with the time of diagnosis. The purpose of this study is to clarify the clinical features of children with renal abscess and to investigate the possible indicators of this disease for early diagnosis and Proper treatment. Methods : Twelve children diagnosed with renal abscess from Jan. 1996 to Jul. 2004 were included. The age of patients ranged from S months to 15 years. We retrospectively analyzed the demographics of patients, their symptoms, predisposing factors, diagnostic methods and causative organisms and the treatment modalities. Results : Fever was the most common manifestation, Five children(42%) had vesicoureteral reflux. Renal ultrasonography and computerized tornography were the most frequently used imaging tools to detect renal abscess. Gram negative bacteria were isolated in 7 patients and Staphylococcus aureus grew in 2 patients. All patients received intravenous antibiotics and 4 patients underwent aspiration or drainage of renal abscess. The average admission duration was 30 days. Conclusion : Renal abscess should be included in the differential diagnosis of prolonged fever in children, especially when flank pain is combined. For early diagnosis and a better prognosis, patients should be promptly investigated with ultrasonography or computerized tomography.
Han Byong-Mu;Cho Jin-Youl;Chuon Ko-Woon;NamGoong Mee-Kyung
Childhood Kidney Diseases
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v.7
no.2
/
pp.150-156
/
2003
Purpose : Efforts to predict the clinicopathological outcome of IgA nephropathy have been made but have yielded conflicting results and have not helped in deciding the appropriate timing of the renal biopsy. In this study, we reviewed the predictive factors of clinicopathological outcome for finding out the criteria of renal biopsy timing of IgA nephropathy. Methods : Forty children diagnosed with biopsy proven IgA nephropathy at Wonju Christian Hospital were studied retrospectively, based on medical records. Results : Among 39 patients, 2 children progressed to higher serum creatinine level. One of them reached to the end stage renal disease within 2 year 7 months. According to WHO histopathological classification, there were 15 cases of class I, 14 cases of class II, 7 cases of class III, and 3 cases of class IV. In the mild histological classes(class I, II), gross hematuria was shown in 23 out of 29 children(P=0.02). In the severe histological classes(class III, IV), gross hematuria was noted in 4 out of 10(P>0.05). The tubulointerstitial changes were grade 1 in 24 cases, grade 2 in 4 cases, grade 3 in 8 cases, and grade 4 in 3 cases. With an increase in the tubulointerstitial grade, the 24 hour urine protein/albumin ratio increased. Serum creatinine less than 0.79 mg/dL could predict the lower grade(grade 1 and 2) of tubulointerstitial changes. But serum creatinine greater than 1.13 mg/dL could predict the higher grade(grade 3 and 4) of tubulointerstitial changes. In children with gross hematuria(n=27), serum creatinine was lower(0.78 vs 1.09 mg/dL, P=0.027), serum IgA was higher(316.3 vs 198.8 mg/dL), and the cases of lower WHO classification(I and II) were more common(23 vs 4, P=0.029) than the children with microscopic hematuria. Conclusion : Serum creatinine less than 0.79 mg/dL, macroscopic hematuria, and higher 24 hour urine protein/albumin ratio would predict the lower grade glomerulo tubulointerstitial lesion in IgA nephropathy and could be used as the criteria delaying the renal biopsy.
A total of 27 strains of Vibrio parahaemolyticus (18 strains isolated from Korea and 9 strains from Japan) were serotyped and examined for biochemical characteristics, antimicrobial susceptibility patterns, cytotoxicity assay, thermostable direct hemolysin (TDH) production and molecular epidemiology. Using polymerase chain reaction (PCR) method and DNA probe hybridization method, the strains were tested for toxR, tdh, trh and ORF 8 genes. The V. parahaemolyticus isolated from patients were belonged to 8 different serotypes : O3:K6, O1:K38, O3:K57, O4:K9, O4:Kl2, O4:K68, O5:Kl5 and O6:K46. Urease-positive strain possessed the trh gene, and conversely, urease-negative strains lacked the gene, indicating that urease production by V. parahemolyticus strains strongly correlates with the possession of the trh gene. Most strains showed multiple resistant to more than three antibiotics and the antibiogram could be classified into 6 group (I to VI). All of the O3:K6 strains isolated in South Korea and Japan producted TDH at high levels. The TDH titers ranged between 256 and 2.048, and the average titer was 1009. To distinguish the new and increasingly common V. parahaemolyticus strains from clinical isolates, ORF 8 is a useful genetic marker. After Southern hybridization, the HindIII restriction fragment patterns of the tdh gene were grouped one type, respectively. One type showed two bands one of which was 4.3kb and the other was 11.5kb in size. Variation between the O3:K6 serotype are minor when compared to the differences seen with the non O3:K6 strains. The migration patterns of Not I -digested of the total DNA of the O3:K6 strains were similar, and only slight variations were observed between the serotypes. By contrast, the O3:K6 strains and non O3:K6 had markedly different profiles. In conclusion, Random amplified polymorphic DNA (RAPD) profile using appropriate primers was an effective epidemiological marker.
Weekly changes of water environments and phytoplankton community with the salinity gradients were investigated at Gyoungpo Lake from April to November in 1998 and 2012. Underwater crossam in Gyoungpo Lake was removed in 2004. Thereafter, average salinity of Gyoungpo lake increased from 7.5 ppt in 1998 to 20 ppt in 2012. A total of 99 and 80 species of phytoplankton was observed from the sampled in 1998 and 2012, respectively. The number of common species during the 2 separate years was 40. Transparency, SS, $NO_3-N$ concentration and N/P ratio in 2012 were lower than those in 1998. During the period of water shortage (April, May) of 2012 transparency decreased due to decreased salinity and increased SS and Chl. a. Correlation coefficients between species and community scores of DCA ordination based on data matrix of the phytoplankton revealed larger variation among sampling seasons in 1998 than in 2012. The increase of seawater influx and conversion rates following the removal of the underwater crossbeam might explain such a differential variation. Gymnodium sp., Peridinium sp., Prorocentrum sp., Nitzschia longissima, Schroederia setigera, Lyngbya sp., Asterococcus limneticus, Asterococcus superbus and Cyclotella meneghiniana were found to well adapt at the high salinities in 2012. Comparatively, Asterrionella formosa, Nitzschia frustulum, Chlorella ellipsoidea, Scenedesmus bijuga and Scenedesmus ellipsoideus were observed at lower salinities in 1998. Two quite contrasting phytoplankton communities were found in the two seasons of a year, spring with limited precipitation and summer, the flood season.
Deep fried instant noodles, biscuits, and cookies were prepared, using the same beef tallow as their fat ingredient. In addition to wheat flour and beef tallow, the common and major ingredients, the deep fried instant noodle contained 1.5% salt before frying, the biscuits 20.0% sucrose and 10.0% nonfat milk solid before baking, and the cookies 20.0% sucrose before baking. The three products and a portion of beef tallow, which was to be used as control, were stored in an incubator at $47.0{\pm}1.5^{\circ}C$. The peroxide value and the free fatty acid value of the control and the extracted fat were determined regularly during the storage period. The fat incorporated in the biscuits exhibited far greater stability to rancidity development than that of the control with regard to both peroxide value and free fatty acid value development. However, the fat incorporated in the deep fried instant noodles and the cookies showed much poorer stability than that of the control. Factors like a deep frying process and/or the presence of a significant amount of salt in the deep fried instant noodles appeared to promote the rancidity development of the fat incorporated in the product. On the other hand, Maillard type browning reaction products in the biscuits seemed to retard effectively the rancidity development of the fat incorporated in the product.
A survey was conducted to investigate the perceptions of health and foods, and the food habits among the elderly men who came to the Tap-Gol park on a daily basis. A total of 253 subjects were selected for this study. The data was analyzed through the $X^2-test$, Duncan's multiple range test and Pearson Correlation by the use of SAS program. The results were as follows. The majority of the subjects were in their 70's. 56.1% of them lived with their sons' families, 9.1% lived alone, and 27.3% lived with a spouse. 32% of the subjects were living with the expense less than 50,000 won per month. Although some were suffering from such diseases as arthritis, indigestion, and hypertension etc., the subjects were generally in good health. Their dependance on dietary supplements were insignificant. Most of the subject had a common-sensible notion as to health. They put emphasis on the three factors for the maintenance of good health: a balanced diet, a peace of mind and exercising. With regard to the food habits, the majority were fair in general. The subject living with family had more regular meals than the single people did. 41.5% of the subjects responded that they had irregular meals, mainly for lunch due to a poor appetite or a financial problem. The respondents cited protein food, milk, fruit, sea weeds and food cooked with oil as conducive to good health. But what they consumed did not match what they thought was good, particularly milk. The results of this study lead to the suggestion that Korea need to develop such a lunch program for the elderly as is practiced in the U.S., through which dietary motivation can be stimulated and a low-priced and balanced diet offered at least for one meal a day.
Objective : Hydrocephalus and vasospasm are the common complications following subarachnoid hemorrhage (SAH). In spite of development of perioperative management and operative technique, hydrocephalus cause neurological deficit and poor prognosis. Usually CSF drainage procedure(external ventricular drainage(EVD) or shunt) is needed in hydrocephalus following SAH. The aim of this study was to investigate whether the need for shunting and the outcome after shunting in hydrocephaus following SAH can be related to the duration, daily and total amount of cerebrospinal fluid(CSF) drainage at EVD. Material and Method : IVH is one of several factors which cause hydrocephalus. In this retrospective study, firstly we investigated the incidence of IVH in total cases and frequency of IVH according to aneurysmal site and then prognosis of IVH following SAH. Among 629 patients with SAH, hydrocephalus was diagnosed by CT scan and symptoms. And then those 102 hydrocephalus following SAH were divided into two groups which were hydrocephalus with IVH group and without IVH group. In these two groups, we investigated and compared the incidence of hydrocephalus in all case, frequency of hydrocephalus according to aneurysmal site, the outcome according to H-H grade on admission and the need rate of shunt, etc. Of those hydrocephalus, 100 EVD procedures were done. The duration, daily and total amount of CSF drainage at EVD were investigated. Fifty cases expired during EVD was excluded. We analyzed whether the need rate of shunt and the final outcome after shunting can be related to IVH, the duration and daily and total amount of CSF drainage. Result : The incidence of hydrocephalus following SAH was 20%(with IVH group ; 64%, without IVH group ; 11%). As H-H grade on admission was better, the outcome of hydrocephalus was also better. The mortality rate of hydrocephalus with IVH was 64% which was higher than 40% that of hydrocephalus without IVH. The need rate of shunt in all cases of hydrocephalus following SAH was 20%, but those with IVH group excluding expired patients before shunt was 40%. This was very similar to 41% of the need rate of shunt in hydrocephalus without IVH. The total amount of CSF drainage was statistically related to the need rate of shunt(total amount : need rate of shunt/<1000cc : 15%, 1000-2000cc : 40%, >2000cc : 50%). The duration and daily amount of CSF drainage were not statistically related to the need rate of shunt, but as daily amount of CSF drainage was more and duration was longer, the need rate of shunt was increased(daily amount : need rate of shunt /<100cc : 16%, 100-200cc : 25%, >200cc : 40%//duration : need rate of shunt/<1week : 8%, 1-2weeks : 30%, >2weeks : 47%), and also the final outcome after shunting was poor. Especially the total amount of CSF drainage was significant related to the final outcome after shunting(total amount : GOS/<1000cc : I&II(3/4), 1000-2000cc : II(2/4), III(2/4), >2000cc : III&IV(6/7)). Conclusion : This study revealed that the incidence and mortality rate of hydrocephalus following SAH were influenced by IVH. So SAH associated IVH has the higher incidence of hydrocephalus and poor outcome. As the CSF drainage amount was more and duration of drainage was longer, the need rate of shunt was increased and the final outcome after shunting was poor. Especially the total amount of CSF drainage were strongly related to the need rate of shunt and the outcome after shunting.
Suncheon is a city comprising a rural and urban area, where there are four types of large stores. Studies have shown that there are too many large stores serving the local population of just 300,000. However, geographically, Suncheon is located at a transportation hub that borders the cities of Gwangyang and Yeosu as well as the local counties of Boseong and Gurae. Residents of these areas can reach these shopping stores within an hour's drive. Thus, the managers of these four stores regard residents in these areas as their valued customers and endeavor to create a differentiated image among them. In this study, 13 different images were used to determine the public's opinions and feelings towards these stores and the differences were analyzed. The store images measured overall store impression, diversity of the product, the quality of products displayed at the store, accessibility, the atmosphere, service to the customers, and so on. These images are evaluated subjectively by each customer and are major factors in them deciding to revisit the stores. The 13 images are classified into five main categories and further classified into 13 sub-categories. Three kinds of factor images were extracted from the store images in the five main categories by factor analysis using SPSS Ver. 19. The first factor image was extracted from the images of convenience, atmosphere, and service in the main categories and is called a sub-service factor for the store in this study. Accessibility to the store was classified as a convenience image in the main category and was extracted as a common factor along with diversity and the price of goods. These differences are expected according to the store location, that is, the difference between stores located in a large city and those in a small local city, and depending on the nature of survey respondents. The result shows that there is a significant difference between the stores' images with regard to accessibility, the price of products, brand image, and lighting/sound image. This study has the following limitations. First, the survey sample was restricted to residents of a small local city that includes rural and urban populations. The differences between the store images regarding traffic and accessibility are factored by store location, whether they are located within a large or a small city as well as the economic situation of these cities. Second, only the customers of large-scale stores were included in the survey as respondents. Relatively large traditional markets are held every five days in local cities and there is competition between large-scale stores and traditional markets with regard to diversity and the price of goods. It could be expected that customers in large-scale stores and customers in traditional markets would hold different store images. In future studies, images of stores in large cities should be compared with the images of stores located in small local cities. In addition, customer behavior when buying goods in large-scale stores should be compared with their behavior when buying goods in traditional markets.
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