• The Korean Society of Law and Medicine
• /
• v.18 no.2
• /
• pp.163-194
• /
• 2017

Coronary artery disease has increased in Korea as the country enters the aged society. It is well known that the incidence of coronary artery disease is related to aging, hypertension, diabetes, hyperlipidemia, and dietary habit. For effective treatment of significant coronary stenosis, close coordination between cardiac surgery and cardiology team is essential. Especially cardiologists' decision whether to do the stent placement or CABG is very important because the cardiologists usually start to consult the patients for their treatment. Recently, non-surgical interventions(that is stent placement) in cardiology field have dramatically increased as the national insurance system removed the limitation of the number of stents deployed. However, accidents are often caused by inappropriate use of stents, especially in patients with triple coronary disease or left main disease with heavy coronary calcifications. Another aspect of stent placement is to cope with an emergency case in the event of coronary rupture or pericardial tamponade during coronary interventions without cardiac surgeons. In the past two years, the Korea Consumer Agency (Consumer Dispute Coordination Committee) analyzed eight cases of medical dispute settlement. Only two hospitals were manned with both cardiologists and cardiac surgeons. Seven patients died of procedures of stenting and five patients died on the day of the procedure. Among the 8 cases, 5 cases showed 3 vessel disease and the rest of the cases had either severe calcification, complete occlusion or poor coronary antomies for stenting According to a 2017 national data registry of coronary stenting, less than 3 drug-eluting stents were implanted in 98% of all patients. In 2015, the number of stent procedures was 38,922, and approximately in 800 (2%) cases, more than four stents were used per patient. We emphasize that it is necessary to seriously consider the cost-benefit analysis between stent and CABG. The patient has the right to choose the right procedure by asking the liability of 'instruction explanation obligation'. He should be well informed of the pros and cons of both procedures to avoid overuse of stent. It can be solved by intimate discussion of individual cases with the cardiac surgeon and the patient. Unilateral dialogue with the patient, forceful restriction on the number of stenting, lack of surgeon's backup in difficult cases should all be avoided. It is also necessary to solve the problem not only at the hospital level, such as multidisciplinary integrated medical care, but also a nationwide solution such as expanding cardiac surgeons as essential personnel to public officials.

• Analytical Science and Technology
• /
• v.9 no.4
• /
• pp.336-344
• /
• 1996

The extraction of trace cobalt, copper, nickel, cadmium, lead and zinc in urine samples of organic and alkali metal matrix into chloroform by the complex with a dithizone was studied for graphite furnace AAS determination. Various experimental conditions such as the pretreatment of urine, the pH of sample solution, and dithizone concentration in a solvent were optimized for the effective extraction, and some essential conditions were also studied for the back-extraction and digestion as well. All organic materials in 100 mL urine were destructed by the digestion with conc. $HNO_3$ 30 mL and 30% $H_2O_2$ 50 mL. Here, $H_2O_2$ was added dropwise with each 5.0 mL, serially. Analytes were extracted into 15.0 mL chloroform of 0.1% dithizone from the digested urine at pH 8.0 by shaking for 90 minutes. The pH was adjusted with a commercial buffer solution. Among analytes, cadmium, lead and zinc were back-extracted to 10.00 mL of 0.2 M $HNO_3$ from the solvent for the determination, and after the organic solvent was evaporated, others were dissolved with $HNO_3-H_2O_2$ and diluted to 10.00 mL with a deionized water. Synthetic digested urines were used to obtain optimum conditions and to plot calibration-eurves. Average recoveries of 77 to 109% for each element were obtained in sample solutions in which given amounts of analytes were added, and detection limits were Cd 0.09, Pb 0.59, Zn 0.18, Co 0.24, Cu 1.3 and Ni 1.7 ng/mL, respectively. It was concluded that this method could be applied for the determination of heavy elements in urine samples without any interferences of organic materials and major alkaline elements.

• Neonatal Medicine
• /
• v.16 no.2
• /
• pp.197-204
• /
• 2009

Purpose: The objective of this study was to describe the frequency of hepatobiliary dysfunction (HD) at our hospital and determine the possible risk factors and complications associated with the development of HD in very low birth weight infants (VLBWI) treated with parenteral nutrition (PN). Methods: A retrospective study of VLBWI (n=92) that required PN between 2004 and 2008 in the NICU at the Bucheon St. Marys Hospital of Catholic University was performed. HD was defined by a direct bilirubin (DB) >2 mg and a transaminase of 60 IU/L defined cholestasis and liver injury. Groups I, II, and III were limited to cases of cholestasis, liver injury without cholestasis, and no abnormalities, respectively. The VLBWI were compared to each other. Results: Thirty-six subjects (39.1%) had cholestasis and 51 (55.4%) had liver injury. In addition, 36 (39.1%), 19 (20.7%), and 37 (40.2%) subjects were classified as groups I, II, and III, respectively. The three groups showed significant differences in gestational age, 1- and 5-minute Apgar scores, use of surfactant, duration of parenteral nutrition, frequency of RBC transfusions, bronchopulmonary dysplasia (BPD), and patent ductus arteriosus (PDA) (P<0.05). The multiple regression analysis with cholestasis as the dependent variable, showed a significant correlation with gestational age, use of surfactant, frequency of RBC transfusions, and PDA. Conclusion: Various factors, such as birth weight, gestational age, 1- and 5-minute Apgar scores, use of surfactant for respiratory distress syndrome (RDS), frequency of RBC transfusions, BPD, and PDA may be related to hepatobiliary dysfunction in VLBWI treated with PN.

• Journal of Biomedical Engineering Research
• /
• v.24 no.5
• /
• pp.401-410
• /
• 2003

This study investigates the biomechanical efficacies of various cement augmentation techniques with or without pressurization for varying degrees of osteoporotic femur. For this study, a biomechanical analysis using a finite element method (FEM) was undertaken to evaluate surgical procedures, Simulated models include the non-cemented(i.e., hip screw only, Type I), the cement-augmented(Type II), and the cemented augmented with pressurization(Type III) models. To simulate the fracture plane and other interfacial regions, 3-D contact elements were used with appropriate friction coefficients. Material properties of the cancellous bone were varied to accommodate varying degrees of osteoporosis(Singh indices, II∼V). For each model. the following items were analyzed to investigate the effect surgical procedures in relation to osteoporosis of varying degrees : (a) von Mises stress distribution within the femoral head in terms of volumetric percentages. (b) Peak von Mises stress(PVMS) within the femoral head and the surgical constructs. (c) Maximum von Mises strain(MVMS) within the femoral head, (d) micromotions at the fracture plane and at the interfacial region between surgical construct and surrounding bone. Type III showed the lowest PVMS and MVMS at the cancellous bone near the bone-construct interface regardless of bone densities. an indication of its least likelihood of construct loosening due to failure of the host bone. Particularly, its efficacy was more prominent when the bone density level was low. Micromotions at the interfacial surgical construct was lowest in Type III. followed by Type I and Type II. They were about 15-20% of other types. which suggested that pressurization was most effective in limiting the interfacial motion. Our results demonstrated the cement augmentation with hip screw could be more effective when used with pressurization technique for the treatment of intertrochanteric fractures. For patients with low bone density. its effectiveness can be more pronounced in limiting construct loosening and promoting bone union.

• Journal of Periodontal and Implant Science
• /
• v.24 no.1
• /
• pp.131-143
• /
• 1994

For maintenance of exposed implant in healthy state, it is necessary to treat the surface of implant fixture and provide the surface adjustable to surrounding tissues. Variable techniques have been introduced such as citric acid and air-abrasive system to treat the failed implant. Although when the rough surface of HA coated implant was exposed to oral environment, the surface treatment method with citric acid or air-abrasive system is effective for removal of bacterial endotoxin, it is unsuccessful to prevent plaque deposition due to difficulty in removal of rough surface of HA coated implant. Thus, in this study the method that removes bacterial endotoxin and makes smooch surface without alteration of surface characteristics was studied. HA coated disc manufactured by IMZ Co. Was treated with high speed diamond bur, low speed diamond bur, stone bur, rubber point, jetpolisher. And then its surface state was examined with profilometer and SEM to evaluate the surface smoothness, and its surface component was analyzed with EDX to evaluate wheter the surface characteristics were altered or not. As a result, following results were obtained. When the surface roughness of each implant disc was measured by profilometer, the group I showed a $R_{max}\;2.11{\mu}m$ and the group II, III, IV, V showed a $R_{max2}\;4.17{\mu}m$, $7.28{\mu}m$, $8.61{\mu}m$ and $39.44{\mu}m$ respectively. That is, surface smoothness was highest in the group I and it has been gradually decreased in the group II, III, IV and V. Under the SEM examination, the group I showed relatively smooth surface and the group II showed slightly rougher surface than the group I due to partially remaining HA particles while most HA particle was removed. The group III and IV showed rough topography due to HA particles that was not grinded, and HA coated surface in group V showed very irregular surface with deep groove and prominence. In cross-sectional view, the group I showed uniform surface, and the group III, IV showed rough surface due to remaining HA particles but the thickness of HA coating was remarkably reduced. The group II has similar pattern in group I, and the group V showed about $40{\mu}m$ thickness although it was not constant. By analysis of surface component with EDX, the group II in which the grinding was effective showed a small quantity of calcium and phosphorous and the group III, IV, in which the grinding was incomplete showed calcium and phosphorus peak. In all experimental group, no other than titanium, aluminum, calcium, phosphorus was observed.

• Tuberculosis and Respiratory Diseases
• /
• v.58 no.1
• /
• pp.5-10
• /
• 2005

Background : A pleural effusion is a common medical problem. Despite several diagnostic tests, 15-20% of pleural effusions go undiagnosed. The aim of this study was to evaluate the clinical characteristics and prognosis of a lymphocyte dominant exudative pleural effusion with a low adenosine deaminase (ADA), low carcinoembryonic antigen (CEA), negative cytology and negative acid fast bacilli (AFB) smear. Method : From Jan 2000 to Aug 2001, 43 patients with lymphocyte dominant exudative pleural effusions whose AFB smear and cytologic exam were negative, their pleural fluid ADA level was < 40 IU/L, and their CEA level was < 10 ng/mL were enrolled in this study. A retrospective analysis of the patients' medical records was carried out. Result : Among 31 of the 43 cases (72%), probable underlying diseases causing the pleural effusion were identified: 21cases of malignant diseases, 4 cases of liver cirrhosis, 2 cases of pulmonary tuberculosis, 1 case of end stage renal disease, 1 case of a chylothorax, 1 case of a post-CABG (coronary artery bypass graft) state, 1 case of a pulmonary embolism. No clinically suspected etiology was identified in the remaining 12 cases (28%). Of these 12 pleural effusions, 7 cases spontaneously resolved, 2 effusions resolved with antibiotics, and the other 2 cases were persistent. Conclusion : Lymphocyte dominant exudative pleural effusions with a low ADA, low CEA, negative cytological exam, and negative AFB smear, but without a definite cause might have a benign course and clinicians can observe them with attention.

• Radiation Oncology Journal
• /
• v.14 no.3
• /
• pp.211-219
• /
• 1996

Purpose : Hysterectomy without lymph node dissection was considered an inadequate treatment method for invasive uterine cervix cancer. Usually the procedure was performed inadvertently on patients who were thought to have benign or premalignant conditions preoperatively. We analysed radiotherapy results of such patients to evaluate survival rates, failure patterns and prognostic factors according to various conditions. Materials and Methods : Sixty one patients undergoing hysterectomy in the presence of invasive cervical carcinoma were reviewed retrospectively. Preoperative diagnosis were carcinoma in situ (38 cases), severe dysplasia (2), myoma (6), uterine bleeding (4), uterine prolapse (2). and early invasive cervix cancer (10) (One patient had myoma and carcinoma in situ coincidently). Patients received postoperative megavoltage radiotherapy from August 1985 to December 1993, and minimum follow-up period was 24 months. Eight patients received ICR only, 6 patients ICR and external radiation, and 47 patients received external radiation therapy only. Results : Overall 5-year survival rate and relapse-free survival rate werer $83.8\%$, $86.9\%$ respectively. For patients with retrospective stage IA, IB, IIB (gross residual after surgery), and vaginal cuff recurrence were $90.9\%$, $88.8\%$, $38.4\%$, and $100\%$ respectively There were 8 cases of treatment failure, most of them (5/8) were in patients with gross residual disease, other patients were full thickness involvement of cervix wall (2/8) except one. Patients with early vaginal cuff recurrence and microinvasive cervical cancer (stage IA) had no treatment related failure Prognostic factors affecting survival by univariate analysis were status of residual disease, tumor histology and retrospective stage. Conclusion : Adjuvant radiotherapy appeared to be effective treatment method for patients with presumed stage IA, IB and early local recurrent disease after inadvertent hysterectomy Survivals for patients with gross disease remained after inappropriate hysterectomy was poor, So, early cancer detection and Proper management with precise pretreatment s1aging is necessary to avoid inadherent hysterectomy especially in the cases of gross residual disease.

• Clinical and Experimental Pediatrics
• /
• v.53 no.3
• /
• pp.392-396
• /
• 2010

Purpose : The association between iron deficiency anemia and febrile convulsion in infants has been examined in several studies with conflicting results. Therefore, the authors aimed to evaluate the precise relationship involved. Methods : In this case-control study, the authors assessed 100 children with a diagnosis of febrile convulsion, aged between 9 months and 2 years, during January 2007 to July 2009. The control group consisted of 100 febrile children without convulsion; controls were closely matched to the cases by age, gender, and underlying disease. Results : The mean ages of the febrile convulsion and control group were $16.3{\pm}7.4$ and $15.8{\pm}6.1$ months, respectively, and the two groups had no differences in clinical features. Iron deficiency anemia (Hb <10.5 gm/dL) was more frequent in the febrile convulsion group than in the control group, although there was no statistical significance. Unexpectably, the RDW (red blood cell distribution width) was significantly lower and the MCNC (mean corpuscular hemoglobin concentration) was significantly higher among seizure cases than among the controls (P <0.05). There is no statistical difference between simple and complex febrile groups in the clinical and laboratory profiles. On multiple logistic regression analysis, iron deficiency anemia was more frequent, but the RDW was lower, among the cases with febrile convulsion, compared with the controls. Conclusions : Our study suggests that the iron deficiency anemia is associated with febrile convulsion, and screening for iron deficiency anemia should be considered in children with febrile convulsions.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
• /
• v.5 no.1
• /
• pp.108-117
• /
• 1994

Twenty nine children with autism and thirty children with mental retardation were examined for association between autism and chromosomal disorders including fragile X. The peripheral blood was cultured in Medium 199 with methotrexate and without methorexate for 70 hours. Thirty metaphase cells in each case were karyotyped in all samples. Chromosomal abnormalities were found in 11 cases(37.9%) of autistic disorder and 10 cases (33.3%) of mental retardation, but in none of fragile(X)(q27.3) from all cases. Chromosomal abnormalities were present on group A, C, D and X in autistic disorder and on group A, B, C, D, E and X in mental retardation. No specific chromosomal region was found in both autistic disorder and mental retardation. Types of chromosomal disorders were only fragile and/or gap but no numerical abnormality was present in all cases. Number of cells which revealed fragile sites were 31 cells(3.6%) out of 870 cells in autistic disorder and 29 cells(3.2%) out of 900 cells in mental retardation Number of cells which revealed gaps were 43 cells(4.9%) out of 870 cells in autistic disorder and 35 cells(3.9%) out of 900 cells in mental retardation. Autistic disorder may not be directly correlated with fragile X but with nonspecific chromosomal breakages from these data.

• Korean Journal of Agricultural Science
• /
• v.23 no.2
• /
• pp.301-322
• /
• 1996

This study is first aimed at identifying the possibility of labour saving and production cost decreasing in rice production with respect to seed broad casting technology. Comparison of labour inputs and production costs of rice in-between USA and Korea and recommendation of policy guidelines for the continous rice cultivation are the second objective of this study. Under the WTO system, rice enterprice is the most vulnerable crop in the sense of labour productivity and price competitiveness in the international market. How to adapt labour saving technology and how to decrease production costs are the most imminent problems to be solved in rice production. To achieve the objectives, survey on nine rice enterprice farms were made in Daeho tidal farmland with respect to the size of farm, labour inputs, productivity, farm mechanization and farm land base development. The existing data on labour saving technology by seed broadcasting which had surveyed by Rural Development Administration were collected to compare the surveyed data from Daeho tidal farm land The study results and policy recommendation are summarized as follows; 1. Labour requirements per 10a for rice enterprise farms with seed broadcasting and with transplanting were estimated 11.4 and 18.5hours respectively. 'This above labour inputs were equivalent to 1/3-1/5 of the national average labour inputs of 53.6 hours which were included transplanting and harvesting by machinery. Considering the labour requirement of 1.7 hours per 10a for the USA rice production, Korea rice culture has possibility to decrease labour demand upto USA level of labour inputs. 2. Production cost of rice in Korea were estimated US$4,181 per ha which were higher than that of USA by 3.00 times and production costs per ton were shown as US$313 for USA rice and US$1,018 for Korean rice. 3. Land productivity of rice per 10a in America was reached to 4,325kg and the counterpart of Korea was about 4,181kg in recent year. In the sense of land productivity, both yields of rice were comparable. 4. The price of japonica type rice similar to Korean traditional rice in international market in 1994 was f.o.b US$466 per ton which was equivalent to import parity price of US$830 per ton in domestic market. The price of rice purchased by Korean G't and received by farmers were amounted to US$ 2,013 and US$ 1,663 respectively in the same year. Domestic prices mentioned above were higher than the import parity price as US$830 by 2.0-2.4 times. 5. American rice production competitive to Korean rice was equivalent to 17,012 thousand tons, 1.28% of the world production of rice in 1991 and consumption of rice in America was amounted to 2,633 thousand tons. Exportable quantity of USA rice were estimated as 4,379 thousand tons of which 52.3%, 2,300 thousand tons, were exported indeed in the same year. 6. The quantity of Korean rice produced in 1991 was estimated 1.00% of the world production. The world amount of rice exported in 1991 was reached to 2.45% of the world production of which 34.2% was occupied by USA The remaining quantities of world exported rice were dominated by Tiland, Pakistan and Vietnam where produced indica variety. 7. Under the given technology, labour inputs per 10a for rice production could be possible to save by 70% of the national average labour requirement of 53.6 hours through implmenting complete farm mechanization with land consolidation and on-farm development and improvement of fanning practices like seedbroad casting txchnology etc. On the other hand, prduction costs of rice could be decreased by 10% rather than 49% as target indicated in the Rural Development Counter Measures of Korean Government in 1994 owing to increasing farm mechanization cost and interest on land service with high price. Accordingly production cost of rice per kg could be decreased only by 10% of the 1994 production cost. 8. Rice policy of Korean government in the future should take into account the labour saving technology to solve labour shortage in rural area and to enhance off-farm incomes by creating job opportunities in agro-industrial zones and special production area. On account of the staple food and main energy source for people's health, rice production even encountered vulnerable economic settings should be continued without price distortion policies and discouraging farmer's intention to cultivate rice by importing institutionally the direct income subsidy system.