Comparison of Long-Term(Over 10 Years) Outcome of Percutaneous Mitral Balloon Valvuloplotomy between Moderate and Severe Mitral Stenosis

BACKGROUND AND OBJECTIVES: Percutaneous mitral balloon valvuloplotomy (PMV) is a safe and effective procedure for the treatment of mitral stenosis (MS); however, its long-term results according to the severity of MS remain unknown. The aim of this study was to compare the long-term results of PMV between moderate and severe MS. SUBJECTS AND METHODS: The immediate and long-term outcomes of 786 patients (198 male, mean age; 43 years) who underwent PMV at a single referral center, between 1988 and 2000, were analyzed. The clinical and echocardiographic data were compared between moderate (n=357) and severe MS (n=429). RESULTS: Optimal results were gained in 618 (79%) patients, including 80 and 76% moderate and severe MS cases, respectively (p=0.13). Acute complications occurred in 85 patients (11%), but without significant difference between the two groups. After a mean follow-up period of 94 months (range, 6 to 210 month), the 5 year event-free survival rate was better in moderate (88%) than in severe MS (79%), but the 10 year event-free survival rates were no different (65% vs. 65%). Independent predictors for better prognosis were a lower echo score ( or =1.7 cm2)(p=0.002, HR=0.65), less mitral regurgitation (

Long-Term Outcome of Clinically Insignificant Aortic Valve Disease in Patients Undergoing Mitral Valve Surgery for Rheumatic Heart Disease

BACKGROUND AND OBJECT: A considerable proportion of patients who require mitral valve (MV) replacement present with a coexisting pathology of the aortic valve (AV). However, combined AV and MV replacement is associated with higher operative risk and poorer long-term survival than MV replacement (MVR) only. Little is known about the natural history of AV disease in patients undergoing MV surgery. The purpose of this study was to analyze long-term clinical outcome and the need for subsequent AV replacement (AVR) in patients with mild to moderate AV disease at the time of MV surgery. MATERIALS AND METHODS: One hundred forty-one patients (97 female, mean age 43 years) with mild to moderate AV disease and severe rheumatic MV disease were treated with MV surgery. The patients were followed for an average period of 8+/-3 years (range 1-16) after MV surgery. Primary outcomes (death and subsequent AVR) were evaluated. METHODS: At the time of MV surgery, 104 patients (73.8%) had mild aortic regurgitation (AR), 37 patients (26.2%) moderate AR, 5 patients (3.5%) mild aortic stenosis (AS) and 2 patients (1.4%) moderate AS. At the end of follow-up period, only one patient had severe AR. Eight patients (5.7%) died during the follow-up, and four patients (2.8%) treated with AVR after a mean period of 9 years. Survival analysis with Kaplan-Meier method revealed 10-year survival rates of 95.5% and 10-year event free survival rates of 93.6%. CONCLUSION: In most patients with mild to moderate rheumatic AV disease at the time of MV surgery, subsequent AVR is rarely needed after a long follow-up period. These data may support the decision not to recommend prophylactic AVR at the time of MV surgery in these patients.

Establishment of a Screenig Test System for Early Diagnosis of Hepatocellular Carcinoma in High-Risk Patients and the Evaluation of Its Effectiveness / 대한암학회지

PURPOSE: To evaluate the effectiveness of clinic-based screening program for early detection of hepatocellular carcinoma (HCC) and to assess the risk factors of HCC in Korea. MATERIALS AND METHODS: The data of 14,259 patients who had ultrasonography (US) due to chronic liver diseases were collected into a data base program from 1990 to 1998. RESULTS: A total of 4,339 patients were enrolled who had repeated US. 237 patients were diagnosed as HCC during follow-up (mean 33 months). The tumor size detected by screening within a 6-months interval was significantly smaller than that of a longer interval (2.7 cm vs 3.9 cm, P<0.01). The smaller the tumor was at detection, the longer the survival time was. Only 29.9% of HCC patients had an elevated serum alpha-fetoprotein (alphaFP) level above 400 ng/ml. Multivariate analysis showed liver cirrhosis, chronic hepatitis B or C and old age over 40 years to be significantly associated with an increased risk of HCC. CONCLUSION: The US screening within a 6-months interval is beneficial to high-risk patients over 40 years old through the early detection of HCC and prolonged survival. According to the risk factors, the necessity for screening test and proper interval should be reconsidered.

Structural Modeling of Quality, Satisfaction, Value and Purchase Intention in Health Care Service / 예방의학회지

OBJECTIVES: To determine the relationships among quality, satisfaction, value and purchase intention in health care service. METHODS: The data were gathered from out-patients who had used hospital services. They were asked to assess service quality, satisfaction, service value, and purchase intention. A total of 557 usable questionnaires were gathered. The data were analyzed using SAS version 6.12. The analytic methods employed in the study were confirmatory analysis and covariance structural analysis. RESULTS: Service quality exhibited a significant and positive relationship with satisfaction, service value, and purchase intention. Furthermore, satisfaction had a significant and positive relationship with purchase intention. And finally, service value had a significant and positive relationship with both satisfaction and purchase intention. Based on these findings, it is evident that satisfaction was a mediator between service quality and purchase intention. Also service value played a mediating role between service quality and satisfaction. CONCLUSIONS: These results suggest that service quality is an antecedent of satisfaction and service value, and exerts a stronger influence on purchase intentions than satisfaction and service value do. Thus, managers may need to emphasize service quality in health care.

A study on the relationship between juvenile delinquency and family environment

This study was conducted to find out an appropriate means for preventing the juvenile delinquency (JD), which is supposed to be greatly realted to family environment. The data were collected through a questionnaire survey with a means of writing by themself, to 257 middle and high school students and 309 juvenile delinquents who were in confinement. The questionnaire was consisted of 27 items of juvenile delinquencies, 15 questions about personal environment in their period of childhood, 36 questions on their home atmosphere, 25 items with regard to their parental behavior to their children in the rearing of them. The extent of delinquency was calculated by summing the numbers of experienced delinquencies of the listed items. The study subjects were divided into two groups; student group (SG) and juvenile delinquent group (JDG) and the collected data were analyzed with the extent of delinquency in each group by SPSS/PC+statistical package. The extent of JD was increased as the study subjects grew older, defective families were more common, total family income was more poor, parents' educational level was lower, personal expenses were higher and the conflicts between parents were more high in JDG as compared with of SG. The differences were statistically significant. As long as the extent of delinquency is concerned, delimquent points of JDG were significantly higher as compared with that of SG in all items except one item, below the primary school item in fathers' educational level. (In order to prevent JD in our country, it is recommended that educational level and the living standared of the lower class people should be raised, the sound families which do have less conflictsshould be established as much as possible, the present educational system which is making much conflicts between parents and their offsprings should be changed so that their given temperament would be brought up to the highest level, defective families should be reduced as much as possible and adults should not do actions that are considered not to be done by youngsters and must set a good example.)