Key Issues of Hospital Information Systems Management / 대한의료정보학회지

OBJECTIVE: This study was conducted to identify 3 to 5 years of future management issues in hospital information systems (HIS). METHODS: Two rounds of interview surveys were conducted based on the sample survey of 50 managers from 28 hospital information centers utilizing the Delphi method. RESULTS: From the survey, management issues in HIS were identified in the following order: 'top management support', 'close relationship with users', 'PACS', 'disaster recovery', improving IS strategic planning'. Compared with the 1999 survey, the issues that rank within the top 10 management issues were as follows: 'top management support', 'security and control', 'close relationship with users'. Recently surfaced issues are 'disaster recovery' and 'standardization'. The issues that dropped out of the top 10 ranks were 'network management', 'recruiting and developing IS human resource'which were very fundamental issues in the initial state of the introduction of the hospital information system. CONCLUSION: The two main significance of this study involves predicting future management issues based on the comparison of the current issues with the 1999 issues and recommendingmanagement strategies based on the classification of issues by importance and persistence.

Clinical Outcomes of Self-Expanding Metal Stent Insertion for Obstructive Left-Sided Colorectal Cancer: Comparison with Emergency Operation / 대한소화기내시경학회지

BACKGROUND/AIMS: The aim of this study was to compare the outcome of colorectal stenting with that of performing emergency operation for the patients with malignant left-sided colon obstruction. METHODS: The patients with obstructing left-sided colorectal cancer were treated with 'bridge to surgery stenting' and this was followed by operation (group A, n=20), emergency operation (group B, n=21), palliative stenting (group C, n=16), and emergency palliative operation (group D, n=15). RESULTS: The primary anastomosis rate was significantly higher for group A than for group B (65.0 vs. 33.3%, respectively, p0.05). In regard to palliative treatment, the stoma creation rate was 86.7% for group D, and 2 patients in group D needed intensive care. The mean hospital stay was significantly shorter for group C than for group D (9.3 vs. 20.7 days, respectively, p<0.05). CONCLUSIONS: Stent placement is a useful alternative to emergency surgery for the management of malignant colorectal obstruction.

Usefulness of PIVKA-II for diagnosis and evaluation of recurrence of hepatocellular carcinoma / 대한내과학회지

BACKGROUND: Although alpha-fetoprotein (AFP) is most widely used tumor marker for hepatocellular carcinoma (HCC), the sensitivity is about 60~70% in advanced HCC. Furthermore, the specificity of AFP is relatively low. The aim of this study was to evaluate the usefulness of prothrombin-induced by vitamin K absence or antagonist-II (PIVKA-II) in diagnosis of HCC, and of recurrence after curative surgical resection. METHODS: Between April 2001 and March 2004, a total of 245 patients with pathologically confirmed HCC and a total of 267 patients with non-HCC, chronic liver diseases were enrolled. RESULTS: With cutoff-value 20 ng/mL for AFP and 40 mAU/mL for PIVKA-II, the sensitivity of AFP and PIVKA-II was 48.6% (119/245) and 75.1% (184/245), respectively. The specificity of them was 81.3% (217/267) and 94.8% (253/267), respectively. When AFP and PIVKA-II were combined, the sensitivity and specificity was 83.3% (204/245) and 77.2% (206/267), respectively. For HCC

Clinical Outcome of Pulmonary Resections in Patients with Pulmonary Metastasis of Hepatocellular Carcinoma / 대한간학회지

BACKGROUND/AIMS: Although the lung is the most common site of extrahepatic spread from hepatocellular carcinoma (HCC), the role of surgery for pulmonary metastasis remains unclear. The aim of this study was to evaluate the efficacy of pulmonary resection in patients with pulmonary metastasis from HCC. METHODS: Between July 2000 and July 2004, a total of 6 patients with pulmonary metastasis from HCC underwent curative pulmonary resections. The patients were divided into two groups (Surgery group and Non-surgery group) according to the primary treatment modality of HCC. Medical records, imaging studies, and pathologic reports of the surgical specimens were reviewed. RESULTS: Three patients in the surgery group underwent pulmonary resections for a solitary metastasis after hepatectomy for HCC, and they are all still alive. One of the 3 patients developed a tumor recurrence in the chest wall after pulmonary resection. The survival time after diagnosis of HCC were 79, 122, and 54 months, respectively. The survival time after pulmonary metastatectomy were 49, 39, and 20 months in the three patients. Another 3 patients in the non-surgery group, received a pulmonary metastatectomy; they had either a complete response HCC or partial radiologic response. These 3 patients developed recurrent disease in the liver. One of 3 patients died. The survival time after diagnosis of HCC were 153, 83, 12 months. The survival time after pulmonary metastatectomy were 51, 4, 2 months. CONCLUSIONS: The surgical resections of a solitary pulmonary metastasis from HCC in highly selected patients might be an effective treatment modalities for prolonged survival.

Effects of Immunostimulatory CpG-Oligodeoxynucleotides of Bronchial Asthma in Rat / 결핵

BACKGROUND AND OBJECT: Immunostimulatory CpG-oligodeoxynucleotides (ISS CpG-ODN) up-regulate the TH1-type immune response and down-regulate the TH2-type response. This study was performed to investigate the immune response changes resulting from ISS CpG-ODN on bronchial hyperrestponsiveness, eosinophilic inflammation and mucus hypersecretion in rat asthma. MATERIALS AND METHODS: 10 normal controls(NC) and 26 asthmatic rats, which were generated by ovallbumin(OVA) sensitization and challenge, were studied. The asthmatic rats were randomized into 11 asthma controls(AC) and 15 in the asthma-CpG treatment group(CpG). The CpG group was administered ISS CpG-ODN intramuscularly and the AC group was administered a placebo(0.9% NaCl)on day 15 and 20. After CpG-ODN or placebo administration, we measured the IFN-(TH1-type cytokine) and IL-4(TH2-type cytokine) levels in the bronchoalveolar lavage fluid(BALF), the specific airway resistance(sRaw), eosinophilic fraction in BALF, eosinophilic infiltration, goblet cell dysplasia and MUC5AC gene expression in the lung tissue. RESULTS: In the BALF of the CpG group, the IFN-γ concentration was significantly high and the IL-4 concentration was significantly low when compared with the AC group. Both the sRaw and eosinophilic fraction, and infiltration into the BALF and lung tissue significantly lower in the CpG group when compared with the AC group. However, little difference in goblet cell dysplasia and MUC5Ac gene expression was observed between the CpG group and the Ac group. CONCLUSION: ISS CpG-ODN decreases bronchial hyperresponsiveness and eosinophilic inflammation in the rat asthma model through the up-regulation of the TH1-type immune response with the down-regulation of the TH2-type response. However, the effect of these immune response changes on mucus hypersecretion was is not remarkable in this study.

Fat embolism syndrome with pulmonary hemorrhage of unknown origin / 결핵

Fat embolism syndrome is a rare but serious complication occurring most of the time in patients with long bone fractures. And it occasionally occurs when patient had underlying disease. For example, pancreatitis, diabetes mellitus, alcoholic liver disease and connective tissue disease can be risk factors. The 44-year old woman visited to the Korea university hospital because of sudden dry cough, blood tinged sputum, and exertional dyspnea. We found petechiae on her anterior chest wall. Chest X-ray and CT showed patchy opacities and multifocal ground-glass opacities in both lung fields. Open lung biopsy demonstrated diffuse pulmonary hemorrhage and intravascular macrovesicular fat bubbles. After conservative management, her symptoms and radiologic findings were significantly improved. We report a case of fat embolism syndrome without any known risk factors.

The Effects of Cyclooxygenase-2 (COX-2) Inhibitor on COX-2 and Prostaglandin E2 Expression in Ovalbumin Induced Early Phase Bronchoconstriction of Rats / 결핵

BACKGROUND: Bronchial asthma is characterized by airway hyperresponsiveness (BHR) and airway (delete) inflammation. The cyclooxygenase(COX) seems (is believed ) to be one of the important enzyme (enzymes) in these inflammatory reaction (reactions). Recently, the COX was divided into two isoforms, COX1 and COX2. COX2 is induced by lipopolysaccharide and some cytokines at the site of inflammation (inflammation site). Prostaglandin E2 (PGE2), which is (delete) produced from COX2, may affect on (delete) airway inflammation. The purpose of this study was (is) to evaluate the effect of COX2 inhibitor on COX2 expression, plasma PGE2 and(,)airway resistance and histologic finding in (an) animal asthma model. METHODS : Sprague-Dawley rats were divided into 3 groups. Normal control didn't (The normal control group did not) receive any treatment. Asthma (,but the asthma) control group was sensitized by ovalbumin but not treated with (the) COX2 inhibitor(nimesulide, Mesulid ). Treatment (The treatment) group was sensitized and treated with nimesulide. We examined specific airway resistance (sRaw) before and after nimesulide ingestion (was investigated) . Also, we examined (The) PGE2 level in (the) plasma was examined and performed COX2 immunogold-silver stain on lung tissue (was performed). RESULTS: sRaw and eosionophilic infiltration on airway were,( which) increased in the asthma control group which was (, was) compared to normal control(p=0.014). But there However, there was no difference in eosinophilic infiltration between asthma control and treatment group (groups)(p=0.408). There was (and) no difference in COX2 expression on bronchiolar epithelium among (the) three groups. Plasma PGE2 levels were no statistically significant difference (were not statically different) among (the) three groups. CONCLUSION: We conclude that the role (The role )of COX2 in the allergen(-) induced BHR was not significant. The effect of nimesulide was not observed on BHR, COX2 expression, and plasma PGE2 level. Therefore, COX2 may not be a major substance on (of) allergic asthma.

Diffuse pulmonary nodular lesions persisting for 5 years / 결핵

Diffuse pulmonary nodular lesions have many causes. When they are caused by infection, the likely organisms are M. tuberculosis and various fungi. Silicosis, eosinophilic granuloma and pulmonary metastasis should be considered for differential diagnosis. Differential diagnosis needs detailed clinical history, physical examination and various laboratory tests. A case of persistent diffuse pulmonary nodular lesions which had persisted 5 years is reported. The patient was a 25 years old man with minimal pulmonary symptoms. Detailed past history and physical examination suggested thyroid tumor. Chest radiography showed numerous evenly sized well-defined nodules scattered in entire lung fields. Previous chest X-rays showed similar nodular lesions, which had lasted for 5 years. The number of nodules was slightly increased. Neck CT showed heterogenous mass in left lobe of thyroid gland and multiple lymphadenopathies along both internal jugular chains. Total thyroidectomy was performed. A case of lung metastasis which progressed slowly in papillary thyroid cancer is reported.

Association between beta2 adrenoceptor polymorphisms and atopy/serum IgE in asthmatic patients / 결핵

BACKGROUND: The beta2 adrenergic receptor (beta2 AR) polymorphisms occurring at amino acid position 16 (Arg to Gly), 27 (Gln to Glu), 34 (Val to Met), and 164 (Thr to Ile) are known to be functionally relevant and also disease-modifying in subjects with asthma. However the contribution of these polymorphisms to the development of the asthmatic phenotype or other markers for allergic disease remains to be established. METHODS: 109 patients with bronchial asthma and 42 healthy person were included. Serum total IgE, allergen specific IgE, and skin prick test were performed to all of the subjects. beta2 AR polymorphisms were checked by mutated allele specific amplification (MASA) method. RESULTS: The results were as follows. The frequencies of beta2 AR polymorphisms in asthmatic patients and healthy person were not statistically different(p>0.05). There was no association between beta2 AR polymorphisms of amino acid position 16, 27, 34 and the existence of atopy among asthmatic patients (p>0.05). Between asthmatic patients with or without elevated IgE level and beta2 AR polymorphisms of amino acid position 16, 27, 34, there was no statistically significant association(p>0.05). CONCLUSION: There was no difference in frequency of the beta2 AR polymorphism between asthmatic patients and healthy person. In the bronchial asthma, association of beta2 AR polymorphism and atopy/serum total IgE was not found.

Clinical Investigation of Women with Asthma Worsened during Pregnancy / 결핵

BACKGROUND: Asthma is the most common respiratory crisis encountered in clinical practice, occurring in up to 4% of all pregnancies. Pregnancy often appears to alter the course of asthma. But the mechanisms responsible for variable changes in the asthma course during pregnancy remain unknown. Poor control and exacerbations of asthma during pregnancy may result in serious maternal and fetal complications. To investigate the course of asthma during pregnancy in korean women, we did a retrograde study of 27 pregnant women who had been admitted to Korea University Hospital for asthma worsened. METHOD: Twenty seven pregnant women who had been visited to Korea University Hospital for asthma worsened were enrolled in our retrospective study. We reviewed medical recordings and interviewed patients with asthma. RESULTS: Twenty seven pregnant women with asthma were evaluated, and 25 patients were enrolled to our study. Two patients experienced abortions at 6 weeks and 25 weeks gestation, respectively. The period of asthma worsened was commonly during weeks 20 to 28 of gestation. And all patients wosened were improved during the last 4 weeks of pregnancy. Twenty(80%) of 25 women whose asthma worsened during pregnancy reverted toward their prepregnancy status after delivery(p<0.002). The causes of asthma worsened during pregnancy are reduction or even complete cessaton of medication due to fears about its safety(40%), worsening after upper respiratory infection(28%), and unknown(32%). There were no adverse perinatal outcomes in 25 pregnant asthma subjects. CONCLUSIONS: A major problem of therapy for asthma during pregnancy is reduction or even complete cessation of medication due to fears of fetal effects. Therefore, maternal education and optimal clinical and pharmacologic management is necessary to mitigate maternal and fetal complications.

Clinical Investigation of Women with Asthma Worsened during Pregnancy / 결핵

BACKGROUND: Asthma is the most common respiratory crisis encountered in clinical practice, occurring in up to 4% of all pregnancies. Pregnancy often appears to alter the course of asthma. But the mechanisms responsible for variable changes in the asthma course during pregnancy remain unknown. Poor control and exacerbations of asthma during pregnancy may result in serious maternal and fetal complications. To investigate the course of asthma during pregnancy in korean women, we did a retrograde study of 27 pregnant women who had been admitted to Korea University Hospital for asthma worsened. METHOD: Twenty seven pregnant women who had been visited to Korea University Hospital for asthma worsened were enrolled in our retrospective study. We reviewed medical recordings and interviewed patients with asthma. RESULTS: Twenty seven pregnant women with asthma were evaluated, and 25 patients were enrolled to our study. Two patients experienced abortions at 6 weeks and 25 weeks gestation, respectively. The period of asthma worsened was commonly during weeks 20 to 28 of gestation. And all patients wosened were improved during the last 4 weeks of pregnancy. Twenty(80%) of 25 women whose asthma worsened during pregnancy reverted toward their prepregnancy status after delivery(p<0.002). The causes of asthma worsened during pregnancy are reduction or even complete cessaton of medication due to fears about its safety(40%), worsening after upper respiratory infection(28%), and unknown(32%). There were no adverse perinatal outcomes in 25 pregnant asthma subjects. CONCLUSIONS: A major problem of therapy for asthma during pregnancy is reduction or even complete cessation of medication due to fears of fetal effects. Therefore, maternal education and optimal clinical and pharmacologic management is necessary to mitigate maternal and fetal complications.

Effects of pranlukast on ovalbumin induced early-phase bronchoconstriction in guinea pigs / 결핵

BACKGROUND: Leukotriene (LT) C4, D4, and E4, the main components of slow-reacting substance of anaphylaxis (SRS-A), have been suggested to play an important role in bronchial asthma such as antigen- induced bronchoconstriction, airway hyperreactivity, and pulmonary eosinophil accumulation. The purpose of this study was to evaluate the effects of treatment with the cysteinyl-LTs (cys-LTs) antagonist, pranlukast on allergen-induced guinea pig asthma model. METHODS: Guinea pigs of treatment and placebo groups were sensitized by subcutaneous injection of ovalbumin (OVA) and challenged by inhalation of aerosolized OVA (1% weight/volume OVA). Normal control group did not sensitize with OVA. Oral ingestion of pranlukast and normal saline to the treatment and placebo groups was performed. In the treatment and placebo groups, airway resistance was measured before and after oral ingestion. Serum LTC4 and eosinophilic infiltration of the bronchiolar and peribronchiolar tissues were measured after ingestion in the treatment and placebo groups. RESULTS: Allergen-induced airway constriction developed in 20 (8 in treatment group, 12 in placebo group) among 35 guinea pigs. Airway resistance was significantly decreased at 3 and 6 minutes after OVA challenge in the pranlukast treatment group. In the placebo group, there was no difference of airway resistance between before and after saline ingestion. Serum LTC4 levels showed 348.4 pg/ml in the treatment group, 373.9 pg/ml in the placebo group, and 364.4 pg/ml in the control group. There were no statistically significant difference between treatment and placebo group (p=0.232), and treatment and control group (p=0.501). Eosinophilic infiltrations in the peribronchiolar region per one-microscopic field (X400 high power fields) demonstrated 7.06 in the treatment group, 19.2 in the placebo group, and 4.50 in the control group. There was significant decrement of eosinophilic infiltration in the treatment group which was compared with placebo group (p=0.001). CONCLUSION: These results demonstrate that pranlukast, a cys-LTs receptor antagonist, can attenuate allergen induced early-phase bronchoconstriction and eosinophilic infiltration in the bronchiolar tissues.

Correlation Between Angiotensin-Converting Enzyme(ACE) Inhibitor Induced Dry Cough and ACE Gene Insertion/Deletion(I/D) Polymorphism / 결핵

BACKGROUND: Persistent nonproductive cough is a major adverse effect encountered with ACE inhibitor treatment and the most frequent reason for withdrawal of the drug. The mechanism of cough was postulated to be associated with accumulation of bronchial irritants which are substrates of ACE. It has been speculated that occurrence of this adverse effect is genetically predetermined; in particular, variants of the genes encoding ACE. To investigate this relationship, we determined ACE gene Insertion/Deletion polymorphism in subjects with and without a history of ACE inhibitor-induced cough. METHODS: Among the 339 patients with ACE inhibitor treatment, subjects who developed cough that resolved when not taking medication were designated to cough group and other subjects who did not complain cough were designated to non-cough group. Clinical characteristics of the patients were collected by review of medical records. ACE genotypes were determined by PCR amplification of DNA from peripheral blood RESULTS: 37 patients complained of dry cough(cough group) and 302 patients did not complained of cough(non-cough group). The incidence of ACE inhibitor induced dry cough was 10.9%. There was a preponderance of females in the cough group (M:F=24.3%:75.7%) compared to the non-cough group(M:F=49.7%:50.3%, p=0.004). There was no significant difference in mean age, underlying diseases, and kinds and frequencies of ACE inhibitors and their mean dosage between the both groups. ACE genotypic frequencies were I/I : I/D : D/D = 16.2%:18.9%:64.9% in the cough group and 18.9%:18.2%:62.9% in the non-cough group which showed no significant difference between the both groups(p=0.926). Allelic frequencies were I : D = 25.7%:74.3% and 28.0%:72.0% in the cough and non-cough group respectively and the difference was not significant(p=0.676). CONCLUSION: The incidence of ACE inhibitor-induced cough are 10.9%, and women are more susceptible to ACE inhibitor-induce cough. ACE inhibitor induce dry cough is not associated with ACE gene Insertion/Deletion polymorphism.

The Bronchial Biopsies and Steroid Response in Unexplained Chronic Non-Productive Cough / 결핵

BACKGROUND: The purpose of this study was to examine the causes and pathologic process of chronic non-productive cough as an isolated symptom with a normal spirometry and chest radiograph by investigating clinicopathologic findings. METHOD: We studied 25 adults with chronic non-productive cough over a 3-week period with a normal chest radiograph and pulmonary function tests without any other symptoms. Clinical assessment, cough score, chest and sinus radiograph, pulmonary function tests, methacholine challenge, allergic skin prick test, and bronchoscopy for bronchial biopsies were performed. Subjects were then treated with prednesolone 20 to 30 mg/day for 1 to 2 weeks. RESULTS: The experimental group was divided into two subgroups - those infiltrated with eosinophils, and those infiltrated with lymphocytes depending on eosinophil and lymphocyte counts, both of which were respectively higher than those of the control group. Eosinophils infiltrated group had mean numbers of eosinophil of 89.8 cells/mm(2) while control group's mean was 0.4 cells/mm(2)(P=0.005). Lymphocyte infiltrated group was 4 patients whose mean was 84.3 cells/mm(2) with 28.4 cells/mm(2) of control group(P=0.026). In addition, the mean thickeness of the basement membrane of experimental group was 14.20+/-5.20microM in contrast of control group whose mean was 3.50+/-1.37microM(P=0.001). With the methacholine challenge test, 7 of the 21 eosinophil infiltrated subjects were diagnosed with cough asthma; the other 14 with eosinophilic bronchitis. Three subjects with eosinophilic bronchitis were atopic positive(21.4%) with the skin prick test. In the lymphocyte dominant group, all four subjects were diagnosed with lymphocytic bronchitis. Cough score was improved after steroid treatment in 22 of 25 subjects in the experimental group (88.0%). CONCLUSION: These results suggest chronic non-productive cough as an isolated symptom with a normal spirometry and chest radiograph was associated with airway inflammation by eosinophil and lymphocyte infiltration. The causes for chronic non-productive cough were eosinophilic bronchitis, cough variant asthma, and lymphocytic bronchitis(written in frequency). They further suggest that therapeutic treatment with steroids can provide effective symptomatic relief.

The effects of treatment with cyclophosphamide and methylprednisolone on expression of endothelin-1 in unilateral instillation of paraquat-induced pulmonary fibrosis in guinea pigs / 결핵

BACKGROUND: The herbicide paraquat can cause severe lung injury and fibrosis in experimental animals. In this study we have investigated the changes in lung endothelin-1 levels and immunohistochemical localization in relation to treatment with cyclophosphamide and methylprednisolone in paraquat induced pulmonary fibrosis in guinea pigs. MATERIAL AND METHODS: 29 male Hartley guinea pigs were divided into 4 groups. Group I was normal control. Paraquat was instilled into the lung of guinea pig of group II, III and IV unilaterally. Group II was treated with cyclophosphamide and methylprednisolone. Group III was treated with methlprednisolone. Group IV was not treated. The degree of fibrosis was evaluated by H-E stains and Masson's trichrome stains and cell activity was assessed by endothelin-1 immunohistochemical stains. Statistical evaluation was performed using the Kruskawallis oneway analysis. RESULTS: Paraquat induced an increase in numbers of fibroblasts and total amount of lung collagen in Group IV compared to the normal controls. There was no significant difference in total numbers of fibroblasts between any of paraquat instilled groups, but there was significant increase in total amount of collagen in Group IV compared to group II and III (p<0.05).The treatment of cyclophosphamide and methyprednisolone suppressed the growths of both fibroblasts and collagen, but this suppression was stastically significant only in the case of collagen. ET-1(endothelin 1) immunoreactivities of bronchial epithelium, type II pneumocytes, endothelial cells and fibroblast in group II and III were decreased compared to those in group IV. CONCLUSION: These results demonstrate that ET-1 is an important contributing factor in the pathogenesis of pulmonary fibrosis. ET-1 is synthesized and released by bronchial epithelium, Type II pneumocyte, endothelial cells, alveolar macrophages and fibroblasts.Especially they are associated with alveolar macrophage and fibroblasts. We conclude that combined therapy of cyclophosphamide and methylprednisolone are more effective in the control of ET-1 expression and collagen deposition.