Health-Related Quality of Life in Korean Patients with Chronic Diseases / 대한류마티스학회지

OBJECTIVE: Few studies have examined the impact of chronic diseases on populations using a comprehensive health-related quality of life (HRQOL) in Korea. We assessed HRQOL of patients with 16 common chronic diseases. METHODS: We interviewed patients with chronic diseases (n=980) and healthy control (n=288) using two HRQOL measurements: Korean Medical Outcome Study Short Form-36 (KSF-36) and Korena EuroQol-5 Dimensions (KEQ-5D), and questions on sociodemographic and clinical characteristics. RESULTS: Each illness had a distinctive profile. Among disease groups, the KSF-36 global health score was highest in DM and lowest in fibromyalgia. The KSF-36 physical component summary score was highest in DM and lowest in osteoarthritis . The KSF-36 mental component summary score was highest in hypertension and lowest in fibromyalgia. The KEQ-5D utility score was highest in DM and lowest in fibromyalgia. The KEQ-5D visual analog score was highest in DM and lowest in liver cirrhosis. In correlation analysis, the KSF-36 physical component summary, mental component summary and five domains in KEQ-5D were well correlated with each others. CONCLUSION: Health related quality of life in Korean patients with chronic disease is lower than healthy control. Patients with hypertension and DM registered the two highest scores in global health but patients with fibromyalgia reported the worst health experience in global health.We can compare the profiles of the groups and determine the relative impact on the patients of the various diseases and these data will provide a baseline of the current health related quality of life of individuals suffering from a variety of conditions.

The Relationship between Tumor Stage and the Expression of Multiple Drug Resistance, Neovascularization and Tumor Proliferative Activity in Breast Cancer / 한국유방암학회지

BACKGROUND: Breast cancer is supposed that its biological behavior should be changed in some relationship with the advancement of tumor. P-glycoprotein is the well-known nuclear protein which shows multiple drug resistance, and its expression means the resistance to various chemotherapeutic agents including anthracyclines. Angiogenesis was also suggested to have an important role in tumor progression and metastasis, which has been considered to be one of valuable independent prognostic factors. Tumor proliferative activity also has been thought to be very useful as a factor representing the biological behavior of tumor, but its role isn't fully understood yet. In this study we aimed to observe how these factors are expressed with any relationship according to the tumor stage and to find the feature of its expression in each stage and its clinicopathologic significances. MATERIALS AND METHOD: 62 cases of patients histologically proven into invasive ductal carcinoma, who were diagnosed and treated at the Department of Surgery, Chonnam National University Hospital, were selected. In order to estimate the staining results accurately, we classified the expression grades of Pgp into 5 classes according to the count of immunostained cells after immunohistochemical staining. Angiogensis was determined by the mean count of microvessels measured by image analyzer moving more than 40 fields with 200 folds magnification after immunohistochemical staining for CD34. Tumor proloferative activity were presented in percentage by counting the positively immunostained cells in more than 500 tumor cells after immunohistochemical staining with Ki67. Statistical evaluation was done by Mann-Whitney test and we determined that the result showing p-value less than 0.05 is statistically significant. RESULTS: The mean that age was 49 year(from 33years to 82years) and the stage distribution was stage I: 4 patients, stage II a : 25, stage II b : 18, stage III a : 7, stage III b : 3, and stage IV : 5 patients. In spite of Pgp expression tended to increase as the stage advanced, it did not show any ststistically significant difference(P=0.165). Although Ki67 score representing tumor proliferation activity was observed from 0% to 30.8%, any significant differences according advancement of stage were not found(P=0.850). Tumoric angiogenesis also did not show any statistical difference according to advancement of stage(p=0.189). CONCLUSIONS: We could not find any significant proportional correlationship between the tumor stage and Pgp expression, tumor proliferative activity, and angiogenesis. Therefore, the clinicopathologic significances of these factors are supposed to determined an individual biological feature of the tumor irrespective of stage.

Experimental Study of Heterograft Method on the Healing Process of Long Bone Defect in Rabbits / 대한정형외과학회잡지

Bone grafts are used in the repair of segmental bone loss caused by severe trauma, bone tumors and infection, and to enhance bone healing in ununited fractures. Autograft is the most frequently used and the most effective method, but because of inadquate supply and additional operative morbidity, allograft or heterograft could be used. Heterograft has been shown to be poorly tolerated by the host and ineffective in providing an osteogenic system. The objective of this study is to observe healing process of a segmental defect of long bone following to heterograft, and to compare the difference of histologic process between autograft and hetero graft. Twenty-four white rabbits weighing 1,000 to 2,000 grams were used for the experiment. A segment measuring three times the diameter of the ulna shaft (1.5 to 2cm) of rabbit was resected with its periosteum. Twenty-four white rabbit were divided into three groups (control, autograft, heterograft group) according to graft methods, each group comprising of eight rabbits. The animals were sacrificed at 2, 4, 8 and 12 weeks after the experimental procedures and were periodically evaluated by radiographs and histology. The obtained results were as follows: 1. The results of the radiological evaluation showed that no ungrafted ulnar defects (control group) healed. In the heterograft group, partial union was observed from 8 weeks and complete union was obtained on 12 weeks. In the autograft group, partial union was observed on 2 weeks and complete union was obtained on 4 weeks. 2. The results from histological examination showed that the ungrafted ulnae did not heal across the defect but some immature trabeculae were founded on the edges of the defect. In the heterograft group, immature trabeculae were appeared from 4 weeks and defects were substituted with mature trabeculae on 12 weeks. In autograft group, defects were substituted with immature trabeculae on 2 weeks and with mature trabeculae on 4 weeks. As seen in the results of the experiment, union could be obtained with the heterograft, but needed more long time than autograft. Though the autograft is the most effective graft method in bone defect or non-union, above results suggest the heterograft as the alternative method in the treatment of large bone defect, in a multioperated patient, or in the children or the elderly, combined with autograft or alone.

Intraarticular Arthroscopic Finding in Grade III MCL Rupture / 대한정형외과학회잡지

The medial collateral ligament is the most commonly injured ligamentous structure of the knee. The management of the medial collateral ligament injuries were divided into surgical and conservative treatment. More recently, many investigators reported that isolated medial collateral ligament injuries did well under non-operative treatment. So, arthroscopic examination of the knee to rule out other intraarticular pathologic conditions such as cruciate ligament injuries, meniscal tear and osteochondral lesion is essential. From October 1993 to April 1995, we treated 45 cases of Grade III medial collateral ligament injuries and arthroscopic finding for cruciate ligament, meniscus, bony structure were analized in these cases. The result were as follows; 1. Anterior cruciate ligament injury:37.5% in +1 degree, 42.8% in +2 degree, 86.7% in +3 degree 2. Posterior cruciate ligament injury:12.5% in +1 degree, 13.4% in +2 degree, 33.3% in +3 degree 3. Meniscal injury:12.5% in +1 degree, 21.3% in +2 degree, 33.4% in +3 degree 4. Medial capsular ligament injury was more frequent and severe in the meniscofemoral ligament than in the meniscotibial ligament, but that finding was not correlated with degree of medial instability.

The Role of Chest CT Scans in the Management of Empyema / 결핵

BACKGROUND: To decide the optimal antibiotics and application of chest tube, examination of pleural fluid is fundamental in the management of empyema. Some criteria for drainage of pleural fluid have been recommended but some controversies have been suggested. Recently, newer radiologic methods including ultrasound and computed tomography scanning, have been applied to the diagnosis and management of pleural effusions. We undertook a retrospective analysis of 30 patients with pleural effusion who had CT scans of the chest in order to apply the criteria of Light et at retrospectively to patients with loculation and to correlate the radiologic appearance of pleural effusions with pleural fluid chemistry. METHOD: We analyzed the records of 30 out of 147 patients with pleural effusion undergoing chest CT scans. RESULTS: 1) Six of the pleural fluid cultures yielded gram negative organisms and three anaerobic bacterias and one Staphylococcus aureus and one non-hemolytic Streptococci. No organism was cultured in nineteen cases(63.0%). 2) The reasons for taking chest CT scans were to rule out malignancy or parenchymal lung disease(46.7%), Poor response to antibiotics(40.0%), hard to aspirate pleural fluid(10.0%) and to decide the site for chest tube insertion(3.3%). 3) There was no significant correlations between ATS stages and loculation but there was a tendency to Inoculate in stage III. 4) There was a significant inverse relationship between the level of pH and loculation(P<0.05) but there appeared to be no relationship between pleural fluid, LDH, glucose, protein, loculation and pleural thickening. 5) In 12 out of 30, therapeutic measures were changed according to the chest CT scan findings. CONCLUSION: We were unable to identify any correlations between the plerual fluid chemistry, ATS stages and loculations except pH, and we suggest that tube thoracotomy should be individualized according to the clinical judgement arid serial observation. All patients with empyema do not need a chest CT scan but a CT scan can provide determination of loculation, guiding and assessing therapy which should decrease morbidity and hospital stay.

A Clinical Study on the Multiple Pin Fixation of the Femoral Neck Fracture / 대한정형외과학회잡지

Fractures of the neck of the femur have always presented great challenges to orthopedic surgeons and still remain as one of the unsolved fracture as far as treatment and results are concerned. With life expectancy increasing with each decade, becoming more and more patients suffering from femoral neck fractures and their sequelae. The objoct of this study is to observe the relationship between the clinical results and the degree of displacement of fracture, degree of osteoporosis and duration between injury and operation in femoral neck fractures treated with multiple pin fixation. The author clinically analyzed 56 patients of the femoral neck fractures treated with closed reduction and multiple Knowles pinning followed by more than 1 year at Korea University Hospital from January 1986 to December 1991. There were 20 male and 36 female. The age of patients were ranged from 32 to 88 years(average:65.1 years) and most commonly occurred in 7th decade (23cases,41%). The most common cause was slip down(44 cases;79%). The most common type of fracture was stage III (48%) following to Gardens classification. The obtained results were as follows; 1. Union occurred in 49 cases(88%). 2. Among fifty-six cases, five cases(9%) of avascular necrosis, two cases(4%) Of non-union, two cases(4%) of malunion and one case of posttraumatic arthritis were occurred. 3. The functional results by Lunceford criteria were excellent in 30 cases(53% ), good in 13 cases(23%), fair in 5 cases(10%) and poor in 8 cases(14%). 4. Unsatisfactory results were noted in Garden stage II or IV, osteoporosis below Singh index 3 and delayed treatment over 1 week. Above results suggest that multiple Knowles pinning in femoral neck fractures offers high union rate and low complication rate, and so is also one of salvaging method of femoral head.

Clincal Manifestations of Patients Dying of Severe Community Acquired Pneumonia / 결핵

BACKGROUND: In 1987, the British Thoracic Society (BTS) subjected an extensive list of patient variables to statistical analysis in a prospective study of prognosis in 453 adults with communityacquired pneumonia and, subsequently published guidelines for management of severe community acquired pneumonia. It was hoped that those at risk of dying from community acquired pneumonia could be easily identified and treated appropriately, thereby reducing mortality. To date, severe community acquired pneumonia has not been well studied in Korea. Therefore, we studied retrospectively 10 patients dying of severe community acquired pneumonia in Dongsan Hospital to see clinical manifestations of .dying of severe community-acquired pneumonia. METHODS: Between July 1987 and july 1993, 498 patients were admitted to Keimyung University Dongsan Hospital with community acquired pneumonia, and 77 of them received intensive care. Of the 77 patients, 10 patients died. We reviewed medical records of these patients. RESULTS: 1) The mean age of the patients was 56.2 years(range, 25 to 75 years). There were 7 men and 3 women. Seven patients(70%) were older than 60years of age. 2) The clinical features on admission were as follows: tachypnea, hypoxemia, mental change, cyanosis, leukopenia, leukocytosis, azotemia, hypotension, hypoalbuminemia in order of frequency. Three patients had one abnormal physical finding, 3 patients had 2, 2 patients had 3, and 2 patients had none of these abnormal physical findings. All patients had at least one of the abnormal laboratory findings. 3) A potential bacterial pathogen was isolated in sputum culture from 2 patients. One was E.coli, the other Enterobacter species. Sputum stain were positive in eight cases (G(+)cocci in six, G(+)cocci and G(-)bacilli in two). 4) Features of respiratory failure were the main reasons for ICU transfer, but two patients were transferred only following a cardiac or respiratory arrest in the general ward. 5) The mean of 2.7 different antibiotics were given to the patients. The aminoglycoside and first generation cephalosporin were the most frequently prescribed antibiotics, followed by the third generation cephalosporin and vancomycin. The most frequently prescribed antibiotics combination was a 1st generation cephalosporin plus an aminoglycoside. 6) Save patients death(70%) occured after admission within the first five days, and a mean duration of hospitalization was 11.2 days. CONCLUSION: As the results show most death occured within the first days after admission and aged patients; consequently, an aggressive intensive treatment should be provided early to the patients with severe community acquired pneumonia, and we should pay more attention to the aged patients.

Toe to finger transfer in traumatic amputated index finger / 대한정형외과학회잡지

No abstract available.

Tendocutaneous free flap transfer from dorsum of the foot / 대한정형외과학회잡지

No abstract available.