Current status of invasive fungal infection in pediatric intensive care unit / 中国小儿急救医学

The invasive fungal infection( IFI)in PICU has increased steadily during the recent years. Candida spp. and Aspergillus spp. are the most frequently fungi in children. Candida spp. is the leading cause and invasive Candida spp. Infection( ICI)is approximately five times frequency than invasive Aspergillus spp. Infection( IAI). The attributable mortality of ICI or IAI remains different mainly because of different basic diseases. Stay in the PICU presents risk factors for ICI especialy using central venous catheter,parenteral nutrition,dialysis,mechanical ventilation,and prolonged antibiotics application. The patients with hematologic malignancies and leukemia are higher prevalence of IAI who were treated with cytotoxic or immunosuppres-sive drugs,broad-spectrum antibiotics and stem cell transplantation. The most important challenge remains to propose targeted prophylaxis and to identify IFI earily in high risk critically ill children in PICU.

The Results of Gastric Cancer Surgery during the Early Stage of a Training Hospital

PURPOSE: Konkuk University Hospital (KUH), which opened in September 2005, is currently categorized as a secondary hospital. Early on after its establishment, the surgical residents and nurses were relatively inexperienced in the treatment of stomach cancer. Therefore, the quality of surgery for stomach cancer at KUH may be different from that of the existing large-scale tertiary hospitals. The purpose of this study is first to investigate the clinicopathological characteristics of the gastric cancer patients at the KUH, and second to compare our morbidity & mortality rates with those of previous studies, and we also analyzed the risk factors of morbidity at the early stage of a training hospital. MATERIALS AND METHODS: This study retrospectively collected the clinicopathological characteristics and the post-operative morbidity rates and mortality rates with using the electronic medical records of all the patients who went under a gastric cancer operation at KUH from September 2005 to April 2008. RESULTS: The total number of gastric cancer patients who underwent operation was 201. The morbidity rate and death rate at KUH were 10.4% and 0.5%, respectively. The morbidity has increased with an older age. The other variables had no influence on morbidity. CONCLUSION: The morbidity rate, death rate and the clinicopathological characteristics of gastric cancer patients at KUH were similar to those of the previous reports. We found that age is the main factor affecting the morbidity rate after stomach cancer surgery. For further surgical qualification of stomach cancer surgery at KUH, it is necessary to collect the survival data of patients who undergo stomach cancer surgery.

Arterial Switch Operation: The Technical Modification of Coronary Reimplantation and Risk Factors for Operative Death / 대한흉부외과학회지

BACKGROUND: Anatomic correction of the transposition of the great arteries (TGA) or Taussig-Bing anomaly by means of the arterial switch operation is now accepted as the therapeutic method of choice. This retrospective study was conducted to evaluate the risk factors for operative deaths and the efficacy of technical modification of the coronary transfer. MATERIAL AND METHOD: 85 arterial switch operations for TGA or Taussig-Bing anomaly which were performed by one surgeon from 1994 to July 2002 at Dong-A university hospital were included in this retrospective study. Multivariate analysis of perioperative variables for operative mortality including technical modification of the coronary transfer was performed. RESULT: Overall postoperative hospital mortality was 20.0% (17/85). The mortality before 1998 was 31.0% (13/42), but reduced to 9.3% (4/43) from 1998. The mortality in the patients with arch anomaly was 61.5% (8/13), but 12.5% (9/72) in those without arch anomaly. In patients who underwent an open coronary reimplantation technique, the operative mortality was 28.1% (18/64), but 4.8% (1/21) in patients undergoing a technique of reimplantation coronary buttons after neoarotic reconstruction. Risk factors for operative death from multivariated analysis were cardiopulmonary bypass time (> = or 250 minutes), aortic cross-clamping time (> = or 150 minutes), aortic arch anomaly, preoperative event, and open coronary reimplantation technique. CONCLUSION: Operative mortality has been reduced with time. Aortic arch anomaly and preoperative events were important risk factors for postoperative mortality. However atypical coronary artery patterns did not work as risk factors. We think that the technical modification of coronary artery transfer played an important role in reducing the postoperative mortality of arterial switch operation.