Effects of clinical practice stress and moral sensitivity on clinical competency in nursing students / 한국간호교육학회지

Purpose@#This study was conducted to explore how clinical practice stress and moral sensitivity affect the clinical competency of nursing students. @*Methods@#Participants had completed at least a one year (2 semesters) clinical nursing practicum through K University in D Metropolitan City. A total of 188 nursing students were recruited: third grade (n=104) and fourth grade (n=84). The questionnaires were adopted with clinical practice stress, Korean version of moral sensitivity questionnaire (K-MSQ), and the clinical competency. @*Results@#Clinical competency was positively correlated with patient-oriented care (r=.27, p<.001) and the professional responsibility (r=.32, p<.001) of the moral sensitivity (r=.27, p<.001). The attitude of medical personnel experiencing clinical practice stress shows a significant positive relationship with clinical competency (r=.15, p=.038). The attitude of medical personnel (ß=.09, p=.194) experiencing clinical practice stress, patient-oriented care (ß=.16, p=.041) and professional responsibility (ß=.23, p=.003) of the moral sensitivity explained 12% of the variance in clinical competency (F=9.17, p<.001). Therefore, the influential factors on clinical competency were two sub-factors of moral sensitivity. @*Conclusion@#Moral educational programs should be considered to develop a nursing students' clinical competency.

Incidence of Cholangiocarcinoma with or without Previous Resection of Liver for Hepatolithiasis

BACKGROUND/AIMS: To investigate the incidence of cholangiocarcinoma in patients with hepatolithiasis with or without previous resection of liver. METHODS: From 2002 to 2009, we retrospectively reviewed 117 patients who were diagnosed and treated for hepatolithiasis in Korea University Guro Hospital. Among the 117 patients, 55 patients who were lost during follow-up were excluded, and 62 patients were eligible for analysis. The hepatic resection group (n=25) included patients who underwent left hemihepatectomy (n=2); left lateral segmentectomy (n=10); left lobectomy (n=9); right lobectomy (n=3); or wedge resection (n=1). The nonhepatic resection group (n=37) included transhepatic cholangiographic lithotomy and endoscopic retrograde cholangiopancreatography-treated patients. The mean follow-up period was 47 months. RESULTS: The incidence of cholangiocarcinoma while patients were followed for hepatolithiasis was 12.9% (8/62) (hepatic resection group, three cases [12%] vs nonhepatic resection group, five cases [13.5%]; p=1.000). The mean follow-up period was 53 months (47+/-11 months) until the diagnosis of cholangiocarcinoma. CONCLUSIONS: There was no difference in the incidence of cholangiocarcinoma according to previous liver resections. Patients with hepatolithiasis should be carefully followed up for detection of cholangiocarcinoma even after a previous liver resection.

A Case of Hypopharyngeal Cancer Treated by Endoscopic Submucosal Dissection / 대한소화기학회지

Recent advances in endoscopic instruments, including narrow-band imaging (NBI) and magnification endoscopy, allowed dramatic increase in the early diagnosis of hypopharyngeal cancers. In addition, endoscopic mucosal resection or endoscopic submucosal dissection has recently been used for the treatment of hypopharyngeal cancer at an early stage, especially in Japan. However, to date, there is no published report in Korea. A 68-year-old man was admitted for preoperative evaluation and treatment for known esophageal cancer initially diagnosed at a local clinic. During the evaluation, magnifying endoscopy combined with the NBI system revealed a concurrent hypopharyngeal cancer not detected by initial conventional endoscopy. In this case report, we describe for the first time in Korea a case of early stage hypopharyngeal carcinoma that was successfully treated by endoscopic submucosal dissection with a review of literature.

Treatment Outcomes after Endoscopic Band Ligation of Symptomatic Internal Hemorrhoids / 대한내과학회지

BACKGROUND/AIMS: Elastic band ligation is a well-established method for the treatment of internal hemorrhoids. The aim of this study was to assess the treatment outcomes of flexible endoscopic rubber band ligation of internal hemorrhoids. METHODS: Using a flexible endoscope, 30 patients with symptomatic internal hemorrhoids were evaluated based on change in clinical symptoms (Goligher grade, bleeding score) and endoscopic classifications (range, size) before and after the procedure. RESULTS: Goligher grade and bleeding score showed significant improvement after the procedure (Goligher grade from 2.12 to 0.54, p<0.01, and bleeding score from 1.80 to 0.40, p<0.01). Endoscopic classification scores improved significantly after the procedure (range 3.03 to 1.55, p<0.01, and size from 1.80 to 0.85, p<0.01). As a complication, mild pain developed in 19 patients (90.5%) and severe pain in two patients (9.5%). Most (90.5%) were well controlled by conservative management, but one patient was operated on for hemorrhoidal thrombosis and in another patient the ligated rubber band had to be released promptly for pain relief. One patient (3.3%) experienced mild infection, which was relieved by medical treatment. During the 16.7+/-3.2-month period of follow-up, two patients relapsed, one was treated with additional endoscopic band ligation, and one underwent surgery. CONCLUSIONS: Flexible endoscopic band ligation is an effective and safe method of treatment in patients with symptomatic internal hemorrhoids.

The Effect of Pantoprazole on Bone Turnover in Ovariectomized ICR Mice / 대한내과학회지

BACKGROUND/AIMS: Long-term exposure to proton pump inhibitors is associated with osteoporosis-related fractures; however, the mechanism is unknown. The purpose of this study was to evaluate the effect of pantoprazole on osteoporosis and bone turnover in ovariectomized ICR mice fed a calcium-free diet. METHODS: Ovariectomized female ICR mice were divided into a pantoprazole group (n=10) and a control group (n=10). The mice in the pantoprazole group were given an intraperitoneal injection of pantoprazole at 20 mg/kg twice daily. After 4 weeks, the mice were humanely euthanized, and bone mineral density (BMD) and dry tibia weight were measured. Serum osteocalcin and CTX-1 levels were measured by enzyme-linked immunosorbent assay. The mRNA expression levels of cytokines that stimulate osteoclast differentiation were determined using RT-PCR. Serum calcium, phosphorus, and alkaline phosphatase (ALP) levels were also analyzed. RESULTS: Serum osteocalcin concentration was significantly lower in the pantoprazole group compared with the control group (p=0.023). There was no difference in BMD, dry tibia weight, or serum ALP, calcium, phosphorus, or CTX-1 between the two groups. The expression of interleukin (IL)-1beta was lower in the pantoprazole group compared with the control group, but not significantly lower (p=0.058). The levels of tumor necrosis factor-alpha and IL-6 did not differ between the two groups. CONCLUSIONS: Pantoprazole, a proton pump inhibitor, decreased serum osteocalcin and suppressed IL-1beta expression, suggesting that pantoprazole affects bone formation and resorption in ovariectomized ICR mice. Further studies using larger sample sizes are needed.

Treatment Outcomes after Endoscopic Submucosal Dissection of Large Superficial Rectosigmoid Colon Tumors / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) of a colorectal tumor is technically difficult. This study aimed to analyze the clinical outcomes of superficial large rectosigmoid tumors after ESD. METHODS: Medical records of 15 patients with large rectosigmoid tumors (more than 30 mm), in which ESD performed, were reviewed retrospectively. RESULTS: The mean tumor size was 42.5+/-14.3 mm (range, 30~78 mm). A histological examination revealed a well-differentiated adenocarcinoma in five cases (33.3%), adenoma with high-grade dysplasia in six cases (40%), and low-grade dysplasia in four cases (26.7%). The mean procedural time was 90.5+/-60.7 min (range, 22~246 min). The en bloc resection rate was 86.7%, and the complete resection rate 100%. The lateral resection margin was positive in four cases (26.6%), but no cases with a positive vertical margin were observed. Bleeding occurred in three cases (20%), and all were treated successfully using endoscopic measures. Perforations occurred in three cases (20%); two cases were treated by clipping and the other by a laparotomy. CONCLUSIONS: ESD is a treatment option for superficial large rectosigmoid tumors. Further studies with larger cases and a longer term follow-up are needed to establish the efficacy and safety of ESD for colorectal tumors.

Factors Affecting Complete Small Bowel Study and Diagnostic Yield in MiroCam(R) Capsule Endoscopy

BACKGROUND/AIMS: Mirocam(R) capsule endoscopy has been widely used in Korea; however, data with respect to Mirocam(R) capsule endoscopy is lacking. We have assessed the factors affecting complete small bowel studies and diagnostic yield in Mirocam(R) capsule endoscopic studies. METHODS: We retrospectively analyzed 103 cases that were assessed with Mirocam(R) capsule endoscopy between June 2007 and February 2010 at Guro Korea University Hospital. RESULTS: The mean age of the 103 cases was 55.47 years (range, 16-99 years) and 67 cases (65%) were male. The indications for capsule endoscopy were hematochezia/melena (77 cases, 74.8%), anemia (8 cases, 7.8%), abdominal pain (12 cases, 11.7%), and miscellaneous (weight loss and chronic diarrhea; 6 cases, 5.8%). The mean stomach transit time was 59.9+/-88.3 minutes (range, 1-630 minutes) and the mean small bowel transit time was 396.0+/-131.7 minutes (range, 117-708 minutes). The rate of successfully performing a complete small bowel study was 82.5% (85 cases), and the stomach transit time was a significant factor for a complete small bowel study (OR=0.991, 95% CI=0.984-0.998, P=0.012). The diagnostic yield was 51.5% (53 cases); visual quality was a significant factor in determining the diagnostic yield (OR=6.776, 95% CI=1.32-34.70, P=0.022). CONCLUSIONS: In a Mirocam(R) capsule endoscopic study, short stomach transit time was a significant factor affecting completion of the small bowel study. Achieving excellent visual quality by good bowel preparation was a significant factor for improving the diagnostic yield.

Anticancer Effects of Astaxanthin and alpha-tocopherol in Esophageal Cancer Cell Lines

BACKGROUND/AIMS: Astaxanthin (AX) has been attributed with potential for protecting the organism against different types of cancer due to its anti-oxidant activity. Also several in vivo and in vitro studies suggest certain naturally occurring vitamin E (i.e. alpha-tocopherol) as promising anticancer agents. We assessed the effect of AX and alpha-tocopherol (AT) respectively and their combination on human esophageal cancer cell lines to investigate the mechanism of anticancer effect and their therapeutic potential. MATERIALS AND METHODS: Two human esophageal cancer cell lines (TE-1, TE-4) were exposed to AX (6 to 10 microg/mL) and AT (20 to 100 microM) for 24 hours. Quantification of proliferation was performed by MTT assay. Cell cycle machinery proteins such as p-AKT, p-p38, cyclin D1, p27 and caspase-3 were investigated by Western blot. RESULTS: Significant inhibition of cell proliferation of AX and AT was observed in TE-4 cell line by a dose-dependent manner. Furthermore, AX and AT as single agents increased the protein expression of p27 and cleaved caspase-3 in TE-4 cell line. The combination of the two agents decreased the expression of cyclin D1, however they did not demonstrate pro-apoptotic effect. CONCLUSIONS: AX and AT as single agents are effective at inhibition of cell proliferation and induce apoptosis by the modulation of cell cycle machinery proteins in esophageal cancer cell lines. However, our data could not suggest that their combination has any cooperative apoptotic effect.

Treatment Outcome and Mortality among Patients with Multidrug-resistant Tuberculosis in Tuberculosis Hospitals of the Public Sector

This study was conducted to evaluate treatment outcome, mortality, and predictors of both in patients with multidrug-resistant tuberculosis (MDR-TB) at 3 TB referral hospitals in the public sector of Korea. We included MDR-TB patients treated at 3 TB referral hospitals in 2004 and reviewed retrospectively their medical records and mortality data. Of 202 MDR-TB patients, 75 (37.1%) had treatment success and 127 (62.9%) poor outcomes. Default rate was high (37.1%, 75/202), comprising 59.1% of poor outcomes. Male sex (adjusted odds ratio [aOR], 2.91; 95% confidence interval [CI], 1.13-7.49), positive smear at treatment initiation (aOR, 5.50; 95% CI, 1.22-24.90), and extensively drug-resistant TB (aOR, 10.72; 95% CI, 1.23-93.64) were independent predictors of poor outcome. The all-cause mortality rate was 31.2% (63/202) during the 3-4 yr after treatment initiation. In conclusion, the treatment outcomes of patients with MDR-TB at the 3 TB hospitals are poor, which may reflect the current status of MDR-TB in the public sector of Korea. A more comprehensive program against MDR-TB needs to be integrated into the National Tuberculosis Program of Korea.

Treatment Outcome and Mortality among Patients with Multidrug-resistant Tuberculosis in Tuberculosis Hospitals of the Public Sector

This study was conducted to evaluate treatment outcome, mortality, and predictors of both in patients with multidrug-resistant tuberculosis (MDR-TB) at 3 TB referral hospitals in the public sector of Korea. We included MDR-TB patients treated at 3 TB referral hospitals in 2004 and reviewed retrospectively their medical records and mortality data. Of 202 MDR-TB patients, 75 (37.1%) had treatment success and 127 (62.9%) poor outcomes. Default rate was high (37.1%, 75/202), comprising 59.1% of poor outcomes. Male sex (adjusted odds ratio [aOR], 2.91; 95% confidence interval [CI], 1.13-7.49), positive smear at treatment initiation (aOR, 5.50; 95% CI, 1.22-24.90), and extensively drug-resistant TB (aOR, 10.72; 95% CI, 1.23-93.64) were independent predictors of poor outcome. The all-cause mortality rate was 31.2% (63/202) during the 3-4 yr after treatment initiation. In conclusion, the treatment outcomes of patients with MDR-TB at the 3 TB hospitals are poor, which may reflect the current status of MDR-TB in the public sector of Korea. A more comprehensive program against MDR-TB needs to be integrated into the National Tuberculosis Program of Korea.

The clinical significance of interferon inducible protein-10 in patients having chronic hepatitis C with genotype I / 대한내과학회지

BACKGROUND/AIMS: Recent studies have shown that serum interferon gamma-inducible protein-10 (IP-10) concentration decreased after pegylated interferon and ribavirin therapy, and was associated with a sustained virologic response (SVR). The aim of this study was to investigate the clinical significance of the pretreatment IP-10 level and change in serum IP-10 level between 1 month before and after treatment and its association with various virologic responses in patients having chronic hepatitis C (CHC) with genotype 1 undergoing pegylated interferon and ribavirin therapy. METHODS: Thirty-six patients having CHC with genotype I undergoing pegylated interferon and ribavirin therapy who had available stored sera 1 month before and after treatment were enrolled retrospectively. Serum IP-10 levels were measured by ELISA. Serum HCV RNA was measured by RT-PCR (detection limit0.05). The change in serum IP-10 between 1 month before and after treatment had no clinical meaning based on various virologic responses (p>0.05). CONCLUSIONS: The level of pretreatment IP-10 and change in IP-10 level between 1 month before and after treatment were not predictive factors of a SVR. Additional large-scale studies to determine the SVR-predicting role of serum IP-10 levels in patients with CHC are needed.

Item Analysis of Clinical Performance Examination Using Item Response Theory and Classical Test Theory / 한국의학교육

PURPOSE: The objectives of this study were: 1) to analyze Clinical Performance Examination(CPX) items using item response theory(IRT) and classical test theory(CTT) and 2) to discuss how to apply and interpret these results in order to improve the quality of CPX items. In addition, we intended to explore statistical procedures in order to merge examination data from several different medical schools. METHODS: The subject of the study was the 2005 CPX examination data from 10 medical schools located in Seoul and the Kyunggi province. For merging data from ten different medical schools, Levene's test for homogeneity of variances was used. Homogeneous group selection was conducted based on ANOVA or Kruskal-Wallis' test and Tukey's multiple comparisons appropriately. The generalized partial credit model was applied to analyze polytomous items and the 2-parameter logistic model was used to analyze dichotomous items. RESULTS: Data from 8 medical schools were incorporated into the analysis. The result of the discrimination index by IRT was different from that of CTT in both polytomous and dichotomous items. Discrimination index from IRT tended to be lower than that of CTT. Difficulty index of dichotomous items of two models was correlated well with each other. However, for polytomous items, IRT model provided more information than CCT. CONCLUSION: We discovered that the CPX items were mostly easy in terms of difficulty index, and the result from IRT and CCT model did not correlated well in the discrimination index. IRT may provide more detailed information for polytomous items, but the checklist and criteria of scoring system should be cautiously reviewed.

Characteristics of necrotizing fasciitis in three university hospitals in Korea / 대한내과학회지

BACKGROUND: Necrotizing fasciitis is a life threatening severe soft tissue infection primarily involving the fascia and the subcutaneous tissue with thrombosis of the cutaneous microcirculation. The purpose of the study was to analyze the microbiological and clinical characteristics of necrotizing fasciitis in Korea and to suggest adequate antibiotic therapy. METHODS: We retrospectively reviewed medical records of three Soonchunhyang University Hospitals in Seoul, Bucheon and Cheonan. Patients admitted for skin graft or secondary treatment were excluded. Blood cultures were obtained at the time of admission and pus cultures were obtained at the time of first operative debridement. RESULTS: Twenty two patients (16 males, 6 females, 16~82 years old, median age: 59 years old) were enrolled for this study. Fourteen pateints underwent surgical treatment and 2 of them died of necrotizing fasciitis. Gram positive organisms were isolated in 13 cases and gram negative organisms were isolated in 11 cases. Third generation cephalosporin resistant gram negative organisms were isolated in 3 cases. CONCLUSIONS: This study suggest that characteristics of necrotizing fascitis in Korea were; high proportion of aged person, predominance of type 2 necrotizing fascitis and increasing tendency of third generation cephalosporin resistant gram negative bacterial infections. Consequently, initial choice of empirical antibiotics for necrotizing fasciitis should consider 3rd generation cephalosporin resistant gram negative organisms. Prompt surgical debridement and adequate antimicrobial therapy are mandatory for improved survival.

Tibial Torsion in Children of the Jeju Area / 소아과

PURPOSE: Internal tibial torsion is prevalent in East Asian countries such as Korea and Japan, where sitting on the floor is common behavior. Internal tibial torsion or excessive lateral tibial torsion may cause esthetical, functional, or psychological problems and also may induce degenerative arthritis in older age. The purpose of this study is to measure the tibial torsion in children of the Jeju area. METHODS: Tibial torsion was measured in 1,042 lower extremities of 521 children from one to 12 years of age. The values of transmalleolar angles were analyzed for each age group divided by 6 months. Quadratic and linear regression models were used to fit patterns of changes in mean values of transmalleolar angles. The age at seven, which provides the highest coefficient of determination for quadratic regression analysis, was used as a cut-off point to fit different statistical models. RESULTS: The mean transmalleolar angle was 0.10+/-5.79degrees in all children, 0.90+/-5.49degrees in males, and -0.80+/-5.97degrees in females. The value was 4.25+/-4.04 in 1 year of age, gradually decreased to the lowest level of -1.98degrees in four years and seven months of age, increased again with age until it reached 0.67+/-1.10degrees at seven years of age, and stayed at that level thereafter. CONCLUSION: Internal tibial torsion in infancy is known to correct spontaneously in the normal developing process. But in this study, the mean transmalleolar angle in children of Jeju area annually decreased after one year of age; to the lowest angle at four years and seven months of age; increased again gradually to the age of seven; and persisted in that level, about 10degrees less than western children, not correcting further thereafter. These findings suggest tibial torsion might be caused by lifestyle, especially sitting on feet. To prevent abnormalities of joints and gaits, early diagnosis of tibial torsion in childhood and posture correction or early treatment when needed, seems to be necessary.

Effect of Collagen Gel with Growth Factor and Wrapping Materials on Fibrovascularization of Porous Orbital Implant

PURPOSE: To determine the effect of bFGF complexed collagen gel, which allows constant release of bFGF along with biodegradation of the collagen gel. The specific study purpose was to determine whether it can accelerate the fibrovascular ingrowth into wrapped HA-coated porous alumina and to verify the safety of new wrapping materials. Synthetic polyester-urethane (Neuropatch(R)) and lyophilized bovine pericardium (Lyoplant(R)) were compared to donor sclera for the fibrovascular ingrowth into HA-coated porous alumina. METHODS: The experimental and control groups, each consisting of 9 rabbits were wrapped with each wrapping materials (3 rabbits per wrapping material). The experimental group underwent pretreatment of bFGF-collagen gel while the control group did not. The fibrovascular ingrowth was compared at 2 and 4 weeks after implantation. Western blot analysis was conducted at 4 weeks using antibodies against CD141 and laminin. The rate of fibrovascular ingrowth was fastest in orbital implant wrapped with Lyoplant(R). RESULTS: Histopathologic examinations at 2 weeks showed no differences in distance and percentage area of fibrovascular ingrowth. Histopathologic examinations at 4 weeks showed that pretreatment of bFGF-collagen gel increased the fibrovascular ingrowth in the experimental group. Western blot analysis on experimental group also showed that the expressions of CD141 and laminin were increased by bFGF-collagen gel, thereby indicating that the fibrovascular proliferations were accelerated by bFGF released from the complex. CONCLUSIONS: bFGF-collagen gel increased the rate and degree of fibrovascular growth into hydroxyapatite-coated porous alumina by releasing bFGF as the collagen gel biodegraded. Both Lyoplant(R) and Neuropatch(R) were evaluated as safe for substitution of the donor sclera.

Minimally Invasive Percutaneous Plate Fixation for Distal Tibia Shaft Fractures / 대한정형외과학회잡지

PURPOSE: To review the efficiency of the minimally invasive plate fixation technique for distal tibia shaft fractures. MATERIALS AND METHODS: Between April 1999 and March 2001, 15 patients with distal tibia fractures were treated operatively by minimally invasive percutaneous plate osteosynthesis. There were 10 men and 5 women with an average age of 51 years (range, 20 to 72 years). The patients were followed for an average of 19 months (range, 12 to 30 months). In all patients, the center of fracture was in the distal tibia and either entirely extraarticular or with minimally displaced extension into the ankle joint. The type of fracture was evaluated using the AO/OTA classification. So far as general condition of patients permitted, temporary reduction of fractures with or without passive traction or distractor was performed under intraoperative fluoroscopy. About a 2 cm to 3 cm incision was made in the metaphyseal region proximal or distal to the fracture site, and screws fixation was performed percutaneously. A clinical assessment was evaluated according to Olerud and Molander ankle score. RESULTS: All of the fractures healed with an average time of 15 weeks (range, 10 to 25 weeks). No patient had an angular deformity more than 5 degrees, or shortening of more than 1 cm. All patients had an excellent or satisfactory ankle function. Checkrein deformity was observed in one patient and superficial infections occurred in two, but no patient experienced deep infection or skin necrosis. CONCLUSION: As compared with conventional open reduction and internal plate fixation, minimally invasive percutaneous plate osteosynthesis technique was found to be an effective method of treating distal tibia fractures, because it facilitates the rehabilitation more rapid patient rehabilitation, and induces osteosynthesis with reduced of the rates of infection and nonunion.

The Results of Cyanoacrylate Glue Application for Corneal Perforation and Impending Perforation

PURPOSE: To investigate the effectiveness of cyanoacrylate glue application in cases of corneal perforation or impending perforation due to refractory keratitis. METHODS: Cyanoacrylate glue was applied on 6 cases of fungal keratitis, 3 cases of herpetic keratitis, and 3 cases of bacterial keratitis from July 1998 to June 2002. 2 cases were corneal perforations and 10 were impending perforations. Cyanoacrylate glue was applied on stromal melting area including normal epithelium. When fibrovascular tissue grew beneath the glue sufficiently, glue was removed. When glue was sloughed off spontaneously or fibrovascular tissue was found to be insufficient, glue was reapplied. RESULTS: After average follow up of 25 weeks, the corneal surface was stabilized in 11 eyes except 1 case of fungal keratitis that had broad area of stromal melting(5.4mm). After use of glue, process of stromal melting was found to be discontinued. As fibrovascular tissue grew up beneath the glue, corneal surface became stable. Average diameter of stromal melting area and of glue application area was 4.0mm and 4.4mm respectively. Average duration of glue application was 17 weeks. CONCLUSIONS: Cyanoacrylate glue application appears to be an effective and convenient method in cases of corneal perforations and impending perforations associated with advanced and extensive fungal, bacterial, and herpetic keratitis with active keratolysis.

Coagulation Disorders of Idiopathic Avascular Necrosis of the Femoral Head in Korean / 대한정형외과학회잡지

PURPOSE: We investigated coagulation disorders in Korean patients of idiopathic avascular necrosis of the femoral head. MATERIALS AND METHODS: Ten laboratory parameters related with coagulation pathway were measured and analyzed in fifty-three patients with idiopathic avascular necrosis of the femoral head and compared the results with those of thirty-one healthy persons. RESULTS: Differences in the values of plasminogen activator inhibitor and D-dimer in the two groups were statistically significant (p<0.05). The number of three or four abnormal parameters in the patient group was nearly twice that of the control. Hypofibrinolytic activity, determined by increased plasminogen activator inhibitor and lipoprotein(a), were observed in eleven cases (20.8%) of the patient group. CONCLUSION: The abnormal results that were observed in the patient group may contribute to the predisposition of thrombotic venous occlusion in the head of the femur, leading to avascular necrosis of the femoral head.

Congenital Tracheoesophageal Fistula in an Adult / 대한흉부외과학회지

Congenital esophago-respiratory fistulae in adults have rarely been reported. Moreover, most of those are the cases of bronchoesophageal fistulae, that is to say esophago-lower respiratory fistulae. We experienced case of a congenital tracheoesophageal fistula in an adult, not a bronchoesophageal fistula. At our hospital, a 20-year-old male with recurrent episodes of a paroxysmal(especially postprandial) cough, respiratory infection and relative growth retardation had been diagnosed by using esophagography and esphagoscopy as having a congenital tracheoesophageal fistula with a concomittant esophageal diverticulum. The surgical correction was done successfully. We are excited to report a case of a congenital tracheoesophageal fistula in an adult, which is believed to be the first case of its kind in Korea.

Transsternal Approach for BPF closure: A Case Report / 대한흉부외과학회지

A patient with post-pneumonectomy empyema was treated sucessfully by modification of Clagett's operation after closure of bronchopleural fistula using a transsternal, transpericardial approach. His primary disease was pulmonary tuberculosis, and he had a past history of left upper lobe lobectomy 34 year ago. Recently recurred pulmonary tuberculosis with aspergilloma in the remaining left lung, empyema with bronchopleural fistula had developed on the post-operative 4th day after completion pneumonectomy. Closed thoracostomy was done at the lowest point of the left pleural cavity immediately. The pleural cavity was irrigated with small amount of normal saline through pigtail catheter. The 2nd operation was done by closure of bronchopleural fistula using a stapler through transsternal, transpericardial approach, and then the pleural space was irrigated with normal saline with Tobramycin which shows sensitivity to isolated organism from pleural cavity. After negative conversion of pleural fluid culture, we performed modified Clagett's operation under local anesthesia. The patient had no evidence of recurrence of empyema and discharged from hospital after 10 days of the 3rd procedure.