OBJECTIVES: Over the last 30 years, despite the increasing sophistication in medical care, the mortality of acute renal failure(ARF) has remained virtually unchanged at 40-50%, but the reasons remain unknown. This study intend to identify prognostic risk factors influencing survival and predict the mortality in ARF patients. METHODS: We retrospectively analyzed 152 patients with ARF who required renal replacement therapy, or whose serum creatinine level above 5 mg/dl, from Jan. 1988 to May. 1995. Multiple factors which may influence mortality were evaluated by univariate and multivariate analysis. RESULTS: 1) Of the 152 patients, 97 were male and 55 were female. The mean age was 47 years and the overall mortality was 36.8%. 2) Based on the univariate analysis, age>60 years, cause of ARF, APACHE II score, number of failing organs, peak serum creatinine level, PaO2, coma, hypotension, ARDS, GI bleeding, ventilatory support, need for antiarrhythmics, DIC, cardiovascular failure, pulmonary failure, neurological failure, and gastrointestinal failure were all significant factors discriminating between survivors and nonsurvivors(p<0.05) 3) By multivariate analysis, hypotension, coma, ventilatory support, and age over 60 years were significant independent predictors influencing survival in ARF patients and logistic equation and logit score were as follows : z=-2.04+1.32(age over 60)+2.18(hypotension)+2.88 (ventilatory support) + 3.28(coma) P=ez/(1+ ez) 4) In ROC(receiver-operating characteristic)curve, when the cutoff point was 0.2, maximum sensitivity was 75% and maximum specificity was 82%. CONCLUSION: In ARF, prognostic risk factors for mortality were age over 60 years, hypotension, assisted ventilation and coma. The logit score by multiple analysis is a reliable predictor of mortality in ARF patients, however the further studies are required to confirm these results.
Acute Kidney Injury* ; APACHE ; Coma ; Creatinine ; Dacarbazine ; Female ; Hemorrhage ; Humans ; Hypotension ; Male ; Mortality* ; Multivariate Analysis ; Renal Replacement Therapy ; Retrospective Studies ; Risk Factors* ; Sensitivity and Specificity ; Survivors ; Ventilation

To determine the safety and efficacy of using subconjunctival 5- fluorouracil(5-FU) injection on high risk eyes for filtration failure who had undergone trabeculectomy with intraoperative mitomycin C(MMC), we conducted a retrospective analysis of 17 eyes of 17 consecutive patients. Intraoperative MMC exposure (0.4mg/ml) was followed by supplemental postoperative 5-FU injection as necessary to titrate bleb vascularity and intraocular pressure (IOP). Exposure time to MMC was 2 to 5 minutes based on multiple preoperative and intraoperative risk factors. Postoperative 5-FU was administered by subconjunctival injection(5mg) adjacent to or into the bleb in a weekly interval(mean 4 injections, range 2-5 injections). Mean follow-up time was 8.6 months. Overall mean preoperative IOP was 27.1+/-7.2mmHg compared with mean postoperative IOP of 12.3+/-7.4mmHg. Fifteen eyes(88%) achieved a final IOP < OR =21mmHg without medicatio and 11 eyes(64%) achieved a final IOP< OR =12mmHg. Complications developed after 5-FU injections included corneal epithelial defect in 2 eyes (12%), hypotony (IOP< OR =5, at least 2 visits) in 2 eyes(12%), and bleb leakage in 1 eye(6%). No patient had a hypotony induced maculopathy, hyphema or choroidal effusion. Our data suggest that postoperative 5-FU may be safely used adjunctively following MMC trabeculectomy in carefully selected patients, and may improve the overall success rate with high risk trabeculectomy.
Blister ; Choroid ; Filtration ; Fluorouracil* ; Follow-Up Studies ; Humans ; Hyphema ; Intraocular Pressure ; Mitomycin* ; Retrospective Studies ; Risk Factors ; Trabeculectomy*

The aim of this study was to analyze the effect of age at beginning of treatment on the results of anisometropic amblyopia in twenty-two consecutive children. The children who had strabismus or any other ocular disease affecting visual acuity was excluded. Two age groups were defined, according to the age at which treatment was started : 7 years or less(group I. N=10), 8 years or more(group II. N=12). Mean age of group I was 5.3 years old(4.1-7.9), while group II was 10.2 years old(8.0-13.2). Six patients were treated with occlusion therapy, 11 patients with atropine penalization, 1 patient with occlusion therapy and atropine penalization alternatively and 4 patients with spectacle correction only. All children had cycloplegic refraction before treatment and at each visit the corrected visual acuity was assessed. The difference in refractive errors between two eyes before treatment was 2.58D(1-9D) in group I and 2.75D in group II. The mean initial corrected visual acuity of amblyopic eyes was 0.43 in group I and 0.46 in group II. There was no significant difference in initial visual acuity between the two groups. The range of follow up times was from 5 to 60 months, with an average of 18 months. There was no significant difference in final visual outcome of amblyopic eye between the two groups. For patients aged 7 years or less, 80%(8/10) of patients achieved a final visual acuity of 0.8 or better and 90%(9/10) achieved the same final visual acuity as in the sound eye. For patients aged 8 years or more, 83%(11/12) of patients achieved a final visual acuity of 0.8 or better and 83%(10/12) achieved the same final visual acuity as in the sound eye. The initial visual acuity, the methods of therapy did not affect the final visual outcome. In pure anisometropic amblyopia, the patients older than 8 years of age have been treated as effectively as the patients 7 years or less.
Age Factors ; Amblyopia* ; Anisometropia ; Atropine ; Child ; Follow-Up Studies ; Humans ; Refractive Errors ; Strabismus ; Treatment Outcome ; Visual Acuity

We studied 52 eyes of 41 patients who received excimer laser in situ keratomileusis with VisX 20/20 and were followed up for at least 6 months. Tweenty three patients were male and mean age was 30.7 years old (21-49 years old). Mean preoperative spherical equivalent was -11.69+/-4.02D and mean postoperative spherical equivalent was -0.49+/-1.32D at I month, -0.73+/-l.17D at 3 months and -1.11+/-l.21D at 6 months. Mean uncorrected visual acuity preoperatively was 0.06 and postoperatively was 0.62 at I month, 0.64 at 3 months, 0. 62 at 6 months. Mean corrected visual acuity preoperatively was 0.77 and postoperatively was 0.76 at I month, 0.78 at 3 months and 0.81 at 6 months. Seven eyes (13%) gained 2 lines or more of spectacle corrected visual acuity and I eye lost 2 lines of spectacle corrected visual acuity. There was no significant contrast sensitivity change between preoperation and postoperation. No eye had intraoperative complications. Postoperative complications included 9 eyes (17%) of interface foreign bodies, 7 eyes (13%) of cap microwrinkling and 15 eyes(29%) of night glare. No eye had postoperaive corneal opacity.
Contrast Sensitivity ; Corneal Opacity ; Foreign Bodies ; Glare ; Humans ; Intraoperative Complications ; Keratomileusis, Laser In Situ* ; Lasers, Excimer ; Male ; Myopia* ; Postoperative Complications ; Visual Acuity

To evaluate the accuracy of the nomogram for LASIK, we retrospectively studied 109 eyes of 81 patients who received LASIK and were followed up for at least 6 months, divided into 3 groups according to the nomogram: the group I include 19 eyed which performed stromal ablation with 85~95% do photorefractive keratectomy(PRK) nomogram, the group II included 60 eyes with 100% of PRK nomogram and the group III included 30 eyes with 105included 30 dyes with 105~110% of PRK nomogram. The Chiron utomated corneal shaper and the Visx 20/20 excimer laser were used in all eyes. Multizone multipass technique was used in all eyes. The mean preoperative spherical equivalent was -12.42D in group I, -11.43D in group II and -11.29D in group III. The mean postoperative spherical equivalent in group I was -0.89D at 1 month, -1.0D at 3 months, -1.64D at 6 months, in group II was -0.31D at 1 month, -0.62D at 3 months, -1.07D at 6 months and in group III was -0.22D at 1 month, -0.46D at 3 months, -0.84D at 6 months. Eleven eyes(58%) were within 1.00D if intended correction at 6 months in group I while 35 eyes(59%) in group II and 20 eyes(67%) in group III were within 1.00D of intended correction at 6 months. Our findings suggest that slight overcorrection is recommanded in LASIK and further study on LASIK nomogram may be required.
Coloring Agents ; Humans ; Keratomileusis, Laser In Situ* ; Lasers, Excimer ; Nomograms* ; Retrospective Studies

BACKGROUND: In recent years, lung cancer has been one of most common cause of death in Korea. Despite many physician's high degree of pessimism about the gains made in treatments progressive improvement in the survival of lung cancer by treatment has occurred, particulary in the early stages of the disease. However, a lot of patients refuse treatment or give up in the fight against the disease. This study was done to evaluate factors ifluencing the compliance to therapy and to lead in the establishment of special programs to enhance compliance in patients with lung cancer. METHODS: The medical records of 903 patients, whose ECOG(Eastern Cooperative Oncology Group) performance status was 3 or less and whose medical record was relatively satisfactory, among 1141 patients diagnosed with lung cancer between January 1989 and December 1996 were reviewed retrospectively. Compliance was classified into three groups based on the degree of compliance with physicians practice guideline : (a) complaints ; (b) patients who initially complied but gave up of themselves midway during the course of treatment ; (c) noncompliants who refused the treatment. RESULTS: The overall compliance rats was 63.9%, which was progressively increased from 57.3-61.3% in 1989 and 1990 to 64.2-67.5% in 1995 and 1996. Age, education level and occupation of patients bore statistically significant relationship with the compliance but sell marital status and smoking history did not. The compliance was significantly higher in patients without symptoms than with, and was also significantly higher in patients with good performance status. The compliance was significantly high in patients with NSCLC(non-small cell lung cancer) compared to SCLC(small cell lung cancer), but after exclusion of stage l and ll, among NSCLC, which had higher compliance to surgery there was no significant difference of compliance by histology. The compliance was significantly lower in advanced stage. CONCLUSION: To enhance the compliance, special care including education programs about therapy including complicantion and prognosis are necessary, especially for educationally and economically disadvantaged patients.
Animals ; Cause of Death ; Compliance* ; Education ; Humans ; Korea ; Lung Neoplasms* ; Lung* ; Marital Status ; Medical Records ; Occupations ; Prognosis ; Rats ; Retrospective Studies ; Smoke ; Smoking ; Vulnerable Populations

We evaluated the antihypertensive effect of amlodipine, a calcium channel bloker, in 35 cases of essential hypertention. After 12 weeks' administration(5~10mg q.d.), the following results were obtained : 1) The systoloic and diastolic blood pressure were decreased significantly(170.3+/-12.2mmHg vs 143.7+/-13.0mmHg p<0.01 and 104.7+/-5.9mmHg vs 87.8+/-6.5mmHg, p<0.01, respectively) but the heart rate was independant of amlodipine administration. 2) The systolic blood pressure was lowered by 20mmHg or more in 26(76.5%) of 34 patients and the diastolic pressure was lowered by 10mmHg or more in 26(76.5%) of 34 patients at 12 weeks after amlodipine administration. 3) The adverse effects of amlodipine were dizziness in 5, edema in 5, indigestion in 3, constipation in 2, headache, flushing, insomnia in 1 patient respectively and only one of them discontinued amlodipine administration due to severs facial flushing and skin eruption.
Amlodipine* ; Blood Pressure ; Calcium Channels ; Constipation ; Dizziness ; Dyspepsia ; Edema ; Flushing ; Headache ; Heart Rate ; Humans ; Skin ; Sleep Initiation and Maintenance Disorders

OBJECTIVES: The most frequently cited health related slogan in North Korea is that socialistic medicine is preventive medicine. It implies that North Korea puts preventive medicine at the operational center of its national health care system. This study aimed at examining and comparing preventive medicine practices in North Korea with those of South Korea. METHODS: Efforts have been made to obtain a textbook for analysis its contents. Many people have iassisted in the study by joining the interview. Some of these people are as follows: a former professor of PyongYang Medical School, NK physicians living in South Korea, WHO staffs, diplomatic officials, etc. The major items of analysis consisted of industrial medicine and hygiene, nutrition, school health, epidemiology, health statistics and heath policy & management. RESULTS: Public health philosophy is finely rooted and well integrated in the operation of the North Korean national health care system, particularly in the area of industrial medicine and hygiene. Preventive medicine with a strong health surveillance system spanning a number of broad social organizations is a major tool to improve the health of the people in North Korea. The emphasis on preventive medicine has a close relationship with the 'Juche Philosophy' and the shortage of pharmaceuticals and medical equipment. To cope with the shortage problem, North Korean health workers are encouraged to grow medicinal herbs. We have found that they put little effort into teaching newly emerging diseases, such as AIDS, VDT syndrome, hazards of EMF, and agricultural chemical poisonings. Of the subjects of the preventive medicine text, 78.9% coincide with those of South Korean industrial health manuals and 34.2% with South Korean epidemiology texts. However, an absolute difference was found to exist between the heath policies and management systems. CONCLUSION: In North Korea, the concept of preventive medicine functions as the basic philosophic strategy of the national health care system. It differs greatly from the South Korean system in both practice and educational content. Its contribution to society is simply incomparable to that of South Korea. More communication and further study is called for in order to improve the preventive medicine practices in the future.
Delivery of Health Care ; Democratic People's Republic of Korea* ; Epidemiology ; Hygiene ; Korea ; Occupational Health ; Occupational Medicine ; Philosophy ; Plants, Medicinal ; Poisoning ; Preventive Medicine* ; Public Health ; School Health Services ; Schools, Medical

Aneurysms arising from ICA bifucation are relatively rare. But they are paticulary difficult to treat surgically because of perforating arteries surrounding and adherent to the aneurysm. In an effort to determine their best management policy, and to improve their surgical outcome, a retrospective clinical analysis of 30 patients who underwent direct surgery from ICA bifucation aneurysm between January, 1984 and December, 1994 was performed. In the same period, total 990 patients with intracranial aneurysms were admitted in our department. The result of carotid bifucation aneurysm surgery was worse than the total surgical result. Motality and morbidity rates were 3/30(10%), 5/30(16%). Surgical complications in this group of aneurysms usually came from injury of perforating arteries, and the causes of death were intraoperative premature rupture and vasospasm. The surgical treatment of aneurysms of internal carotid bifucation is discussed, emphasizing the importance of avoiding damage to perforating vessels and premature rupture. A classification of these aneurysms, according to angiographic and anatomical considerations, is proposed. We suggest that four types of aneurysmal orientation at the bifucation of the internal carotid artery be distinguished:either projecting superiorly, anteriorly, inferiorly, or posteriorly. Posterior orientation was found in 13 cases(43.3%). Superior orientation was found in 11 cases(36.7%), inferior orientation was found in 4 cases(13.3%), and anterior orientation was found in 2 cases(6.7%). From an analysis of these cases and a review of the literature, some characteristics of these aneurysms and their surgical strategies are described.
Aneurysm* ; Arteries ; Carotid Artery, Internal ; Cause of Death ; Classification ; Humans ; Intracranial Aneurysm ; Retrospective Studies ; Rupture

Osteochondromas are common and typically arise from the metaphyseal ends of long bones. An osteochondral neoplasm of the soft tissue, which is a lesion of uncertain pathogenesis, is uncommon and usually arises from the synovial tissue in joints and tendon sheaths. Rarely, extraskeletal osteochondromas also arise outside of synovial compartments. Most of the reported cases were presented in the hands and feet, especially in the fingers. Here we describe a 44-yr-old female patient who presented with a pain in the left buttock. A well-defined osseous mass was detected in the buttock. It consisted of sharply demarcated, mature hyaline cartilage that was covered with a fibrous capsule, which changed gradually into cancellous bone, more pronouncedly at the center. The diagnosis of an extraskeletal osteochondroma should be considered when a discrete, ossified mass is localized in the soft tissues. A case of pathologically proven extraskeletal osteochondroma of the buttock is presented with a literature review, magnetic resonance imaging, and radiological findings.
Accidental Falls ; Adult ; Buttocks* ; Diagnosis, Differential ; Female ; Human ; Myositis Ossificans/diagnosis ; Osteochondroma/complications ; Osteochondroma/diagnosis* ; Osteochondroma/radiography ; Osteochondroma/surgery ; Pain/etiology ; Sarcoma/diagnosis ; Soft Tissue Neoplasms/complications ; Soft Tissue Neoplasms/diagnosis* ; Soft Tissue Neoplasms/radiography ; Soft Tissue Neoplasms/surgery