BACKGROUND: Quinidine appeared to increase serum digoxin levels when given with quinidine. Therefore elevated serum digoxin concentrations and clinical toxicity have been reported in patient receiving quinidine. Currently, Bayesian method which estimates the most probable parameters of the drug for each patient from population parameters data is useful approach for adjusting digoxin dosage. To increase the accuracy of Bayesian method, it is desirable to use population parameters of Korean. Therefore we evaluated the effect of quinidine on digoxin clearance in Korea. METHOD: Patient's records from 19 adult cardiac disease without CHF having normal renal and liver function from Seoul National University of Hospital respectively wre evaluated. Digoxin pharmacokinetic parameters, CL and Vd, were obtained from serum concentration of digoxin of single and combined therapy at each steady-state by using bayesian method. RESULTS: This study show that quinidine reduced the total body clearance of digoxin from 2.39+/-0.17 to 1.51+/-0.08ml/min/kg(p<0.05) and reduced the digoxin volume of distribution from 8.57+/-0.29 to 4.98+/-0.19L/kg(p<0.05). This results show that digoxin dosage reduced to 40-50% in Korean, if quinidine therapy is initiated.
Adult ; Bayes Theorem ; Digoxin* ; Drug Interactions ; Heart Diseases ; Humans ; Korea ; Liver ; Pharmacokinetics ; Quinidine* ; Seoul

Spontaneous thoracic epidural hematoma occur rarely. We present a case of spontaneous thoracic epidural hematoma without any identified etiology and discuss the symptoms, signs and pathophysiology of this disorder. Early diagnosis and treatment by surgery can result in good recovery.
Early Diagnosis ; Hematoma*

PURPOSE: To evaluate the tensile strength and repair-site profile of a technique of resorbable barbed suture tenorrhaphy. METHODS: Forty-eight flexor digitorum profundus tendons were collected from the 8 adult cadavers. In the test group, the tendons were sutured using absorbent 2-0 barb knotless sutures in a 2-strand or 4-strand zig-zag pattern. In the control group, 2-0 Prolene and 3-0 polydioxanone (PDS) were used to suture the tendons using the 2-stand Modified Kessler method and the 4-strand cruciate suture method. Using a tensile force measurement machine, the breaking load (N) and the stiffness (N/mm) were measured. The types of rupture were categorized into suture breaking, knot rupture, and pullout. RESULTS: In the comparative analysis between the absorbent 2-0 Quill (Angiotech Pharmaceuticals, Canada) suture that used the 2-strand core suture and the 3-0 PDS and 2-0 Prolene sutures, the average breaking load for the 2-0 Quill suture was 26.83±7.47 N, and 21.96±6.78 N and 17.20±4.93 N for the 2-0 Prolene and 3-0 PDS sutures. In the comparison using the 4-strand core suture, the average breaking load for the 2-0 Quill suture was 62.50±13.34 N, and 22.35±5.72 N and 18.67±4.27 N for the 2-0 prolene and 3-0 PDS sutures. The most common type of rupture were knot rupture. CONCLUSION: For flexor tendon sutures using the absorbent barb sutures, compared to the conventional 2-0 Prolene or 3-0 PDS sutures, absorbent barbed sutures have a higher tensile strength.
Adult ; Cadaver ; Humans ; Methods ; Polydioxanone ; Polypropylenes ; Rupture ; Sutures* ; Tendons ; Tensile Strength

BACKGROUND: The prognosis for young patients generally considered to be poor. The purpose of this study was to determined whether the clinical characteristics and the survival rate in young lung cancer patients after surgical treatment differs from that in older patients. MATERIAL AND METHOD: Of 526 patients, 28(5.3%) were 30 to 40 years old. We studied the clinical characteristics and prognosis of 28 patients aged 40 years or less(Group 1), in whom primary lung cancer was diagnosed and operated between 1990 and 1997, and compared them with those 498 patients aged more than 40 years(Group 2). RESULT: The differences in sex ratio that were higher for women in Group 1, but there was no significant difference (p=0.297). The percentages for smokers and symptoms in Group 1 were significantly less than in Group 2.(p=0.049, p=0.008). Adenocarcinoma was significantly more common (p=0.018) and squamous cell diagnosed was diagnosed as stage IIIb or stage IV in 9 patients(32.1%), while 12.0% of the patients older than 40 years of age had either stage IIIb or stage IV(p=0.002). The 5-year survival rate was 41.3% in Group 1 ; 37.7% in Group 2, and the median survival time was 24.3 months in Group 1 ; 27.0 months is Group 2. There were no significant difference in survival between two age groups(p=0.808). CONCLUSIONS: Younger patients have more adenocarcinoma, however have less squamous cell carcinoma, less symptoms and less smoking history. Although younger patients tended to have more advanced disease and less complete resection rate, the recurrence and the long term survival in these patients did not differ that of older patients.
Adenocarcinoma ; Adult ; Carcinoma, Squamous Cell ; Female ; Humans ; Lung Neoplasms* ; Lung* ; Prognosis ; Recurrence ; Sex Ratio ; Smoke ; Smoking ; Survival Rate

This case describes a tracheal stenosis complicated by endobronchial truberculosis. A 50-year-old female with progressive dyspnea was referred to us for the management of long segmental tracheal stenosis. Treatment modalities for tracheal stenosis include open surgical resectin and reconstruction, mechanical dilation, laser resection, and placement of an airway prosthesis. The following is a report of a successful treatment of a long segmental tracheal stenosis through a tracheal augmentation and the use of al Bovine pericardium. This technique may provide a relief from tracheal stenosis.
Dyspnea ; Female ; Humans ; Middle Aged ; Pericardium* ; Prostheses and Implants ; Tracheal Stenosis

BACKGROUND: After an esophageal resection for an esophageal disease, the stomach becomes the most common organ for a substitute. The stomach has the advantages of being simple with fewer complications when used properly. The complications of an esophageal reconstruction using the stomach as the substitute are assessed and discussed. MATERIAL AND METHOD: Between 1990 and 1998, 44 patients who underwent esophagogastric anastomosis were treated in the department of Thoracic and Cardiovascular Surgery of Yongdong Severance Hospital, Seoul, Korea. RESULT: The rate of postoperative complications and mortality in these 44 patients were 70.5% and 13.6%, respectively. The major complications in our series involved the stricture of anastomosis(13.6%), pneumonia(11.4%), and wound infection(9.1%). The most frequent causes of postoperative deaths were pulmonary complications and sepsis(6.8%). CONCLUSION: Anastomotic leakage is no longer a major complication of an esophagogastrostomy. Most postoperative stricture can be overcome with frequent esophageal dilations. Postoperative pulmonary infection, nutrition, and physiotherapy are very important in reducing the rate of pulmonary morbidity and mortality.
Anastomotic Leak ; Constriction, Pathologic ; Esophageal Diseases ; Humans ; Korea ; Mortality* ; Postoperative Complications ; Seoul ; Stomach ; Wounds and Injuries

BACKGROUND: Since 1992, we developed the technique for video endoscopic sympathectomy to treat palmar hyperhidrosis. It was soon proven to be a simple and effective therapy for essential hyperhidrosis. Compensatory hyperhidrosis, however, is the main cause of patient dissatisfaction after video-assisted thoracoscopic sympathectomy. According to many authors, initial satisfaction rate was high(94-98%), but it was declined with time (66%) due to mainly to embarrassing side effects. MATERIAL AND METHOD: From January 1992 to February 1998, the thoracoscopic T2 sympathicotomy, T2 sympathectomy and T2-4 sympathectomy were performed in 315 patients suffering from Essential hyperhidrosis in the Department of Thoracic and Cardiovascular Surgery in the Respiratory Center of Yongdong Severance Hospital Seoul, Korea. Eighty-nine patients underwent T2 sympathicotomy, and Eighty-eight patients underwent division T2 sympathectomy. RESULT: All of the treated patients obtained satisfactory alleviation of essential hyperhidrosis. The global rate of compensatory sweating were ; 64.0% in T2 sympathicotomy, 73.8% in T2 sympathectomy and 87.8% in T2-4 sympathectomy. The rate of embarrassing or disabling compensatory sweating was significantly higher in T2 sympathicotomy 15.7%(14/89) and in T2 sympathectomy 32.8%(28/88) than in T2-4 sympathectomy 58.0%(80/138) with significancy in statistic analysis(p<0.05). Video- assisted thoracoscopic sympathectomy is an effective minimally invasive and effective procedure. CONCLUSION: We suggest that the incidence and degree of compensatory hyperhidrosis was closely related to the extent of thoracic sympathectomy.
Humans ; Hyperhidrosis* ; Incidence ; Korea ; Respiratory Center ; Seoul ; Sweat ; Sweating ; Sympathectomy*

This was a clinical trial study to aid the recovery of elderly female alcoholic liver disease patients by providing a balanced nutritional supplement comprising soymilk. All patients gave their consent before enrolling. The average demographics of the subjects were age 81.57 years, height 150.43 cm, weight 52.67 kg, and body mass index 24.15 kg/m2 . An increase in the daily consumption of fruits and fruit juice was observed after the patients had started taking the balanced meal as compared to before. Intakes of vitamin A, vitamin C, vitamin E, and cholesterol decreased after consuming soymilk, whereas vitamin B 12, niacin, folic acid, and dietary fiber significantly increased (P<0.05). Blood cholesterol and BUN levels showed a decreasing tendency.Our results indicate that consuming soymilk in a balanced diet for female patients afflicted with alcoholic liver disease helps improve their nutritional status by increasing the nutrients lacking in the body.

This study was conducted to derive core and detailed competencies of dental hygienists to be utilized as educational targets to be reached by graduation as well as basic data that can be reflected in the development and improvement of dental hygiene curricula. This study analyzed publication reports from the Korean Dental Hygienists Association, the International Federation of Dental Hygienists, the Commission on Dental Accreditation, and the American Dental Education Association. Based on the academic classification system for dental hygiene studies, the components of core and detailed competencies of dental hygiene school at the time of graduation were extracted and developed through expert panel discussions. This study defined competencies at the graduation level of dental hygiene school and derived eight core competencies and their 52 detailed competencies to serve as educational objectives from four areas: professionalism, communication, clinical practice, and community and health promotion. In the future, it will be necessary to conduct self-assessments of competencies based on those developed in this study, at time of the graduation from dental hygiene school, as well as to continuously develop competency-based curricula according to entry level, knowledge level, and graduation level. Thus, it is urgently necessary to develop a system that can evaluate the competencies of dental hygienists after graduation and put this system into practical use.
Accreditation ; Classification ; Competency-Based Education ; Curriculum ; Dental Hygienists ; Education, Dental ; Health Promotion ; Humans ; Oral Hygiene* ; Professionalism ; Publications ; Self-Assessment

Advanced esophageal carcinoma which invades into adjacent organs are classified as T4 esophageal cancer,. Its complete resection without residual tumor would be difficult. Preoperative chemoradiotherapy and combined modality therapy are being tried to improve survival in patients with T4 esophageal carcinoma. In a 74-year-old man a 6cm squamous cell carcinoma of the esophagus with invasion of the thoracic aorta was detected (T4). After neoadjuvant chemoradiotherapy the patient was operated on using bio-pump with aorto-femoral cannulation. The invased segment of descending aorta was resected and reconstructed with a graft. The tumor was resected and EG anastomosis was done. The postoperative period was uneventful the patient was discharged after good condition and has been well to now.
Aged ; Aorta* ; Aorta, Thoracic ; Carcinoma, Squamous Cell ; Catheterization ; Chemoradiotherapy ; Combined Modality Therapy ; Esophageal Neoplasms ; Esophagus ; Humans ; Neoplasm, Residual ; Postoperative Period ; Transplants