CTDs have been a growing problems for US and European industries with higher incidence rate every year. In our country, we have just Started to recognize and to work on the problems in industry. In this respect, this would be the first ergonomic-based CTD study with medical data. Two automobile part plants were ergonomically and clinically surveyed for this study. Specifically,' 25 jobs from A industry and 51 jobs from B industry were matched with the clinical data. Two types of analysis were conducted. First, ergonomic job evaluation using CTD checklist was done for both industries to figure out the relative risks for each jobs. Second, comprehensive analysis for risk factors regarding CTDs was conducted. It produced mainly two results. First, multiple regression analysis of both worker and work-related factors on total scores based on the results of the'physical examination showed that there was no statistically significant relationships between total scores based on physical examinations and either worker or work-related risk factors. Second, logistic analyses for both factors were done. An user-friendly logistic program was developed for this analysis and for the future analysis of CTD study in the long-run. The program would have even non-expert in statistical package easily manipulate logistic analysis. Based on the logistic analysis, there was no significant relationships between worker related risk factors and all CTD types except marital status. However, there was some significant results in terms of work-related factors. Lateral pinch and ulnar deviations had significant relationship with both all CTD types and CTS. Power grip was associated with all types of CTDs, Tendinitis and Carpal Tunnel Syndrome. The cycle time had significant effects only on Carpal Tunnel Syndrome. In conclusion, the first ergonomic-based CTD study has been initiated in Korea. However, it was realized that good overall situation for CTD study in Korea has been before the right time yet. Therefore, futher research on the basis of the framework of this study is strongly suggested to have a complete CTD guidelines in the near future.
Automobiles ; Carpal Tunnel Syndrome ; Checklist ; Cumulative Trauma Disorders ; Hand Strength ; Human Engineering ; Incidence ; Korea ; Marital Status ; Physical Examination ; Risk Factors ; Tendinopathy

CTDs have been a growing problems for US and European industries with higher incidence rate every year. In our country, we have just Started to recognize and to work on the problems in industry. In this respect, this would be the first ergonomic-based CTD study with medical data. Two automobile part plants were ergonomically and clinically surveyed for this study. Specifically,' 25 jobs from A industry and 51 jobs from B industry were matched with the clinical data. Two types of analysis were conducted. First, ergonomic job evaluation using CTD checklist was done for both industries to figure out the relative risks for each jobs. Second, comprehensive analysis for risk factors regarding CTDs was conducted. It produced mainly two results. First, multiple regression analysis of both worker and work-related factors on total scores based on the results of the'physical examination showed that there was no statistically significant relationships between total scores based on physical examinations and either worker or work-related risk factors. Second, logistic analyses for both factors were done. An user-friendly logistic program was developed for this analysis and for the future analysis of CTD study in the long-run. The program would have even non-expert in statistical package easily manipulate logistic analysis. Based on the logistic analysis, there was no significant relationships between worker related risk factors and all CTD types except marital status. However, there was some significant results in terms of work-related factors. Lateral pinch and ulnar deviations had significant relationship with both all CTD types and CTS. Power grip was associated with all types of CTDs, Tendinitis and Carpal Tunnel Syndrome. The cycle time had significant effects only on Carpal Tunnel Syndrome. In conclusion, the first ergonomic-based CTD study has been initiated in Korea. However, it was realized that good overall situation for CTD study in Korea has been before the right time yet. Therefore, futher research on the basis of the framework of this study is strongly suggested to have a complete CTD guidelines in the near future.
Automobiles ; Carpal Tunnel Syndrome ; Checklist ; Cumulative Trauma Disorders ; Hand Strength ; Human Engineering ; Incidence ; Korea ; Marital Status ; Physical Examination ; Risk Factors ; Tendinopathy

No abstract available.
Factor X*

PURPOSE: Although the resectability of hepatocellular carcinoma has increased due to recent advances in diagnostic methods and surgical techniques, the long-term results are unsatisfactory due to their invasiveness and frequent association with cirrhosis. This study was designed to identify the prognostic factors affecting the long term survival and recurrence of tumors in patients having undergone a hepatic resection for a hepatocellular carcinoma. METHODS: Between June 1996 and March 2002, 51 consecutive patients underwent a hepatic resection for a hepatocelluar carcinoma at the Inha University Hospital. The overall cumulative and disease free survival rates for these patients were analysed. Twenty-five clinicopathological factors were evaluated by univariate and multivariate analyse to determine any significant prognostic factors. RESULTS: The cumulative 1, 3 and 5-year survival rates were 84, 70 and 58%, respectively. There were 26 recurrences, and the 1, 3 and 5-year disease free cumulative survival rates were 60, 53 and 31%, respectively. From the univariate analysis, all the factors associated with ascites (P=0.0000), total bilirubin (P=0.0015), albumin (P=0.0271), prothrombin time (P=0.0392), HBe antigen (P=0.0283), Child classification (P=0.0000), celluar differentiation (P=0.0043) were found to correlate with the overall survival. From a Cox regression analysis, the HBe antigen (P=0.019), ascites (P=0.028) were found to be independent prognostic factors of the overall survival. The only factor with an independent effect on disease free survival was the HBe antigen (P=0.037). CONCLUSION: Because prognosis of HBe antigen-positive patients with ascites is poor, frequent postoperative follow up surveys in these patients are needed.
Ascites ; Bilirubin ; Carcinoma, Hepatocellular* ; Child ; Classification ; Disease-Free Survival ; Fibrosis ; Follow-Up Studies ; Humans ; Prognosis ; Prothrombin Time ; Recurrence ; Survival Rate

PURPOSE: The cutting seton technique is a world-wide operative method in management of a complex anal fistula. However it has still some risks of anal deformity and fecal incontinence because of sphincter injury, and also required two-stage operation under the anesthesia. We have modified this conventional method into sphincter-preserving technique using the seton and evaluated the clinical effect of patients with complex anal fistula. METHODS: The operative steps consisted of excision of the fistular tract without cutting the sphincter, and insertion of a non-absorbable suture material as a seton around the sphincter. When enough fibro-granulated tissues grew and pus discharge decreased markedly, the seton was just cut out from the wound without anesthesia at the outpatient basis. The clinical effect following treatment by using this method was assessed retrospectively in 81 patients, including 33 recurrent cases, who were treated during the four and a half-year period. RESULTS: The average follow-up period to remove the seton and to eradicate the fistula was 68.9+/-39.5 and 82.1+/-45.6 days, respectively. No patients experienced fecal incontinence after surgery. The fistula was healed without recurrence in 78 patients (96.3%), preserving integrity of the sphincter. Recurrence developed in 3 patients who had two suprasphincteric fistulas and one transsphincteric fistula with supralevator abscess. CONCLUSION: We suggest that this method is good for treating complex anal fistulas without two-stage operation because it has some advantages such as a lower recurrence, a lower functional impairment, and less anal deformity.
Abscess ; Anesthesia ; Congenital Abnormalities ; Fecal Incontinence ; Fistula ; Follow-Up Studies ; Humans ; Outpatients ; Rectal Fistula* ; Recurrence ; Retrospective Studies ; Suppuration ; Sutures ; Wounds and Injuries

BACKGROUND/AIMS: Hilar cholangiocarcinoma is a tumor with poor prognosis although curative surgical resection is known to be the most effective treatment. To obtain negative resection margin is still a challenging problem for surgeons. We designed this study to investigate further the treatment strategies of the hilar cholangiocarcinoma by comparing the prognosis of patients managed by different modalities with special emphasis on the polarity of the resection margin. METHODS: A retrospective clinical study was performed at the Inha University Hospital for 70 patients managed for hilar cholangiocarcinoma from June 1996 to May 2002. RESULTS: The patients consisted of 45 men and 25 women. The average age of the patients was 66.4 years old. The survival rate for 1 year and 3 years and the median survival period were investigated. For the negative resection margin sub-group, those were 100%, 28.6% and 23 months respectively, while those for the positive resection margin sub-group were 70.6%, 10.8% and 19 months respectively. For the palliative bypass surgery sub-group, those were 0%, 0%, and 5 months, for the biliary stent sub-group, those were 5.3%, 0% and 5 months and for the intraductal radiotherapy sub-group, those were 20%, 0% and 7 months respectively. When the patients were divided between the resection and the non- resection groups, those figures were 79.2%, 12.1% and 20 months for the resection group while for the non-resection group, those were 11.9%, 0% and 6 months respectively. Statistical analysis showed that the survival rates for the resection and the non-resection groups were different (p=0.0001). However, the survival difference for the negative and the positive resection margin sub-groups were insignificant (p= 0.2401). For the three sub-groups of the non-resection group, the survival difference for each sub-groups were also insignificant (p=0.2979). Postoperative complication was observed in 12 patients (38.7%). Three patients died and the postoperative mortality rate was 9.7%. CONCLUSION: To improve the survival of the hilar cholangiocarcinoma patients, it is believed that the best treatment is the aggressive resection of the tumor even if it is difficult to obtain negative resection margin. Considering the high morbidity and mortality rate of extensive surgery and comparable survival of the positive resection margin patients, further extension of the extent of resection to obtain negative resection margin should be performed in selected patients.
Cholangiocarcinoma* ; Female ; Humans ; Male ; Mortality ; Postoperative Complications ; Prognosis* ; Radiotherapy ; Retrospective Studies ; Stents ; Survival Rate

PURPOSE: This study evaluated the pretreatment expression patterns of MDM2, p53, and pRb proteins to determine if the expression patterns could predict the outcome of concurrent chemoradiotherapy (CCRT) for esophageal squamous cell carcinoma and aid in the decisions for the selection of treatment modalities. MATERIALS AND METHODS: Fifty-one patients that were treated with definitive chemoradiotherapy for stage I~IVa esophageal squamous cell carcinoma were selected for this study. Radiotherapy was administered with daily 1.8~2 Gy fractions up to a median dose of 54 Gy for primary tumors, and with four cycles of cisplatin/5- fluorouracil chemotherapy that was administered every 4 weeks, the first two cycles of which were administered concurrently with radiotherapy. Expression of MDM2, p53, and pRb was investigated by immunohistochemical analysis using pretreatment biopsy specimens. RESULTS: MDM2, p53, and pRb were detected with high immunoreactivity in 19.6%, 27.5%, and 66.7% of the patients, respectively. However, there was no significant correlation between expression of these factors and clinical outcome. By the use of multivariate analysis with nine covariates-age, tumor location, tumor length, stage, pathological response, clinical response, MDM2 expression, p53 expression, and pRb expression, only pathological response and stage were significant factors for cause-specific survival. CONCLUSION: Expression of MDM2, p53, and pRb was not found to be clinically significant for predicting outcomes after CCRT in this study. Further studies with a larger patient population and longer follow-up periods are needed to re-evaluate the expression pattern and to identify new predictors for CCRT response.
Biopsy ; Carcinoma, Squamous Cell ; Chemoradiotherapy* ; Drug Therapy ; Esophageal Neoplasms ; Fluorouracil ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Multivariate Analysis ; Radiotherapy

PURPOSE: The diagnosis of acute cholecystitis is usually made by performing ultrasonography or biliary scintigraphy. We have introduced the (99m)Tc-ciprofloxacin (infecton) scan for diagnosing of acute cholecystitis. The main aim of this study was to evaluate the efficacy of (99m)Tc-ciprofloxacin imaging in comparison with ultrasonographic findings for the diagnosis of acute cholecystitis. METHODS: Sixteen patients who were thought to have acute or chronic cholecystitis, based on the clinical and sonographic findings, were included in this study. We gave intravenous (99m)Tc-ciprofloxacin to sixteen patients and we obtained the SPECT images after one hour. The final diagnosis of acute cholecystitis was made according to the pathologic reports. RESULTS: According to pathologic reports, out of the sixteen patients, twelve patients had acute cholecystitis and four patients had chronic cholecystitis. On the (99m)Tc-ciprofloxacin scans, twelve patients had positive images showing acute cholecystitis on account of the hot uptake in the gallbladder and four patents had negative images showing chronic cholecystitis due to the negative uptake in the gallbladder. Among them, one false positive case and one false negative case were observed. With performing ultrasonography, twelve and four patients were diagnosed as having acute and chronic cholecystitis respectively. Out of them one false positive case and three false negative cases were observed. Based on the pathologic reports, (99m)Tc-ciprofloxacin imaging has a sensitivity of 91.7% and a specificity of 75%. The ultrasonography had a sensitivity of 91.7% and a specificity of 25%. CONCLUSION: As a result of comparing the sensitivity and specificity of the (99m)Tc-ciprofloxacin scan with those of the ultrasonography, the (99m)Tc-ciprofloxacin scan is considered to be useful test method to diagnose acute cholecystitis.
Cholecystitis ; Cholecystitis, Acute* ; Diagnosis* ; Gallbladder ; Humans ; Radionuclide Imaging ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon ; Ultrasonography

PURPOSE: In surgical treatment for the elderly patients with the acute abdomen, the high morbidity and mortality rate become a serious problem because of the difficulty of the initial diagnosis. This study, therefore, aims at analyzing the clinical presentation of the elderly patients with the acute abdomen in order to reduce the high mortality rate for the elderly patients. METHODS: This study included 114 elderly patients who underwent the emergency operation due to the acute abdomen from May 2000 to May 2002. The age of the elderly patients was over 65 years old. The clinical characteristics of these patients were investigated retrospectively in this study. RESULTS: The most two common diseases were the acute appendicitis(25.4%) and the acute cholecystitis (21.9%) for the elderly patients. Then comes the intestinal obstruction, the gastrointestinal cancer, the colonic diverticulitis, and the gastrointestinal vascular disease in that order. The accuracy of the initial diagnosis was 79%, but the correlation between the accuracy and age significantly decreased as the age of the elderly patients increased. The postoperative complication rate was 26.3%, and the most common cause of the complications was the postoperative infection. The postoperative mortality rate was 11.4%, and the common causes of the death were the sepsis(61.5%), the postoperative bleeding, the acute renal failure, and the cardiovascular disease in order of frequency. It was found that there was a significant correlation between the complication rate and old age(p=0.021). In addition, there was a significant correla- tion between the mortality rate and old age p=0.012). CONCLUSION: In this study, it was found that the acute appendicitis and the cholecystitis were the common diseases for the elderly patients with the acute abdomen. The accuracy of the initial diagnosis was 79%; however, it decreased with the aging process. For aged people, that caused the increase of the complication and the mortality rate. It thus appears that elderly patients with the acute abdomen should be treated carefully and systematically.
Abdomen, Acute* ; Acute Kidney Injury ; Aged* ; Aging ; Appendicitis ; Cardiovascular Diseases ; Cholecystitis ; Cholecystitis, Acute ; Diagnosis ; Diverticulitis, Colonic ; Emergencies ; Gastrointestinal Neoplasms ; Hemorrhage ; Humans ; Intestinal Obstruction ; Mortality ; Postoperative Complications ; Retrospective Studies ; Vascular Diseases

PURPOSE: In surgical treatment for the elderly patients with the acute abdomen, the high morbidity and mortality rate become a serious problem because of the difficulty of the initial diagnosis. This study, therefore, aims at analyzing the clinical presentation of the elderly patients with the acute abdomen in order to reduce the high mortality rate for the elderly patients. METHODS: This study included 114 elderly patients who underwent the emergency operation due to the acute abdomen from May 2000 to May 2002. The age of the elderly patients was over 65 years old. The clinical characteristics of these patients were investigated retrospectively in this study. RESULTS: The most two common diseases were the acute appendicitis(25.4%) and the acute cholecystitis (21.9%) for the elderly patients. Then comes the intestinal obstruction, the gastrointestinal cancer, the colonic diverticulitis, and the gastrointestinal vascular disease in that order. The accuracy of the initial diagnosis was 79%, but the correlation between the accuracy and age significantly decreased as the age of the elderly patients increased. The postoperative complication rate was 26.3%, and the most common cause of the complications was the postoperative infection. The postoperative mortality rate was 11.4%, and the common causes of the death were the sepsis(61.5%), the postoperative bleeding, the acute renal failure, and the cardiovascular disease in order of frequency. It was found that there was a significant correlation between the complication rate and old age(p=0.021). In addition, there was a significant correla- tion between the mortality rate and old age p=0.012). CONCLUSION: In this study, it was found that the acute appendicitis and the cholecystitis were the common diseases for the elderly patients with the acute abdomen. The accuracy of the initial diagnosis was 79%; however, it decreased with the aging process. For aged people, that caused the increase of the complication and the mortality rate. It thus appears that elderly patients with the acute abdomen should be treated carefully and systematically.
Abdomen, Acute* ; Acute Kidney Injury ; Aged* ; Aging ; Appendicitis ; Cardiovascular Diseases ; Cholecystitis ; Cholecystitis, Acute ; Diagnosis ; Diverticulitis, Colonic ; Emergencies ; Gastrointestinal Neoplasms ; Hemorrhage ; Humans ; Intestinal Obstruction ; Mortality ; Postoperative Complications ; Retrospective Studies ; Vascular Diseases