Leukemia, the most common malignant disease in the pediatric field, is one of the most interesting targets ofmodern medical research. So we reviewed the bone changes in 51 patients of leukemia admitted to the Dept. ofPediatrics Jeonbug National University Hospital for 5 years from Jan. 1st 1977 to Dec. 31st 1981. The results wereas follow. The male patient was more prevalent with sex ratio male to female 2.7:1, and the highest incidence wasnoticed between 2 years and 4 years of age (23.5%) and followed by between 6 years and 8 years of age (21.6%).Acute lymphocytic leukemia occurred in 62.7%(32 cases) and acute myelocytic leukemia in 33.3%(17 cases), chronicmyelocytic leukemia in 2%(1 case), acute monolcytic leukemia in 2%(1 case). The most common symptoms and signs onadmission was fever (56.9%), and followed by lymphadenopathy(52.9%), hepatosplenomegaly (49.0%) in order ofincidence. The most common chief complaint on admission was fever (39.2%), and followed by pallor (37.3%), andgeneralized malaise (25.5%). The patients with hemoglobin value under 4.0m% occupied 21.6% and about two thirdsshowed hemoglobin less than 8.0m%. The leukocyte counts on admission between 5,000 and 1,10,000/mm3 was noticed in6 cases(11.85) and lower than 5,000/mm3 in 8 cases (15.7%). In the chest X-ray the most common osseous change wasmetaphseal band of humerus in 24 cases (47.1%) , and followed by metaphseal cortical scalloping of upper humerusin 39.2%, osteolytic change in 31.4% periosteal reaction in 7.8%, osteosclerosis in 2%. The most common extraosseous change in chest P-A was mediastinal widening with hilar lymphadenopathy in 1.4% and followed by pulmonary infiltration in 29.4%, pleural reaction in 5.9%. The twelve cases in which hematologic changes weremild, showed radiologic abnormalities in 10 cases (83%), and the 39 cases in which hematologic changes were severe, showed radiologic abnormalities in 31 cases(79%). Especially, In hematologic mild group, showed metaphyseal cortical scalloping of proximalhumerus in 5 cases (41 %), and in hematologic severe group, showed metaphyseal cortical scalloping of proximal humerus in 15 cases (40%). 50 metaphyseal contical scalloping of proximal humerus may be the key finding on detection of early childhood leukemia. The osseous changes were noticed in 75% of ALL, and 47% of AM L, and the extraosseous changes were noticed in 60% of ALL, and 47% of AML.
Female ; Fever ; Humans ; Humerus ; Incidence ; Jeollabuk-do ; Leukemia ; Leukemia, Lymphoid ; Leukemia, Myeloid, Acute ; Leukocyte Count ; Lymphatic Diseases ; Male ; Osteosclerosis ; Pallor ; Pectinidae ; Sex Ratio ; Thorax

OBJECTIVE: To supplement a previous study on the management of medical records with a view to preparing a system capable of ensuring basic patient rights regarding the protection of confidential medical information. The study objectives are to provide detailed guidelines to regulate the access and protection of medical information by analyzing patients' understanding and views regarding the dissemination of medical records. METHODS: A self-administered questionnaire was administered to 781 patients who visited five University hospitals located in Seoul, Busan, Gyeonggi, Chungnam and Jeonnam from July to September, 2008 and asked for copies of medical records to be issued. Data were analyzed by using the statistical program SPSS 13.0. RESULTS: More than 70% of respondents wanted to access their medical records after confirming the required documents. The highest distribution in the range of persons able to receive copies of medical records without the individual patient's consent or required documents was 'only personally' in each variable. Copies of medical records were issued mostly within 1 hour, while the appropriate time of issuing the copies was within one day. Half of respondents approved of a subscription system that did not require a doctor consultation. The results regarding changes in the ways to request/issue copies of medical records to improve the convenience for applicants differed significantly according to age. CONCLUSION: Considering the sensitivity of personal health information, medical records should only be issued with the patient's consent and by confirming the identity of the designated person with required documents. Furthermore, people should be aware of the importance of protecting personal health information, and medical institutes should inform the requirements for bringing the relevant documents. Medical institutes play an important role in protecting personal records, which necessitates generalized guidelines.
Academies and Institutes ; Coat Protein Complex I ; Surveys and Questionnaires ; Hospitals, University ; Humans ; Medical Records ; Patient Rights

PURPOSE: The follicular variant of papillary thyroid carcinoma (FVPTC) is difficult to diagnose due to pathologic features. There is also debate on the optimal extent of surgery. We separated FVPTC into two groups and compared the clinical features in an attempt to apply the treatment. METHODS: All 40 patients with FVPTC who were diagnosed between 1990 and 2009 were reviewed and separated into two groups, an encapsulated group and an infiltrative group, based on whether a capsule was formed or infiltration occurred. These two different subtypes of FVPTC were compared on the traits of sensitivity of diagnosis and clinicopathologic features. RESULTS: After review by a pathologist, 21 of 40 patients (55%) were found to have encapsulated tumors, and 18 patients (45%) had infiltrative tumors. There was no difference in age, sex, or size. Patients with encapsulated FVPTC had a significantly lower rate of lymph node metastasis (4.5%), multicentric tumors (18.2%), and thyroid capsular invasion (9.1%) compared with the infiltrative tumor group (50%, 50% and 50%, P<0.05). There was no difference in FNA sensitivity between the two groups, but the sensitivity to frozen biopsy was higher in the infiltrative group. There was no recurrence in the encapsulated group, but 4 patients (22.2%) experienced recurrence in the infiltrative group. CONCLUSION: FVPTC can be separated into two subgroups by histologic features, and there are some clinicopathologic differences between the two groups. Patients who had encapsulated FVPTC had a lower rate of lymph node metastasis, multicentric tumors, and thyroid capsular invasion. They also showed a lower rate of recurrence than the infiltrative group. It is suggested that the encapsulated group can be treated with limited surgery and the infiltrative group needs aggressive treatment.
Biopsy ; Diagnosis ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Recurrence ; Thyroid Gland* ; Thyroid Neoplasms*

Velopharyngeal incompetence is rare and difficult to diagnose, especially if there is no structural or neurologic cause for it. The authors have recently experienced a case of unexplained velopharyngeal incompetence in a 67-year old female patient with terminal-staged breast cancer (T4N2M1), who had received surgery before but failed. During her hospitalization for palliative treatment, the patient was referred to our department for hypernasality, nasal regurgitation and poor oral intake. Although clinical evaluations were completed to find the causes of velopharyngeal incompetence, no definite causes were found. Authors performed a palatopharyngoplasty with the superiorly based pharyngeal flap and her symptoms were cured. We report our case with a brief review of the literatures.
Breast ; Breast Neoplasms ; Female ; Hospitalization ; Humans ; Muscular Diseases ; Palliative Care ; Paraneoplastic Syndromes ; Surgical Flaps ; Velopharyngeal Insufficiency

Objectives: This study investigated the effects of mouthwashes containing cetylpyridinium chloride and zinc acetate on oral health. Methods: A total of 60 participants were included in the study. Fifty-three participants (27 and 26 participants in the experimental and control groups, respectively) were retained, excluding seven candidates who dropped out. The mouthwash used for the study was spat out after 10-15 ml of mouth-washing for 3 s in the oral cavity after breakfast, lunch, and dinner. Oral examination indices included the gingival (gingival index, PMA index), the patient hygiene performance (PHP index, Turesky plaque index), and the bad breath (BB checker, Oral chroma) indices. Five measurements were taken after 2, 4, 6, 8, and 12 weeks and compared. Results: Measurements of the gingival index showed a statistically significant difference between the experimental and the control groups after 4 weeks, and the PMA index from eight weeks (P<0.05). Measurements of the PHP and Turesky plaque indices showed a significant difference in the experimental and control groups after 4 weeks (P<0.05). Compared to the PHP index before the experiment, that of the experimental group showed a significant index decrease after 2 weeks (P<0.05). Results of measuring bad breath through a BB checker showed a statistically significant difference between the experimental and control groups after 4 weeks (P<0.05). Conclusions Oral mouthwash products containing cetylpyridinium chloride and zinc acetate relieves gingivitis, removes bacterial plaque, and reduces bad breath.

Purpose: Endocrine therapy is the first-line treatment recommended for patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer without visceral crisis. However, this recommendation has not been followed clinically because of efficacy issues. In this study, the survival of patients with HR-positive/HER2-negative metastatic breast cancer was evaluated based on the following first-line treatment regimens: the combination of palbociclib plus letrozole, conventional endocrine therapy, or chemotherapy. Methods: Medical records were reviewed for this retrospective analysis. Patients with HR-positive/HER2-negative metastatic breast cancer were included. Progression-free survival (PFS) and overall survival (OS) were compared based on first-line treatment regimens. Results: A total of 184 patients were included in the analysis. The first-line treatments were palbociclib plus letrozole in 46 patients (25.0%), endocrine therapy in 40 patients (21.7%), and chemotherapy in 98 patients (53.3%). The PFS of the palbociclib plus letrozole group was significantly longer than that of the endocrine therapy (hazard ratio=3.43, p<0.001) and chemotherapy (hazard ratio=2.88, p=0.001) groups. No significant difference was observed between the endocrine therapy and chemotherapy groups (p=0.430). The OS of the palbociclib plus letrozole group was significantly longer than that of the endocrine therapy (hazard ratio=5.34, p=0.009) and chemotherapy (hazard ratio 4.23, p=0.043) groups. No significant difference was observed between the endocrine therapy and chemotherapy groups (p=0.451). Conclusion The combination regimen of palbociclib and letrozole could be recommended as the first-line treatment of choice in patients with HR-positive/HER2-negative metastatic breast cancer.

BACKGROUND: In esthetic surgery, understanding the factors that influence patient satisfaction is important for successful practice. We hypothesize that the factors that influence patient satisfaction include not only aesthetic and functional outcomes, but also personal factors such as the level of familiarity with factors affecting wound healing and expectations regarding aesthetic outcome. METHODS: One hundred patients who underwent esthetic closure after thyroidectomy were included in this study. In order to evaluate the individual characteristics of the patients, a preoperative survey was administered to the patients. We estimated the patient satisfaction six months postoperatively and assessed the aesthetic and functional outcomes using the Patient and Observer Scar Assessment Scale. RESULTS: According to the results of correlation analysis, level of familiarity with wound healing factors had a positive correlation with satisfaction. High expectations, pain, itching, and high observer scale score had negative correlations with satisfaction. The factors that were correlated with satisfaction were included in the multiple regression analysis. Level of familiarity with wound healing factors was found to have a positive relationship with satisfaction, while itching and observer scale were found to have a negative relationship with satisfaction. After excluding 10 patients who had hypertrophic scars, only level of familiarity with wound healing factors and expectations affected satisfaction. CONCLUSIONS: The level of familiarity with factors affecting wound healing and expectations were found to independently affect satisfaction. Improving patients' level of familiarity with wound healing factors and reducing their expectations by providing suitable preoperative education has the potential to improve patient satisfaction.
Cicatrix ; Cicatrix, Hypertrophic ; Esthetics ; Female ; Humans ; Patient Satisfaction ; Personal Satisfaction ; Pruritus ; Recognition (Psychology) ; Surgery, Plastic ; Sutures ; Thyroidectomy ; Wound Healing

OBJECTIVES: The information security management systems (ISMS) of 5 hospitals with more than 500 beds were evaluated with regards to the level of information security, management, and physical and technical aspects so that we might make recommendations on information security and security countermeasures which meet both international standards and the needs of individual hospitals. METHODS: The ISMS check-list derived from international/domestic standards was distributed to each hospital to complete and the staff of each hospital was interviewed. Information Security Indicator and Information Security Values were used to estimate the present security levels and evaluate the application of each hospital's current system. RESULTS: With regard to the moderate clause of the ISMS, the hospitals were determined to be in compliance. The most vulnerable clause was asset management, in particular, information asset classification guidelines. The clauses of information security incident management and business continuity management were deemed necessary for the establishment of successful ISMS. CONCLUSIONS: The level of current ISMS in the hospitals evaluated was determined to be insufficient. Establishment of adequate ISMS is necessary to ensure patient privacy and the safe use of medical records for various purposes. Implementation of ISMS which meet international standards with a long-term and comprehensive perspective is of prime importance. To reflect the requirements of the varied interests of medical staff, consumers, and institutions, the establishment of political support is essential to create suitable hospital ISMS.
Commerce ; Compliance ; Dietary Sucrose ; Hospitals ; Humans ; Medical Records ; Medical Staff ; Privacy

PURPOSE: Despite the increasing use of continuous renal replacement therapy (CRRT) in the neonatal intensive care unit (NICU), few studies have investigated its use in preterm infants. This study evaluated the prognosis of preterm infants after CRRT and identified risk factors of mortality after CRRT. MATERIALS AND METHODS: A retrospective review was performed in 33 preterm infants who underwent CRRT at the NICU of Samsung Medical Center between 2008 and 2017. Data of the demographic characteristics, predisposing morbidity, cardiopulmonary function, and CRRT were collected and compared between surviving and non-surviving preterm infants treated with CRRT. Univariable and multivariable analyses were performed to identify factors affecting mortality. RESULTS: Compared with the survivors, the non-survivors showed younger gestational age (29.3 vs. 33.6 weeks), lower birth weight (1359 vs. 2174 g), and lower Apgar scores at 1 minute (4.4 vs. 6.6) and 5 minutes (6.5 vs. 8.6). At the initiation of CRRT, the non-survivors showed a higher incidence of inotropic use (93% vs. 40%, p=0.017) and fluid overload (16.8% vs. 4.0%, p=0.031). Multivariable analysis revealed that fluid overload >10% at CRRT initiation was the primary determinant of mortality after CRRT in premature infants, with an adjusted odds ratio of 14.6 and a 95% confidence interval of 1.10–211.29. CONCLUSION: Our data suggest that the degree of immaturity, cardiopulmonary instability, and fluid overload affect the prognosis of preterm infants after CRRT. Preventing fluid overload and earlier initiation of CRRT may improve treatment outcomes.
Birth Weight ; Gestational Age ; Humans ; Incidence ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Mortality ; Odds Ratio ; Prognosis ; Renal Replacement Therapy ; Retrospective Studies ; Risk Factors ; Survivors

BACKGROUND: To investigate the incidence of surgical intervention in very low birth weight (VLBW) infants and the impact of surgery on neurodevelopmental outcomes at corrected ages (CAs) of 18–24 months, using data from the Korean Neonatal Network (KNN). METHODS: Data from 7,885 VLBW infants who were born and registered with the KNN between 2013 to 2016 were analyzed in this study. The incidences of various surgical interventions and related morbidities were analyzed. Long-term neurodevelopmental outcomes at CAs of 18–24 months were compared between infants (born during 2013 to 2015, n = 3,777) with and without surgery. RESULTS: A total of 1,509 out of 7,885 (19.1%) infants received surgical interventions during neonatal intensive care unit (NICU) hospitalization. Surgical ligation of patent ductus arteriosus (n = 840) was most frequently performed, followed by laser therapy for retinopathy of prematurity and laparotomy due to intestinal perforation. Infants who underwent surgery had higher mortality rates and greater neurodevelopmental impairment than infants who did not undergo surgery (P value < 0.01, both). On multivariate analysis, single or multiple surgeries increased the risk of neurodevelopmental impairment compared to no surgery with adjusted odds ratios (ORs) of 1.6 with 95% confidence interval (CI) of 1.1–2.6 and 2.3 with 95% CI of 1.1–4.9. CONCLUSION: Approximately one fifth of VLBW infants underwent one or more surgical interventions during NICU hospitalization. The impact of surgical intervention on long-term neurodevelopmental outcomes was sustained over a follow-up of CA 18–24 months. Infants with multiple surgeries had an increased risk of neurodevelopmental impairment compared to infants with single surgeries or no surgeries after adjustment for possible confounders.
Cohort Studies ; Ductus Arteriosus, Patent ; Follow-Up Studies ; Hospitalization ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Very Low Birth Weight ; Intensive Care, Neonatal ; Intestinal Perforation ; Korea ; Laparotomy ; Laser Therapy ; Ligation ; Mortality ; Multivariate Analysis ; Odds Ratio ; Retinopathy of Prematurity