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Park H.W.,Yonsei University | Park J.W.,National Health Insurance Service Ilsan Hospital
Journal of Korean medical science | Year: 2016

Dry eye syndrome (DES) is recognized as a public health concern. One of the pathophysiologies in the development of DES is inflammation, and metabolic syndrome (MetS), which is highly prevalent in the general population, is a well-known chronic and systemic inflammatory condition. Despite the increasing interest regarding a relationship between DES and MetS, information is lacking on the association between DES and MetS and its individual components. We investigated the association between DES symptoms and MetS and its components among adults aged ≥ 19 years using population-based data from the Korea National Health and Nutrition Examination Survey V. A sample group of 15,294 adults (42.67% men and 57.33% women) completed household interviews in which they provided blood (for high-density lipoprotein cholesterol, triglyceride, and glucose) and anthropometric measurements (including waist circumference, weight, and height) to define MetS. We also collected information regarding sociodemographic and behavioral risk factors. The survey results showed that 11.50% of men and 22.35% of women experienced DES and 5.30% of patients had both DES and diagnosis of MetS, including 204 men and 606 women. Thus, no significant difference was observed between DES and the diagnosis of MetS according to sex (P = 0.4008 in men; P = 0.0804 in women); however, a significant association was observed between DES and hypertriglyceridemia in women (OR, 1.13; 95% CI, 1.01-1.29). Therefore, hypertriglyceridemia might be an important factor in the association between DES and MetS. Further longitudinal research is needed to evaluate this relationship.


Kim S.W.,National Health Insurance Service Ilsan Hospital | Kim J.H.,National Health Insurance Corporation Ilsan Hospital | Han Z.-A.,National Rehabilitation Center
Brain Injury | Year: 2013

Background: Intracranial stab wounds are low-velocity, penetrating injuries to the brain and fatality and outcome significantly depend on route, depth and location of cranial penetration. Due to the effective barrier provided by the adult calvarium, most injuries occur through the orbitae or temporal regions where bony layers are thin. Self-inflicted intracranial stab wounds are an even rarer form of traumatic brain injury, with common entry points being the orbital space and the nose. Intracranial brainstem injuries mostly result in death, with reported penetration areas being the pons or midbrain. Case: The following report reviews a first reported case of self-inflicted intracranial stabbing via a trans-oral route with lesions to the medulla oblongata and cerebellum. Unlike previous cases of low velocity penetrating injuries to the brainstem, the patient underwent full neurologic recovery after manual knife removal and intensive rehabilitation. Conclusion: Self-inflicted transcranial injuries have been mentioned only briefly and sporadically in the literature. This article highlights a rare case of self-inflicted intracranial stabbing with a not yet reported entry route and brainstem lesion. Unlike the other fatal outcomes associated with such injuries, the patient underwent full neurological and functional recovery through a comprehensive approach that included intensive rehabilitation. © 2013 Informa UK Ltd. All rights reserved: reproduction in whole or part not permitted.


Song T.,CHA Medical University | Lee S.-H.,National Health Insurance Service Ilsan Hospital
Journal of Minimally Invasive Gynecology | Year: 2014

Study Objective: To compare surgical outcomes between barbed suture and traditional suture used in repair of the vaginal vault during single-port total laparoscopic hysterectomy (TLH). Design: Case-control study (Canadian Task Force classification II-2). Setting: Two institutions. Patients: One hundred two patients with benign uterine disease. Interventions: Single-port TLH using barbed suture (n=43) or traditional suture (n=59). Measurements and Main Results: Patient characteristics (age, body mass index, demographic data), procedures performed, uterine weight, and uterine disease were similar between the 2 study groups. There were also no differences in operative complications, conversion to other surgical approaches, operative blood loss, postoperative pain, and duration of hospital stay between the 2 groups. Use of barbed suture significantly reduced the time required for vaginal cuff suturing (11.4 vs 22.5minutes; p<.001), as well as total operative time (92.0 vs 105.2minutes; p=.002). Use of barbed suture is less technically demanding than traditional suture (p<.001). Conclusion: Use of barbed suture in single-port TLH may aid surgeons by reducing operative time, suturing time, and surgical difficulty. © 2014 AAGL.


Song T.,Sungkyunkwan University | Lee S.-H.,National Health Insurance Service Ilsan Hospital | Kim W.Y.,Sungkyunkwan University
Human Reproduction | Year: 2014

Study question: Is hemostasis by hemostatic sealant superior to that achieved by bipolar coagulation in preserving ovarian reserve in patients undergoing laparoscopic ovarian cystectomy? Summary answer: Post-operative ovarian reserve, determined by serial serum anti-Müllerian hormone (AMH) levels, was significantly less diminished after ovarian hemostasis when hemostatic sealant was used rather than bipolar coagulation. What is known already: Hemostasis achieved with bipolar coagulation at ovarian bleeding site results in damage to the ovarian reserve. Study design, size, duration: Aprospective, multi-center randomized trialwas conducted on 100 participants with benign ovarian cysts, between December 2012 and October 2013. Participant/materials, setting, methods: Participants were randomized to undergo hemostasis by use of either hemostatic sealant (FloSeal™) or bipolar coagulation during laparoendoscopic single-site (LESS) ovarian cystectomy. The primary end-pointwas the rate of decline of ovarian reserve calculated by measuring serum AMH levels preoperatively and 3 months post-operatively. Main results and the role of chance: Age, parity, socio-demographic variables, preoperativeAMHlevels, procedures performed and histologic findings were similar between the two groups of patients. There were also no differences in operative outcomes, such as conversion to other surgical approaches, operative time, estimated blood loss, or perioperative complications between the two groups. In both study groups, postoperativeAMHlevelswere lower than preoperativeAMHlevels (all P< 0.001).The rate of decline ofAMHlevelswas significantly greater in the bipolar coagulation group than the hemostatic sealant group (41.2% [IQR, 17.2-54.5%] and 16.1% [IQR, 8.3-44.7%], respectively, P = 0.004). Limitations, reasons for caution: Some caution is warranted because other ovarian reserve markers such as serum markers (basal FSH and inhibin-B) or sonographic markers were not assessed. Wider implications of the findings: The present study shows that the use of a hemostatic sealant during laparoscopic ovarian cystectomy should be considered, as hemostatic sealant provides the additional benefit of preservation of ovarian reserve. © The Author 2014.


Kim J.-H.,National Health Insurance Service Ilsan Hospital | Shim J.-K.,Yonsei University | Song J.-W.,Yonsei University | Song Y.,Yonsei University | And 2 more authors.
Critical Care | Year: 2013

Introduction: Recombinant human erythropoietin (EPO) is known to provide organ protection against ischemia-reperfusion injury through its pleiotropic properties. The aim of this single-site, randomized, case-controlled, and double-blind study was to investigate the effect of pre-emptive EPO administration on the incidence of postoperative acute kidney injury (AKI) in patients with risk factors for AKI undergoing complex valvular heart surgery. Methods: We studied ninety-eight patients with preoperative risk factors for AKI. The patients were randomly allocated to either the EPO group (n = 49) or the control group (n = 49). The EPO group received 300 IU/kg of EPO intravenously after anesthetic induction. The control group received an equivalent volume of normal saline. AKI was defined as an increase in serum creatinine >0.3 mg/dl or >50% from baseline. Biomarkers of renal injury were serially measured until five days postoperatively. Results: Patient characteristics and operative data, including the duration of cardiopulmonary bypass, were similar between the two groups. Incidence of postoperative AKI (32.7% versus 34.7%, P = 0.831) and biomarkers of renal injury including cystatin C and neutrophil gelatinase-associated lipocalin showed no significant differences between the groups. The postoperative increase in interleukin-6 and myeloperoxidase was similar between the groups. None of the patients developed adverse complications related to EPO administration, including thromboembolic events, throughout the study period. Conclusions: Intravenous administration of 300 IU/kg of EPO did not provide renal protection in patients who are at increased risk of developing AKI after undergoing complex valvular heart surgery.Trial registration: Clinical Trial.gov, NCT01758861. © 2013 Kim et al.; licensee BioMed Central Ltd.


Chung J.H.,Catholic Kwandong University | Han C.H.,National Health Insurance Service Ilsan Hospital | Park S.C.,National Health Insurance Service Ilsan Hospital | Kim C.J.,National Health Insurance Service Ilsan Hospital
npj Primary Care Respiratory Medicine | Year: 2014

Background: There is good evidence for an association between chronic obstructive pulmonary disease (COPD) and depression, but there are few studies on the relationship between COPD and suicidal ideation/suicidal attempts. Aims: To evaluate the mental health of patients with COPD in Korea and to compare it with that of the general population. Methods: We analysed data of 15,718 subjects (age 3/440 years) who participated in the 2007-2012 Korea National Health and Nutrition Examination Survey. COPD was defined according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria for people aged 3/440 years. We compared the mental health outcomes of 2,506 patients with COPD (2,355 GOLD stages I and II; 151 GOLD stages III and IV) with those of 13,212 controls. Results: Suicidal thoughts were reported by 16.0% of patients in stages I and II, by 23.8% of those in stages III and IV and by 15.7% of controls (P=0.023). Suicidal attempts were reported by 0.6% of patients in stages I and II, by 2.6% of those in stages III and IV and by 1.0% of controls (P=0.019). The crude odds ratio (OR) for suicidal ideation in those in stages III and IV was 1.68 (95% confidence interval (CI), 1.16-2.46), and the OR for suicidal attempts in stages III and IV was 2.83 (95% CI, 1.03-7.75). In multivariate analysis, the OR for suicidal ideation in stages III and IV was 1.67 (95% CI, 1.12-2.49) and that for suicidal attempts was 2.94 (95% CI, 1.03-8.31). Conclusions: GOLD stages III and IV COPD were associated with a marked increase in suicidal behaviour. © 2014 Primary Care Respiratory Society UK/Macmillan Publishers Limited.


Chung J.H.,Catholic Kwandong University | Hwang H.-J.,Catholic Kwandong University | Han C.H.,National Health Insurance Service Ilsan Hospital | Son B.S.,Pusan National University | And 2 more authors.
COPD: Journal of Chronic Obstructive Pulmonary Disease | Year: 2015

Aim: It is not clear whether the restrictive or obstructive pattern of spirometry is associated with metabolic syndrome. We investigated the associations between restrictive and obstructive spirometric patterns and metabolic risk factors using data from the Korea National Health and Nutrition Examination Survey (KNHANES). Additionally, we investigated whether sarcopenia is associated with metabolic syndrome in patients with chronic obstructive pulmonary disease (COPD). Methods: Using data from KNHANES between 2008 and 2011, we enrolled 8,145 subjects (normal lung function: 6,077, obstructive spirometric pattern: 1,039, restrictive pattern: 1,029) aged ≥40 years who underwent anthropometric measurement, laboratory tests, spirometry and estimation of appendicular muscle mass. Sarcopenia was defined as an appendicular skeletal muscle mass divided by body weight squared <2 SD below the sex-specific mean for the young reference group. Results: Sarcopenia was found in 32.8 of male and 12.2 of female patients with COPD. The odds ratio (OR) of metabolic syndrome for the restrictive spirometric pattern in male was 1.29 (95 confidence interval CI, 1.021.65), and that for obstructive pattern in males was 0.99 (95 CI, 0.791.26) after adjustments for covariables (female restrictive pattern (ORs, 1,45; 95 CI, 1.091.91) and female obstructive pattern (ORs 0.73; 95 CI, 0.491.09). After adjustment for other confounding factors, the risk of metabolic syndrome was higher in sarcopenic male (OR, 1.88; 95 CI, 1.272.77) with COPD than in those without sarcopenia. Conclusions: The restrictive spirometric pattern is associated with metabolic syndrome, and sarcopenia may contribute to the risk of metabolic syndrome in male patients with COPD. Copyright © Informa Healthcare USA, Inc.


PURPOSE:: To evaluate the risk of stroke after ranibizumab treatment for neovascular age-related macular degeneration. METHODS:: National registry data for 1,025,340 random subjects in the year 2002 were used. The ranibizumab group comprised patients diagnosed with neovascular age-related macular degeneration and treated with ranibizumab between 2009 and 2013 (n = 467). The two types of comparison groups were defined as comorbidity-matched controls (n = 2,330) comprised of randomly selected patients (5 per age-related macular degeneration patient), who were matched to the ranibizumab group according to sociodemographic factors, hypertension, atrial fibrillation, and the Charlson comorbidities index, and sociodemographic-matched controls (n = 2,331) matched according to sociodemographic factors only. Each sampled patient was tracked until 2013. The Cox proportional hazard regression was used. RESULTS:: Stroke occurred in 6.6% of the ranibizumab group versus 7.0% of the comorbidity-matched controls and 6.7% of the sociodemographic-matched controls; these differences were not statistically significant. The overall incidence of stroke was similar for the ranibizumab group versus the comorbidity-matched controls and sociodemographic-matched controls, based on the multivariable Cox regression (hazard ratio = 0.88; 95% confidence interval, 0.60–1.30; hazard ratio = 0.95, 95% confidence interval, 0.64–1.41, respectively). CONCLUSION:: Ranibizumab treatment for neovascular age-related macular degeneration did not increase the overall risk of stroke, compared with comorbidity-matched controls or sociodemographic-matched controls. © 2016 by Ophthalmic Communications Society, Inc.


Chang T.I.,National Health Insurance Service Ilsan Hospital | Nam J.Y.,National Health Insurance Service Ilsan Hospital | Shin S.K.,National Health Insurance Service Ilsan Hospital | Kang E.W.,National Health Insurance Service Ilsan Hospital
Clinical Journal of the American Society of Nephrology | Year: 2015

Background and objectives: A direct association between low triiodothyronine (T3) syndrome and cardiovascular (CV) mortality has been reported in hemodialysis patients. However, the implications of this syndrome in peritoneal dialysis (PD) patients have not been properly investigated. This study examined the association between low T3 syndrome and CV mortality including sudden death in a large cohort of incident PD patients. Design, setting, participants, & measurements: This prospective observational study included 447 euthyroid patients who started PD between January 2000 and December 2009. Measurement of thyroid hormones was performed at baseline. All-cause and cause-specific deaths were registered during the median 46 months of follow-up. The survival rate was compared among three groups based on tertile of T3 levels. Results: In Kaplan–Meyer analysis, patients with the lowest tertile were significantly associated with higher risk of all-cause and CV mortality including sudden death (P<0.001 for trend). In Cox analyses, T3 level was a significant predictor of all-cause mortality (per 10-unit increase, adjusted hazard ratio [HR], 0.86; 95% confidence interval [95% CI], 0.78 to 0.94; P=0.002), CV death (per 10-unit increase, adjusted HR, 0.84; 95% CI, 0.75 to 0.98; P=0.01), and sudden death (per 10-unit increase, adjusted HR, 0.69; 95% CI, 0.56 to 0.86; P=0.001) after adjusting for well known risk factors including inflammation and malnutrition. The higher T3 level was also independently associated with lower risk for sudden death (per 10-unit increase, adjusted HR, 0.71; 95% CI, 0.56 to 0.90; P=0.01) even when accounting for competing risks of death from other causes. Conclusions: T3 level at the initiation of PD was a strong independent predictor of long-term CV mortality, particularly sudden death, even after adjusting well known risk factors. Low T3 syndrome might represent a factor directly implicated in cardiac complications in PD patients. © 2015 by the American Society of Nephrology.


Hong K.P.,National Health Insurance Service Ilsan Hospital
Korean Journal of Thoracic and Cardiovascular Surgery | Year: 2015

Background: The aim of this study was to evaluate the midterm clinical outcomes after modified high ligation and segmental stripping of small saphenous vein (SSV) varicosities. Methods: Between January 2010 and March 2013, 62 patients (69 legs) with isolated primary small saphenous varicose veins were enrolled in this study. The outcomes measured were reflux in the remaining distal SSV, the recurrence of varicose veins, the improvement of preoperative symptoms, and the rate of postoperative complications. Results: No major complications occurred. No instances of the recurrence of varicose veins at previous stripping sites were noted. Three legs (4.3%) showed reflux in the remaining distal small saphenous veins. The preoperative symptoms were found to have improved in 96.4% of the cases. Conclusion: In the absence of flush ligation of the saphenopopliteal junction, modified high ligation and segmental stripping of small saphenous vein varicosities with preoperative duplex marking is an effective treatment method for reducing postoperative complications and the recurrence of SSV incompetence.

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