• Title/Summary/Keyword: 치료성과

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The Diagnostic Value of Bronchoalveolar lavage fluid microscopic study and PCR in Pulmonary tuberculosis (폐결핵에 있어서 기관지폐포세척액 결핵균검사 및 PCR의 진단적 가치)

  • Park, Moon-Hwan;Choi, Choon-Han;Kim, Nam-Jin
    • Tuberculosis and Respiratory Diseases
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    • v.43 no.2
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    • pp.128-137
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    • 1996
  • Background : We can diagnose pulmonary tuberculosis with sputum AFB smear and culture, but sputum AFB smear has low sensitivity and culture needs long period, and they are not available in the patients who can not expectorate effectively. Recently developed, PCR is a fast diagnostic tool in tuberculosis, but false positive and false negative are important problems. So, we studied the diagnostic value of bronchoalveolar lavage fluid AFB smear, culture, PCR through the bronchoscopy. Methods : The 67 pulmonary tuberculosis patients and 43 non-pulmonary tuberculosis patients were analyzed with their sputum specimen AFB smear and culture. Also, bronchoscopy and bronchoalveolar lavage were done, and bronchoalveolar lavage fluid AFB smear, culture and PCR were done. Results: 1) In the cases of pulmonary tuberculosis, the sensitivity of sputum AFB smear and culture were 32.8% and 57.4%, respectively. And the sensitivity of bronchoalveolar lavage fluid AFB smear and culture were 47.8% and 80.6%. respectively. 2) In the cases of pulmonary tuberculosis, the sensitivity and the positive predictive value(for predicting a positive culture) of PCR were 80.6% and 81.5%, respectively. 3) In the cases of sputum AFB smear-negative and culture-negative pulmonary tuberculosis, the sensitivity of bronchoalveolar lavage fluid AFB smear, culture, PCR, and the positive predictive value(for predicting a positive culture) of PCR were 23.1%, 100%, 88.5%, and 82.4%, respectively. 4) The specificity of bronchoalveolar lavage fluid PCR was 77.0%. 5) The median number of days between obtaining a specimen and starting therapy was 5 days for sputum AFB smear, 9 days for bronchoalveolar lavage fluid AFB smear, 26 days for bronchoalveolar lavage fluid PCR, 32 days for sputum culture, 56 days for bronchoalveolar lavage fluid culture. Conclusion : The sensitivity of bronchoalveolar lavage fluid AFB smear and culture are higher than sputum AFB smear and culture. So, the bronchoscopy must be considered for evaluating suspected cases of pulmonary tuberculosis in patients from whom smears of expectorated sputum do not reveal mycobacteria or from whom no sputum can be obtained. Especially, combined with PCR, it is expected that pulmonary tuberculosis can be diagnosed more rapidly and more accurately, so bronchoalveolar lavage fluid APB smear and PCR can be helpful in the early treatment of pulmonary tuberculosis.

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Risk Factors of Extubation Failure and Analysis of Cuff Leak Test as a Predictor for Postextubation Stridor (발관 실패의 위험 인자 및 발관 후 천음과 재삽관의 예측에 있어 Cuff Leak Test 의 유용성과 의미 분석)

  • Lim, Seong Yong;Suh, Gee Young;Kyung, Sun Yong;An, Chang Hyeok;Park, Jung Woong;Lee, Sang Pyo;Jeong, Sung Hwan;Ham, Hyoung Suk;Ahn, Young Mee;Lim, Si Young;Koh, Won Jung;Chung, Man Pyo;Kim, Ho Joong;Kwon, O Jung
    • Tuberculosis and Respiratory Diseases
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    • v.61 no.1
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    • pp.34-40
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    • 2006
  • Background: Extubation failure was associated with poor prognosis and high hospital mortality. Cuff leak test (CLT) has been proposed as a relatively simple method for detecting laryngeal obstruction that predispose toward postextubation stridor (PES) and reintubation. We examined the risk factors of extubation failure and evaluated the usefulness and limitation of CLT for predicting PES and reintubation. Methods: Thirty-four consecutive patients intubated more than 24 hours were examined. The subjects were evaluated daily for extubation readiness, and CLT was performed prior to extubation. Several parameters in the extubation success and failure group were compared. The accuracy and limitation of CLT were evaluated after choosing the thresholds values of the cuff leak volume (CLV) and percentage (CLP). Results: Of the 34 patients studied, 6 (17.6%) developed extubation failure and 3 (8.8%) were accompanied by PES. The patients who had extubation failure were more likely to have a longer duration of intubation and more severe illness. The patients who developed PES had a smaller cuff leak than the others: according to the CLV ($22.5{\pm}23.8$ vs $233.3{\pm}147.1ml$, p=0.020) or CLP ($6.2{\pm}7.3$ vs $44.3{\pm}24.7%$, p=0.013). The best cut off values for the CLV and CLP were 50ml and 14.7%, respectively. The sensitivity, negative predictive value, and specificity of CLT were relatively high, but the positive predictive value was low. Conclusion: The likelihood of developing extubation failure increases with increasing severity of illness and duration of intubation. A low CLV or CLP (<50ml or 14.7%) is useful in identifying patients at risk of PES, but the CLT is not an absolute predictor and should not be used an indicator for delaying extubation.

A Study on Experimental Construction of Community Garden - A Case Study on Rooftop of SAHA Disabled Welfare House - (커뮤니티 가든 조성을 위한 실험 연구 - 사하 장애인복지관 옥상을 대상으로 -)

  • Kim, Seung-Hwan;Yoon, Sung-Yung;Cha, Min-Jun;Yoo, yeon-seo;Cho, Ji-Young;Kim, Yoon-Sun
    • Journal of the Korean Institute of Landscape Architecture
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    • v.40 no.2
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    • pp.24-37
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    • 2012
  • In this study, Community Garden of various national and international practices trends to an advanced research, the concept of community garden participated with a group operation out of initiative to produce safety food while securing space for the community, ensuring the area that has gone through a new form of active secure urban green space plan, urban renewal movement was defined as the mean. Furthermore, for the purpose of improving the poor welfare environment by attempting to experimentally make a community garden of a disabled welfare house rooftop and how to target its planning and construction process, partnership involvement, business processes have been investigated, such as cost sharing. The whole process including a budget for development of this case was conducted by the Busan Green Trust. Standard Chartered (SC) First Bank's 50% fund share by community chest, participation of volunteers, support of Busan City and Saba-gu, outside of that, sharing parts or trial to participate by diverse partnership of enterprise, public corporation and laboratory, these are the key in developing community garden's model. Established community garden places resulted food production to users of welfare center for the disabled, participating urban agricultural experience program, horticultural therapy, complex community chapter and cultural center. Furthermore, we could find the meaning of rooftop community garden in the point that it is a low cost garden by applying movable and unmovable planters. This study is profitable for improving urban environment, ensuring community chapter and urban green areas, regenerating a city to develop experimental community garden model by using a welfare house rooftop.

A historical study on the flexibility square-format typeface and the prospects - Focused on the three-pairs fonts of hangeul - (탈네모글꼴에 관한 역사적 연구와 전망 - 세벌식 한글 글꼴을 중심으로 -)

  • Yu, Jeong-Mi
    • Archives of design research
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    • v.19 no.2 s.64
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    • pp.241-250
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    • 2006
  • Hangeul as the Korean unique characters were invented according to some character-making principles and based on scholars' exhaustive researches. While most of the characters in the world evolved naturally, Hangeul was invented based on a precise linguistic analysis of the time, and therefore, it is most scientific and reasonable among various characters throughout the world. Nevertheless, Hangeul typeface designs do not seem to inherit the ideology of scientific and reasonable Hangeul correctly. For the square forms have been used intact due to the influences from the Chinese characters which prevailed during the time. If a single set of square characters should be designed, as much as 11,172 fonts should be designed, which suggests that advantages of Mangeul may not well be used fully; Hangeul was invented to visualize every sound with the combinations of 28 vowels and consonants. Problems of such square fonts began to be identified since 1900's when typewriters were introduced first from the West. Since a typewriter is designed with 28 characters laid out on its keyboard by using such combinations, the letters may be easily combined on it. The so-called the flexibility square-format typeface was born as such. Specially, the three-pairs fonts of these can be combined up to 67 letters including vowels and consonants. The three-pairs fonts system can help to solve the problems arising form the conventional square fonts and inherit the original ideology of Hangeul invention. This study aims to review the history of the three-pairs fonts designs facilitated by mechanic encoding of Hangeul and thereupon, suggest some desirable directions for future Hangeul fonts. Since the flexibility square-format typeface is expected to evolve more and more owing to development of the digital technology, they would serve our age of information in terms of both functions and convenience. Just as Hunminjongum tried to be literally independent from the Chinese characters, so the flexibility square-format typeface designs would serve to recover identity of our Hangeul font designs.

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Role of Intra-aortic Balloon Pump in High Risk Patients undergoing Off-Pump Coronary artery bypass graft (심폐바이패스 없이 시행하는 관상동맥 우회술시 고위험군 환자에서 대동맥내 풍선 펌프의 유용성)

  • Cho, Suk-Ki;Jang, Woo-Ik;Lim, Cheong;Lee, Cheul;Lee, Jae-Ik;Kim, Yong-Lak;Ham, Byung-Moon;Kim, Ki-Bong
    • Journal of Chest Surgery
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    • v.34 no.12
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    • pp.895-900
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    • 2001
  • Background : This study aimed to evaluate the usefulness of preoperative placement of intraaortic balloon pump(IABP) in reducing operative risk and facilitating posterior vessel OPCAB in high risk patients with left main disease( 75% stenosis), intractable resting angina, postinfarction angina, or left ventricular dysfunction(ejection fraction 35%). Material and Method : One hundred eighty- nine consecutive patients who underwent multi-vessel OPCAB including posterior vessel revascularization were studied. The patients were divided into group I(n=74) that received preoperative or intraoperative IABP and group II(n=115) that did not receive IABP. In group I, there were 39 patients with left main disease, 40 patients with intractable resting angina, 14 patients with left ventricular dysfunction and 7 patients with postinfarction angina. Ten patients received intraoperative IABP support due to hemodynamic instability during OPCAB. Result : There was one operative mortality in group I and two mortalities in group II. The average number of distal anastomoses was not different between group I and group II(3.5$\pm$0.9 vs 3.4$\pm$0.9, p=ns). There were no significant differences in the number of posterior vessel anastomosis per patient between the two groups. There were no differences in ventilator support time, length of hospital stay, and morbidity between the two groups. There was one case of IABP-related complication in group I. Conclusion : IABP facilitates posterior vessel OPCAB in high risk patients, with comparable surgical results to low risk patients

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Video-Assisted Thoracic Surgery Lobectomy: Experience with 36 Cases (비디오 흉강경을 이용한 폐엽절제술: 치험 36예)

  • Lee, Hee-Sung;Lee, Jae-Woong;Kim, Kun-Il;Cho, Sung-Woo;Park, Sang-Jun;Kim, Hyoung-Soo;Shin, Yoon-Cheol;Shin, Ho-Seung
    • Journal of Chest Surgery
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    • v.42 no.6
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    • pp.732-737
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    • 2009
  • Background: Many video-assisted thoracic surgery (VATS) lobectomies are performed as a potential alternative to thoracotomy despite the controversy about the safety and the associated morbidity/mortality rates. Material and Method: Between November 2006 and August 2008, we performed 87 lobectomies (VATS 36, Thoracotomy 51) and we retrospectively reviewed the surgical treatment results. A VATS lobectomy was performed by a 4~5 cm thoracotomy without rib spreading and this included anatomic hilar dissection, individual vessel and bronchus stapling and lymph node dissection. Result: We studied 52 male and 35 female patients whose age ranged from 6 to 79 (average age: $59.8{\pm}15.0$ years). The cases were diagnosed with lung cancer (66) (SQC 24, ADC 38, others 4), pulmonary metastasis (2), carcinoid (2) and benign diseases (17). There was no intraoperative death. Postoperative complications were seen in 5 (15.6%) VATS and 33 (64.7%) thoracotomies, and perioperative death caused by adult respiratory distress syndrome occurred in 1 (2.8%) VATS and 3 (5.9%) thoracotomies. Three patients Underwent conversion to thoracotomy (8.3%). The mean time to chest tube removal was 6 days for VATS and 9.4 days for thoracotomy (p<0.001), and the mean length of the hospital stay was 8 days for VATS and 12.8 days for thoracotomy (p<0.001). Conclusion: VATS lobectomy can be performed safely with low morbidity/mortality rates. Furthermore, all the patients benefited from earlier postoperative rehabilitation and less pain and they were candidates for an earlier return to normal activities.

Diagnostic limitation and usefulness of 99mTc-DISIDA hepatobiliary scanning on neonatal cholestasis (신생아 담즙정체성 간 질환에서 담도 폐쇄증 감별을 위한 DISIDA 스캔의 진단적 한계성과 유용성)

  • Kim, Jung Mi;Choe, Byung-Ho;Jang, You Cheol;Oh, Ki Won;Cho, Min Hyun;Lee, Kyung Hee;Park, Jin-Young;Kim, Heng Mi
    • Clinical and Experimental Pediatrics
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    • v.49 no.7
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    • pp.737-744
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    • 2006
  • Purpose : To assess the usefulness of $^{99m}Tc-DISIDA$ scanning in the early evaluation of neonatal cholestasis and to verify the diagnostic value of this test in the differential diagnosis of biliary atresia. Methods : DISIDA scannings were performed and analyzed in 87 children(58 males and 29 females; age, 18-139 days, mean, 59.1 days) with neonatal cholestasis. Five groups according to the final diagnosis and the results of DISIDA scanning were analyzed by scatter plots using the parameters of age and the level of liver function tests(direct bilirubin, AST, ALT, ALP, GGT). The diagnostic sensitivity, specificity and accuracy of DISIDA scanning in the diagnosis of biliary atresia were compared between a higher bilirubin group and a lower bilirubin group(direct bilirubin level >5 mg/dL vs. <5 mg/dL) decided by the pattern of scatter plots. Results : DISIDA scannings in the diagnosis of biliary atresia were analyzed by high sensitivity(100 percent, 16/16) but lower specificity(70.4 percent, 50/71) and accuracy(75.9 percent, 66/87). False positivity(29.6 percent, 21/71) was higher in patients with a higher direct bilirubin level(42.5 percent for >5 mg/dL vs. 9.7 percent for <5 mg/dL, P<0.01). The age and the level of liver function tests(AST, ALT, ALP, GGT) analyzed by scatter plots revealed neither diagnostic value in predicting final diagnosis nor estimated the accuracy rate of DISIDA scanning in the evaluation of neonatal cholestasis. Conclusion : We suggest that DISIDA scannings should not be routinely used in evaluating neonatal cholestasis with elevated direct bilirubin level(>5 mg/dL), especially if it delays early diagnosis and surgical intervention.

An analysis of current condition of student's selection process in Hansung science highschool (한성과학고등학교 학생 선발과정의 현황 분석)

  • Dong, Hyo-Kwan;Jhun, Young-Seok
    • Journal of Gifted/Talented Education
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    • v.13 no.4
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    • pp.65-94
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    • 2003
  • The purpose of this study is to acquire the information on the current situation of students' selection process in order to renovate the system of picking up the students. As a first step of the study, we examined the validity of the factors of the single-out system such as qualification and the process for the application and the standards and proceeding of the selection. Then we analysed the result of the entrance examination of Hansung Science Highschool in 2002. The analysis was on the correlation between the result of entrance examination and the achievement in the school and the decision of the course after graduation. To know on the achievement of the students, we investigated the records of regular tests and asked the teachers' opinion in math and science classes. As a result, we gained the following points: First, the present single-out system has a danger of excluding students who are much talented in science and math field because it is based on students' achievements in middle schools; Second, the new selection system should consider the character and attitude of the applicants in addition to their knowledge; Third, the continuous observation of the teacher in middle school should be an important factor of the picking up system; Fourth, more questions requiring divergent thinking ability and inquiry skill should be developed as selective examination question. Also examination questions should cover the various contents from mathematics to science, and do not affect pre-learning; Finally, the system of present letting all students stand in one line should be changed into that of letting students in various lines. We can consider using multi-step selection system.

Development and Evaluation of Silicon Passive Layer Dosimeter Based Lead-Monoxide for Measuring Skin Dose (피부선량 측정을 위한 Lead-Monoxide 기반의 Silicon Passive layer PbO 선량계 개발 및 평가)

  • Yang, Seung-Woo;Han, Moo-Jae;Jung, Jae-Hoon;Bae, Sang-Il;Moon, Young-Min;Park, Sung-Kwang;Kim, Jin-Young
    • Journal of the Korean Society of Radiology
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    • v.15 no.6
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    • pp.781-788
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    • 2021
  • Due to the high sensitivity to radiation, excessive exposure needs to be prevented by accurately measuring the dose irradiated to the skin during radiation therapy. Although clinical trials use dosimeters such as film, OSLD, TLD, glass dosimeter, etc. to measure skin dose, these dosimeters have difficulty in accurate dosimetry on skin curves. In this study, to solve these problems, we developed a skin dosimeter that can be attached according to human flexion and evaluated its response characteristics. For the manufacture of the dosimeter, lead oxide (PbO) with high atomic number (ZPb: 82, ZO: 8) and density (9.53 g/cm3) and silicon binders that can bend according to human flexion were used. In the case of a dosimeter made of PbO material, the performance degradation has been prevented by using parylene and others due to the presence of degradation due to oxidation, but the previously used parylene is affected by bending, so a new form of passive layer was produced and applied to the skin dosimeter. The characteristic evaluation of the skin dosimeter was evaluated by analyzing SEM, reproducibility, and linearity. Through SEM analysis, bending was evaluated, reproducibility and linearity at 6 MeV energy were evaluated, and applicability was assessed with a skin dosimeter. As a result of observing the dosimeter surface through SEM analysis, the parylene passive layer PbO dosimeter with the positive layer raised to the parylene produced cracks on the surface when bent. On the other hand, no crack was observed in the silicon passive layer PbO dosimeter, which was raised to silicon passive layer. In the reproducibility measurement results, the RSD of the silicon passive layer PbO dosimeter was 1.47% which satisfied the evaluation criteria RSD 1.5% and the linearity evaluation results showed the R2 value of 0.9990, which satisfied the evaluation criteria R2 9990. The silicon passive layer PbO dosimeter was evaluated to be applicable to skin dosimeters by demonstrating high signal stability, precision, and accuracy in reproducibility and linearity, without cracking due to bending.

Recovery Support Service for Neglected Children and Their Families of Origin: Status and Suggestions (방임 및 보호 아동·청소년 원가정 회복지원 시범사업의 현황과 과제)

  • Jeong, Jeeyoung;Anh, Jinkyung;Kim, Eunhye
    • Journal of Family Resource Management and Policy Review
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    • v.25 no.3
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    • pp.87-102
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    • 2021
  • Child abuse and neglect are recently increasing in Korea, and although the government has actively improved the child protection system, the number of abused children and the rate of cases judged as abuse have continuously risen. Given that 75% of child abusers are parents, child abuse and neglect are expected to recur. To prevent such a recurrence, various intervention programs for abused children and their parents are required. The purpose of this study were to design a recovery support service process and investigate the effectiveness of pilot program for families of origin, including neglected(protected) children, to improve the system by which these programs are operated, and formulate policy alternatives that reinforce "family preservation" principles. The pilot program was implemented from June to November 2020 in 4-local healthy family support center. The number of program participants and the frequency of participation in each other differed, because of the difference in number of confirmed coronavirus cases in each region and the requirement for social distancing. Through the program, a community-based service process was developed for neglected(protected) children and their parents, and cooperative networks between related facilities and institutions were established. The study formulated the following recommendations: First, a cooperation system among government departments mandated to provide different services to neglected(protected) children is needed. Second, wider and various channels through which abused children can avail of protective services should be developed within communities. Third, more stable environments for program operation should be cultivated, and cooperative partnerships should be sought for knowledge sharing among relevant government departments. Another necessary measure is for a center to develop its own business model, in which the duplication of services provided by involved organizations is avoided. Finally, clear guidelines, administrative standards, and specific plans for program operation should be arranged. Also regional characteristics are maintained, but services should be standardized.