• Title/Summary/Keyword: 치료원칙

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Metastatic Pulmonary Hemangiopericytoma from Retroperitoneum -A case report - (후복강에서 폐로 전이된 혈관 주위 세포종 -1예 보고-)

  • Seok Yang-Ki;Lee Eung-Bae
    • Journal of Chest Surgery
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    • v.39 no.6 s.263
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    • pp.495-497
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    • 2006
  • Hemangiopericytoma is a rare vascular tumor derived from the pericyte and usually occures in the lower extremities and the retroperitoneum. Complete excision is treatment of choice. Regular follow up is strongly recommended due to its potential malignancy which is recurrence and metastasis. We experienced surgical excision of metastatic pulmonary hemangiopericytoma from retroperitoneal hemangiopericytoma completely excised 10 years ago.

Clinical Research in Complementary Therapies (1) - Methods and Strategies - (보완치료의 임상시험 (1) - 방법과 전략 -)

  • Yoo, Hwa-Seung
    • Journal of Pharmacopuncture
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    • v.11 no.4
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    • pp.101-105
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    • 2008
  • 여기서는 보완대체의학의 임상효능을 평가하기 위한 일반적인 연구원칙들을 제시하였다. 어떻게 우리가 보완대체의학을 평가할 것인가? 그것이 정말 통상의학과 다른가? 우리는 보완대체의학을 통상의학과 비교하여 우리의 연구 질문들을 다르게 제시해야만 하는가? 보완대체의학은 안전하고 경제적인가? 그리고 우리가 이러한 전문적인 이슈들을 어떻게 제시할 것인가? 보완대체의학 연구는 관심을 가진 임상가들에게 지적인 도전을 제시 한다. 과학적으로 평가하는 것은 가능하긴 하지만 어렵다. 특정 약물치료를 통한 무작위대조 임상시험들은 침술, 동종요법, 수기요법과 같은 유사한 분야의 학문들보다 계획하고 투여하는 것이 훨씬 쉽다. 보완대체의학 분야에서 임상연구의 전술과 전략들은 개념상의 연속되는 도전들을 제시할 것이다.

백고(伯高)의 의학체계에 관한 연구;관어백고의학체계적연구(關於伯高醫學體系的硏究)

  • Park, Hyeon-Guk;Kim, Gi-Uk
    • Journal of Korean Medical classics
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    • v.20 no.1
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    • pp.11-16
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    • 2007
  • 백고주요외표적골격이측량료인체전 후(後) 측면적골도(側面的骨度), 소이타수립료측량(所以他樹立了測量)"맥도(脈度)"的基礎(적기초). 병차타통과실지해부이요조도인체적실지구조, 저위적시인출이수곡능유지생명적생리학적기초(這爲的是認出以水穀能維持生命的生理學的基礎). 저양과정중백고주목료(這樣過程中伯高注目了), 수곡진입어위(水穀進入於胃), 타통과나리포산어전신, 여하이대소변배제(如何以大小便排除), 타인위상초여하초종상구여하구발출(他認爲上焦與下焦從上口與下口發出). 타우관심(他又關心), 대어오미진입어일양성질적장, 통과영(通過營)·위운행(衛運行), 저화상초(這和上焦)·중초련계(中焦聯系), 이차여하형식운행(而且如何形式運行). 우기백고장천인상응어위기운행적시간론(尤其伯高將天人相應於衛氣運行的時間論), 인차타계량화료위기적운행(因此他計量化了衛氣的運行). 타입족어천인상관론이강구료생리(他立足於天人相關論而講究了生理)·병리(病理)·진단급치료법(診斷及治遼法). 동시타입족어형(同時他立足於形)·기이분법적생명관(氣二分法的生命觀), 분류치병이제정자법(分類治病而制定刺法).

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Management of Displaced Bucket-Handle tear - Differences Between Medial & Lateral Menisci - (전위된 양동이 손잡이형 파열의 치료 - 내측과 외측 반월상 연골의 비교 -)

  • Chung Shun Wook;Hahn Sung Ho;Yang Bo Kyu;Yi Seung Rim;Ha Jeong Hyun;Kim Min Seok;Yeo Yong Beom
    • Journal of the Korean Arthroscopy Society
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    • v.7 no.2
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    • pp.153-159
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    • 2003
  • Purpose : The purpose of this study was to compare the pattern of displaced bucket-handle tear of lateral and medial menisci and the treatment modality and results from accompanying injury. Materials and Methods : Patients who were diagnosed for displaced bucket-handle tear of medial meniscus (group I: 52patients, 52cases) and lateral meniscus (group II: 31patients, 32cases) from September 1998 to December 2002. The mean ages were 25years $(16\~66)$ for Group I and 29years $(18\~63)$ for Group II, and the average follow-up period were 18months $(12\~44)$ and 13months $(6\~46)$, respectively. The zone of meniscus tear and the existence of accompanying injury were verified through intraoperative arthroscopy and discoid type meniscus was additionally examined for group II. The assessment was made according to the physical examination and clinical pattern at the postoperative last follow-up, and the 2nd look arthroscopy was performed in 19cases $(23\%)$ for the cases accompanying anterior cruciate ligament (ACL) injury in both groups. Results : There were 38cases $(73\%)$ in group I, 5cases $(16\%)$ in group II for associating ACL injury. We observed discoid type meniscus (19cases, $59\%$) in group II. At last follow-up clinical success in repair cases of group I and II are 22cases $(85\%)$, 2cases $(67\%)$, in resection cases are 26cases $(100\%)$, 26cases $(93\%)$ respectively. Reoperation is performed 2cases in repair cases of group I. One case is re-rupture, the other case is newly developed tear in white-white zone. Reoperation is performed 2cases due to remnant meniscal tear in resection cases of group II. All of 2cases are discoid type menisci. Conclusion : Displaced bucket-handle tear of medial & lateral menisci would be substantially different an aspect, considering on difference would help to select proper treatment modality.

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Human Sexuality and Sexual Dysfunction (성(性)생활과 성기능장애)

  • Cho, Doo-Young
    • Korean Journal of Psychosomatic Medicine
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    • v.7 no.1
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    • pp.10-25
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    • 1999
  • Children above age of two are able to have sexual excitement, and they actively seek the pleasure actively or passively through touch and masturbation. In late $60_s$ and early $70_s$, Masters, obstetrician, and Johnson, social worker, illustrated four phases of human sexual responses, namely excitement, plateau, orgasmic and resolution phases in both sexes, and multiple orgasms in the female. Their treatment principles of sexual dysfunctions were largely based on behavioral model, introducing the concepts of sensate focus, dual therapy and sex education. Following Masters and Johnson, Kaplan, psychiatrist and psychoanalyst, in the early and mid-$70_s$ introduced new sex therapy which was based on the combination of analytically-oriented psychotherapy and behavior therapy, and classified sexual dysfunctions into three categories such as desire excitement and orgasmic phase disorders. Since $1980_s$ other medical fields joined the stream, putting the concentrated effort on the treatment of the impotence in the male. They have developed penile prosthesis, local injection therapy, and the administration of oral medications. Nowadays Sildenafil(Viagra) seems the best choice for the treatment of the impotence in the male.

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Constitutional Limits of the Medical Fee Payment System and the Unconstitutionality of Fixed Payment System (진료수가제도의 헌법적 한계와 정액수가제의 위헌성 -헌법재판소 2020. 4. 23. 선고 2017헌마103 결정을 중심으로-)

  • Hyun, Doo-youn
    • The Korean Society of Law and Medicine
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    • v.21 no.1
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    • pp.69-105
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    • 2020
  • In the health care system, medical fee payment is a very important and basic factor. The National Health Insurance Act adopted a contract system, and the content of the contract is to be determined the unit price per relative value scale. Accordingly, in the National Health Insurance system, the costs of health care benefits are adjusted each year according to inflation or changes in economic conditions. On the other hand, in the Medical Care Assistance system, the Medical Care Assistance Act does not prescribe the method of determining the medical payment, and all matters are delegated to the Minister of Health and Welfare. Accordingly, the Minister has adopted a fixed-payment system for hemodialysis treatment since 2001. A constitutional petition was filed in 2017 against this fixed-payment system, and the Constitutional Court rejected the petition in 2020. In this study, we examine the meaning and content of the medical fee payment system, focusing on the above constitutional petition case, and present three principles as constitutional limits on the system. The first of its principles is the principle of legality, the second is the principle of prohibition of comprehensive delegation, and the third is the principle of proportionality. From that point of view, There are many unconstitutional elements in the fixed-payment system on hemodialysis.

Informed Consent and Refusal of Treatment in Emergency Medical Situation (응급의료에서의 설명·동의 원칙과 응급의료거부죄)

  • Lee, Jung-eun
    • The Korean Society of Law and Medicine
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    • v.23 no.1
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    • pp.37-80
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    • 2022
  • By analyzing informed consent and the refusal of emergency medical treatment (called patient dumping) under the current Emergency Medical Service Act, this study suggests that an emergency medical professional is only liable for patient dumping if their duty to protect the patient's life takes precedence over the patient's right to self-determination. In emergency medical situations, as in general medical situations, medical treatment should be performed after the emergency medical professional informs the patient about the medical treatment, including its necessity and methods, and obtains consent from the patient. Refusing or evading the performance of emergency medical services on the excuse of the informed consent not considering a waiver or alteration of informed consent requirements without reasonable reasons violates the Emergency Medical Service Act and thus makes an emergency medical professional liable to administrative disposition or criminal penalty. In other words, depending on the existence of a waiver of alteration of the informed consent, patient dumping may be established. If the patient is a minor or has no decision-making ability, and their legal representative makes a decision against the patient's medical interests, the opinion of the legal representative is not unconditionally respected. A minor also has the right to decide over their body, and the decisions of their legal representatives should be in the patient's best interests. If the patient refuses treatment, in principle, the obligation of life protection of emergency medical professionals is the top priority. However, making these decisions in the aforementioned situations in the emergency medical field is difficult because of the absence of explicit regulations regarding these exceptional problems. This study aims to organize the following precedents of the Supreme Court of Korea. The court states that, when balancing the conflicting interests between the duty to provide emergency medical service and the duty to inform is unavoidable for emergency medical professionals, they should put the duty to protect the patient's life ahead of the duty to inform if the patient's life matters. Exceptionally, when a patient has seriously considered whether they should receive treatment before the emergency medical situation, their right to self-determination can be considered equal to the obligation of emergency medical professionals to provide emergency medical treatment. This research also suggests that an amendment of the Emergency Medical Service Act should include the following. First, the criteria for determining the decision-making ability of emergency patients should consist of medical content. Second, additional consent from a medical professional is unnecessary for first-aid treatment. Finally, new provisions for emergency medical obligations for minors, new provisions for the decision standard when there are conflicting opinions about the treatment of a patient, and new penalty provisions for professionals who suspend emergency medical examinations and treatments need to be established.

Partial thickness tear: Debris vs. Repair (회전근 개 부전층 파열: 변연절제술가 봉합술)

  • Oh, Jeong-Hwan;Park, Jin-Young
    • Journal of the Korean Arthroscopy Society
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    • v.9 no.1
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    • pp.34-39
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    • 2005
  • Partial thickness rotator cuff tears (PTRCTs) are now a well-established clinical entity, yrt there is no consensus in regards to surgical management. Recommended treatment varies widely from simple debridement of the torn tendon to subacromial decompression to excision of the degenerative tendon and repair. Surgery may be performed using an open, arthroscopically assisted (miniopen), or entirely arthroscopic procedure. The advantages and disadvantages of open and arthroscopic procedures may lie in the balance between precision and morbidity. Visualization of both the articular and bursal surfaces is mandatory to determine the level of rotator cuff disease and formulate a treatment strategy. Because these tear often are secondary finding, recognition of the primary pathology is critical. Treatment of the primary problem usually remedies the partial tear. However, when there is significant PTRCT, an arthroscopic or open repair of the diseased tendon will give the most consistent results.

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Functional Anatomy and Biomechanics of the Patellofemoral Joint (슬개대퇴 관절의 기능적 해부학 및 생체역학)

  • Kim, Hyoung-Soo;Park, Sang-Joon
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.4 no.2
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    • pp.74-78
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    • 2005
  • Even though, anterior knee pains are most frequently encountered in knee clinics, many physicians use a 'recipe'-type of approach to their treatment. But many predisposing factors have been included internal rotation of the femur, valgus knee alignment, external rotation of the extensor mechanism, patellar alta, a flat trochlear groove, patella with poor congruence and ligatmentous laxity. Many scientific principles on which these commonly used treatment are based, can lead to refinements and improvement in treatment. We reviewed and summarized the recent functional anatomical and biomechanical data that are most relevant to the contemporary treatment of patellofemoral joint disorders.

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Esophagus and Pharynx reconstruction for head & Neck cancer (두경부암종에서 식도와 인두의 재건)

  • Son, Jin-Ho
    • Korean Journal of Bronchoesophagology
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    • v.11 no.2 s.22
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    • pp.10-15
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    • 2005
  • 식도와 인두 재건은 연하작용을 원활하게하고 발선기능을 보존하면서 위험부담이 가장 절은 술식을 선택하는 것이 원칙이다. 술식의 선택에 고려되어야 할 주요 인자는 결손부위의 크기, 창상의 상태, 술전 방사선치료 여부, 환자의 전신상태 등이다. 부분인두결손에는 유경근피판(pedicled myocutaneous flap)이나 유리피판이 적합하며 방사선 치료를 받은 경우는 유리피판이 유리하다. 흉곽입구 상부에 국한된 인두와 식도의 전체둘레결손에는 전완부, 외측 대퇴부, 공장의 유리피판이 좋다. 전완부는 피판이 다루기 쉽다는 장점이 있지만 공여부에 합병증이나 미용상의 문제가 있고 외측 대퇴부는 공여부의 문제는 매우 적으나 피판의 사용이 전완부에 비하여 약간 제한적이다. 공장은 허혈에 약하고 공여부 합병증이 다른 피판에 비해 불리하다. 저자의 경험으로는 흉곽상부에 국한된 결손의 재건에 환자가 비만하거나 대퇴부에 털이 많은 경우는 전완부 유리피판이 좋고 그렇지 않으면 외측 대퇴부 유리피판을 선택하는 것이 좋다고 생각된다. 흉곽입구 하방까지 연장된 결손이나 식도전적출술로 인한 결손에는 위전위술이 가장 적합하다. 방사선치료 등으로 창상에 혈관보호가 요구되는 경우는 대흉근피판이 유용하다. 앞으로 새로운 재건술의 개발이 이어지겠지만 모든 환자에게 맞는 이상적인 재건술은 없다. 재건술마다의 장단점과 제약점을 파악하고 환자의 조건에 따라 가장 적절한 재건술을 선택하는 것이 중요하다.

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