• Title/Summary/Keyword: 환자관련 요소

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Mineral Contents in Scalp Hair in Patients with Non-insulin Dependent Diabetes Mellitus (두발중(頭髮中) 일부(一部) 금속(金屬) 농도(濃度)와 인슐린비의존형(非依存形) 당뇨병(糖尿病)과의 관련성(關聯性))

  • Chung, Kyeong-Dong;Kwon, Sam;Kim, Doo-Hee
    • Journal of agricultural medicine and community health
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    • v.22 no.2
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    • pp.215-223
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    • 1997
  • To estimate association of minerals relating to non-insulin dependent diabetes mellitus(NIDDM) the contents of essential minerals and toxic heavy metals in the scalp hair were measured during the period from March 1993 to June 1993. The cases were selected 69 (32 male, 37 female) from the patients who visited Kyungpook University Hospital during the period from March 1993 to June 1993 and 74 controls (47 male 27 female) from normal population. zinc, copper, manganese, lead, cadmium and aluminum were analyzed by atomic absorption spectrophotometer(IL. 551). The results were summarized as follows. In NIDDM group, mean contents of zinc and copper were $132.99{\pm}19.66$ ppm, $8.58{\pm}5.07$ ppm respectively; where as $152.51{\pm}46.15$ ppm, $12.48{\pm}6.56$ ppm in control group. The mean of above two mineral content showed significant difference statistically (p<0.01). But, in manganese the content of NIDDM group; $0.44{\pm}0.27$ ppm were significantly higher than the control group; $0.34{\pm}0.18$ ppm(p<0.05). A thesis submitted to the Council of the Graduate School of Kyungpook National University in partial fulfillment of the require ements for the degree of Ph.D. in Medical Science in June 1994. The mean contents of toxic metals - lead, cadmium, aluminum - in NIDDM group were $10.04{\pm}4.60$ ppm, $0.57{\pm}0.12$ ppm, $11.31{\pm}3.98$ ppm; whereas $8.10{\pm}2.45$ ppm, $0.41{\pm}0.23$ ppm, $7.61{\pm}4.16$ ppm in control group. The mean of above three mineral showed significant difference statistically(p<0.01). Cadmium, zinc and copper were selected statistically significant variables with presence of the NIDDM by multiple logistic regression analysis; copper, zinc and cadmium may be associated with NIDDM.

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The Study on the Relationship Between the Duration of Chest Vibration prior to Endotracheal Suctioning and the Changes in Oxygen Saturation in Low-Birth-Weight Infants (저체중아에 있어 기관내 흡인전 흉부진동법의 기관과 산소포화 변화간의 관계 연구)

  • Ahn, Young-Mee
    • Journal of Korean Academy of Nursing
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    • v.25 no.3
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    • pp.597-607
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    • 1995
  • 1960년대 이후 인공호흡기(mechanical ventilator)의 보급과 최근 의료과학의 발달, 간호의 질적 향상의 결과로 저체중출생아를 포함한 고위험 신생아의 생존율이 높아져왔다. 호흡장애증후군(RDS)은 일차적으로 폐포의 완전한 확장을 위해 필요한 계면활성물질(surfactant)의 부족, 미발달된 심폐기능에 의한 병리적 현상으로 저체중아의 가장 큰 원인이 되어왔다. RDS로 인해 인공호흡기에 의존해 있는 저체중아의 경우 적절한 산소공급과 이를 위한 호흡의 유지는 치료의 가장 큰 핵심이 되며, 이를 위한 기관내 흑은 비인두 흡인 (nasopharyngeal suction)은 신생아 중환자실(NICU)의 가장 중요한 간호행위가 되어왔다. 인공호흡기를 위한 기관삽관은 그 자체가 기도의 성모운동을 방해하고 기침반사를 억제시켜 폐 분비물의 효과적 배출을 억제하며, 특히 저체중아의 경우 조산과 관련하여 미발달된 흥곽운등과 심폐기능은 폐분비물의 이동을 저해하는 요소이다. 따라서 기도내의 분비물의 이동을 효과적으로 하여 흡인 시에 최대한의 효과를 돕기 위해 흥곽 물리요법(chest physiotheraphy : CPT)의 한 형태인 흉곽진동법 (Chest Vibration : CV)가 행해져 왔다. 그러나 저체중아를 위한CV의 임상적 적용은 그 대상의 생리적 특성, CV의 적용부위(site)와 기간(duration)에 대한 과학적 근거 없이 만성감염이나 폐질환을 가진 성인이나 cystic fibrosis환자를 위한 CV protocol을 무분별하게 채택하여 저체중아에게 행하여져 왔다 이에 본 연구자는 저체중아에 대한 CV의 안전성을 평가하고, 이에 기초하여 저체중아에게 바람직한CV의 형태를 알아보고자 본 연구를 시작하였다. 연구설계는 CV의 안전성을 평가하기 위한 실험연구이다. CV의 안전성은 RDS치료의 가장 일차적 목표인 oxygenation변화에 의해 평가될 수 있으므로, 본 실험 연구에서는 Pulse oximeter에 의해 계속적으로 측정된 산소포화 변화(oxygen saturation change)를 측정하였다. 실험대상은 미국동부에 위치한 대학병원의 NICU에 입원하여 RDS와 관련된 호흡장애로 인공호흡기에 의존해 있는 10명의 저체중아였다. 인공호흡기에 의존된 모든 저체중아는 Pulse oximeter와 심폐기능 측정기(cardiopulmonary monitor)에 의해 산소공급과 호흡상태가 계속 측정되고 있었다. 실험대상의 평균 출생시 몸무게는 평균 1,3050gm(SD=580.6)이었고, 임신월령 은 평균 28.6주(SD=3.1)였다. RDS가 그들의 일차적 진단명이었고, 그중 4명은 pneumonia, atelectasis의 합병증을 가지고 있었다. 10명중 6명은 intermittent mandatory ventilation(IMV)의 형태로, 4명은 continuous positive airway pressure(CPAP)의 형태로 인공호흡기에 의존되어 있었고 CV시의 FiO2는 평균 42.3(SD=21.2)였다. CV는 중환아용 소형진동기 (minivibrator)를 이용해 가각 10명 의 간호사에 의해 행하여 졌고, 최소 22초에서 최대 100초 동안 실시되었다. 50%의 간호사는 30초에서 40초간 CV를 실시하였으며, CV의 적용부위도, 전후 흉곽부위, 혹은 병변이 있는 좌 우측, 흑은 양쪽 흉벽 등으로 다양했고, 적용방법도 원형으로 돌려가며(circular motion), 혹은 아래에서 위로, 혹은 아무런 기준없이 간호사의 기호에 따라 다양하게 적용되었다. 산소포화의 변화는 CV가 행해지기 전.후로 5초동안 관찰되었다. 연구의 결과, 산소포화 변화는 비 모수통계(non parametric statistics)의 일종인 Matched Paired Wilcoxon test로 분석 한 결과 CV후에 3%의 감소를 보였다(P<.05). 저체중아에 있어 산소포화의 3%감소는 임상적으로 중요한 의미가 없다고 사료되어지며, 실제 흡인전의 과도호흡에 의해 CV를 행하기 이전의 산소공급수준으로 돌아 왔다. CV실시 기간과 산소포화와의 상관관계는 비 모수통계인 Spearman rho correlation coefficient를 이용하여 분석하였는데, 이 두 변수는 서로 관계가 없는 것으로 나타났다(P>.05) 또한 CV와 흡인 후에 각각의 간호사들에게 CV를 필요로 한 저체중아의 기준, 적용부위, 기간, 방법등에 대한 기준을 물었으나 대상의 특성에 따른 간호사정에 의존하기보다는 간호사 각자의 선호하는 방법이나 습관에 라 행하는 것으로 나타났다. 결론적으로 CV와 산소포화 변화와의 관계, NICU에서 관찰된 CV의 임상적 적용을 기초로 저체중아에게 안전한 CV protocol은 신생아용 소형 진동기를 이용하여, 양쪽 흉곽의 늑골하측 변연 부위(low lateral costal margin)에서 시작하여 흉골 중앙부위 방향으로 30초 동안 진동기를 적용하는 것이 좋은 것으로 나타났다. 이에 CV의 효과를 평가하기 위한 보다 과학적인 접근방법으로, CV와 흡인의 결과인 가래(sputum)에 대한 연구를 제언하는 바이다.

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Features and Trends of IEC Particular Standards for Medical Equipment Related to Diagnostic X-ray Based on IEC 60601-1:2005 Ed. 3.0 (IEC 60601-1: 3판이 적용된 진단용 X선장치 관련 개별규격의 동향 및 특징)

  • Kim, Hyun-Ji;Kim, Jung-Min;Choi, In-Seok;Yoon, Yong-Su;Seo, Deok-Nam;Kim, Jung-Su;Kim, Dae-Young;Park, Sung-Yong
    • Journal of radiological science and technology
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    • v.36 no.1
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    • pp.1-10
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    • 2013
  • IEC publications have applied in many countries all over the world such as Europe or Japan and these also have been published as in dustrial standards (KS) and notifications of Korea Food and Drug Administration (KFDA) in Korea. As the general standard of IEC 60601 series for medical electric (ME) equipment was revised as $3^{rd}$ edition in 2005, additional and particular standards have been revised or established newly. Under these circumstances, it is importance for manufacturing and assembling companies or authorized testing companies to understand the trend for revisions of IEC publications. Therefore in this study, the latest version of 3 IEC standards related to medical X-ray equipment : IEC 60601-2-44 for X-ray equipment for computed tomography (CT), IEC 60601-2-45 for mammographic X-ray equipment and IEC 60601-2-54 for X-ray equipment for radiography or radioscopy were covered and analyzed for trends and features accompanied by revision based on IEC 60601-1 $3^{rd}$ Ed. As KFDA notifications in force have referred to the particular standards based on 2nd edition of IEC 60601-1, those revised version of 3 particular standards were compared to KFDA notifications in force. The features of the latest standards applying IEC 60601-1 $3^{rd}$ Ed were shown as following: 1) Requirements for mechanical hazards, especially (motorized) moving parts were emphasized. 2) Indication and recording of patient dose were required. 3) Risk management process was introduced and enabled to monitor potential risks systematically. 4) DR system (digital radiography system) as well as analogue system (film-screen system) was included in the scope. Presently, KFDA will revise the notifications applying the particular standards based on IEC 60601-1 $3^{rd}$ Ed in a few years. Therefore the features of particular standards applying IEC 60601-1 $3^{rd}$ Ed was expected to help manufacturers, assemblers or testing companies of medical electric equipment understand IEC publications or KFDA notifications slated to be published.

Clinical evaluation of the removable partial dentures with implant fixed prostheses (임플란트 고정성 보철물을 이용한 가철성 국소의치의 합병증에 관한 임상적 평가)

  • Kang, Soo-Hyun;Kim, Seong-Kyun;Heo, Seong-Joo;Koak, Jai-Young;Lee, Joo-Hee;Park, Ji-Man
    • The Journal of Korean Academy of Prosthodontics
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    • v.54 no.3
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    • pp.239-245
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    • 2016
  • Purpose: The purpose of this study was to identify clinical complications in removable partial denture (RPD) with implant-supported surveyed prostheses, and to analyze the factors associated with the complications such as location of the implant, splinting adjacent prostheses, the type of retentive clasps, Kennedy classification, and opposing dentition. Materials and Methods: A retrospective clinical study was carried out for 11 patients (7 male, 4 female), mean age of 67.5, who received RPD with Implant-supported surveyed prostheses between 2000 and 2016. The mechanical complications of 11 RPDs and 37 supporting implant prostheses and the state of natural teeth and peripheral soft tissue were examined. Then the factors associated with the complications were analyzed. Results: The average of 3.4 implant-supported prostheses were used for each RPD. Complications found during the follow-up period of an average of 42.1 months were in order of dislodgement of temporary cement-retained prostheses, opposing tooth fracture/mobility, screw fracture/loosening, clasp loosening, veneer porcelain fracture, marginal bone resorption and mobility of implant, artificial tooth fracture. Complications occurred more frequently in anterior region compared to posterior region, non-splinted prostheses compared to splinted prostheses, surveyed prostheses applied by wrought wire clasp compared to other clasps, and natural dentition compared to other removable prostheses as opposing dentition. There were no significant differences in complications according to the Kennedy classification. Conclusion: All implant-assisted RPD functioned successfully throughout the follow-up. However, further clinical studies are necessary because the clinical evidences are still not enough to guarantee the satisfactory prognosis of implant-assisted RPD for long-term result.

Relationship between maximum bite force and facial skeletal pattern (최대 교합력과 안면 골격 형태에 관한 연구)

  • Choi, Won-Cheul;Kim, Tae-Woo
    • The korean journal of orthodontics
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    • v.33 no.6 s.101
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    • pp.437-451
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    • 2003
  • The purpose of this study was to measure maximum bite force and to investigate its relationship with anteroposterior, vertical, and transverse facial skeletal measurements. From among the dental students at the College of Dentistry, forty subjects (26 male and 14 female) were selected. With two sets of strain gauge, maximum bite force at the right and left first molars and anterior teeth was measured in the morning and afternoon. After taking lateral and posteroanterior cephalograms, fifty and nineteen variables were evaluated, respectively Paired t-tests and an independent t-test were done and correlation coefficients were obtained. 1. The maximum bite force at the first molars was $68.0\pm13.9kg$. in males and $55.6\pm10.5kg$ in females (p<0.05) while the force at the anterior teeth was $8.4\pm4.9kg\;and\;1.1\pm3.4kg$ respectively (p<0.05). 2. Some tendency for a greater value of maximum bite force at the preferred side was observed but not statistically significant (p>0.05). 3. Significant difference was observed between the strong bite force group and the weak bite force group in some cephalometric and other measurements (p<0.05). N-S-Ar, S-Ar-Go, FH-Hl, IMPA and MMO showed a significant difference in posterior maximum bite force (P). N-S-Ar and FH-H1 also showed a significant difference in anterior maximum bite force (A). 4. Several cephalometric variables showed some correlation with maximum bite force (p<0.05). N-S-Ar, S-Ar-Go, UGA, FH-H6, FH-H1, body weight and MMO were significantly correlated with posterior maximum bite force (P). Go-Me, P-1 and IMPA were significantly correlated with anterior maximum bite force (A).

Clinical Characteristics and Prognosis of Neonatal Seizures (신생아 경련의 임상적 양상 및 예후에 관한 고찰)

  • Kim, Chang Wu;Jang, Chang Hwan;Kim, Heng Mi;Choe, Byung Ho;Kwon, Soon Hak
    • Clinical and Experimental Pediatrics
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    • v.46 no.12
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    • pp.1253-1259
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    • 2003
  • Backgroud : Seizures in the neonate are relatively common and their clinical features are different from those in children and adults. The study aimed to provide the clinical profiles of neonatal seizure in our hospital. Methods : A total of 41 newborns with seizures were enrolled in this study over a period of three years. They were evaluated with special reference to risk factors, neurologic examinations, laboratory data, neuroimaging studies, EEG findings, seizure types, response to treatment, and prognosis, etc. Results : The average age at onset of seizures was $6.1{\pm}4.6days$ and the majority of patients(42%) had multifocal clonic seizure and 24% had subtle seizure. Factors that are known to increase risk of neonatal seizures include abnormal delivery history, birth asphyxia, and electrolyte imbalance, etc. However, they remain obscure in about 20% of cases. More than 50 percent showed abnormal lesions on neuroimaging studies such as brain hemorrhage, periventricular leukomalacia, brain infarction, cortical dysplasia, hydrocephalus, etc. and 17 out of 32 patients showed abnormal electroencephalographic patterns. Phenobarbital was tried as a first line antiepileptic drug and phenytoin was added if it failed to control seizures. The treatments were terminated in the majority of patients during the hospital stay. The overall prognosis was relatively good except for those with abnormal EEG background or congenital central nervous system malformations. Conclusion : Neonatal seizures may permanently disrupt brain development. Better understanding of their clinical profiles and appropriate management may lead to a reduction in neurological disability in later childhood.

Comparison of Retinal Ganglion Cell Responses to Different Voltage Stimulation Parameters in Normal and rd1 Mouse Retina (정상망막과 변성망막에서 전압자극 파라미터 변화에 따른 망막신경절세포의 반응 비교)

  • Ye, Jang-Hee;Ryu, Sang-Baek;Kim, Kyung-Hwan;Goo, Yong-Sook
    • Progress in Medical Physics
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    • v.21 no.2
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    • pp.209-217
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    • 2010
  • Retinal prostheses are being developed to restore vision for the blind with retinal diseases such as retinitis pigmentosa (RP) or age-related macular degeneration (AMD). Since retinal prostheses depend upon electrical stimulation to control neural activity, optimal stimulation parameters for successful encoding of visual information are one of the most important requirements to enable visual perception. Therefore, in this paper, we focused on retinal ganglion cell (RGC) responses to different voltage stimulation parameters and compared threshold charge densities in normal and rd1 mice. For this purpose, we used in vitro preparation for the retina of normal and rd1 mice on micro-electrode arrays. When the neural network of rd1 mouse retinas is stimulated with voltage-controlled pulses, RGCs in degenerated retina also respond to voltage amplitude or voltage duration modulation as well in wild-type RGCs. But the temporal pattern of RGCs response is very different; in wild-type RGCs, single peak within 100 ms appears while in RGCs in degenerated retina multiple peaks (~4 peaks) with ~10 Hz rhythm within 400 ms appear. The thresholds for electrical activation of RGCs are overall more elevated in rd1 mouse retinas compared to wild-type mouse retinas: The thresholds for activation of RGCs in rd1 mouse retinas were on average two times higher ($70.50{\sim}99.87\;{\mu}C/cm^2$ vs. $37.23{\sim}61.65\;{\mu}C/cm^2$) in the experiment of voltage amplitude modulation and five times higher ($120.5{\sim}170.6\;{\mu}C/cm^2$ vs. $22.69{\sim}37.57\;{\mu}C/cm^2$) in the experiment of voltage duration modulation than those in wild-type mouse retinas. This is compatible with the findings from human studies that the currents required for evoking visual percepts in RP patients is much higher than those needed in healthy individuals. These results will be used as a guideline for optimal stimulation parameters for upcoming Korean-type retinal prosthesis.

Adoption and Efficacy of ISO 15189 in Medical Laboratories for Diagnostic and Research (메디컬시험기관에서 ISO 15189 도입의 필요성과 시행의 효용성)

  • Yang, Man-Gil;Lee, Won Ho;Jun, Jin Hyun
    • Korean Journal of Clinical Laboratory Science
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    • v.48 no.2
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    • pp.158-167
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    • 2016
  • The requirements for medical laboratories ISO 15189 is examined in organization and a quality management system, stressing the importance of evidence, document control, and control of records and clinical material. Medical services are provided from the areas of resource management, and pre-examination, examination and post-examination processes. The main goal of ISO 15189 accreditation is to improve the quality of laboratory services provided for patients and clinical users not only through compliance with consensually developed and harmonized requirements but also by adopting the philosophy of continual improvement using the Plan-Do-Check-Act cycle. Laboratory quality should be evaluated and improved in all steps of the testing process as the state-of-the art indicates that the pre- and post-analytical phases are more vulnerable to errors than the intra-analytical phase. The Korea Laboratory Accreditation Scheme (KOLAS), a national accreditation body, provides medical laboratory accreditations for appropriate approaches to evaluating the competence of a medical laboratory in providing effective services to its customers and clinical users. Adoption of ISO 15189 in 2010s as a government policy has been delayed, and only 5 laboratories have been accredited to date in Korea. The medical laboratories should seek the adoption of ISO 15189 with a positive attitude for quality improvement and strengthening of international competitiveness.

Detection of Pyrazinamide-Resistant Mycobacterium tuberculosis is by PCR-SSCP of pncA Gene (pncA 유전자 PCR-SSCP법을 이용한 결핵균 Pyrazinamide 내성의 진단)

  • Shim, Tae-Sun;Kim, Young-Whan;Chin, Jae-Yong;Lim, Chae-Man;Lee, Sang-Do;Koh, Youn-Suck;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong
    • Tuberculosis and Respiratory Diseases
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    • v.45 no.6
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    • pp.1178-1187
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    • 1998
  • Background : Recently the incidence of tuberculosis is increasing in many countries and control of the disease is further threatened by the emergence of multi-drug resistant tuberculosis. So rapid detection of drug resistance is very important. Pyrazinamide (PZA) is a first-line chemotherapeutic agent for tuberculosis. Now in Korea, we perform PZase activity test instead of actual pyrazinamide susceptibility test for the detection of PZA resistant M. tuberculosis. Recently the pncA gene, encoding the PZase of M. tuberculosis, was completely sequenced. And it was reported that the mutation of pncA gene would be associated with PZA resistance of M. tuberculosis. Therefore we performed this study to evaluate the possibility for the rapid detection of PZA resistant M. tuberculosis using PCR-SSCP of pncA gene. Method : 44 cultured clinical isolates of M. tuberculosis, BCG Tokyo strain. BCG French strain, and one M. bovis isolate were studied. We used H37Rv as the reference strain, The PZase activity test was done at the reference laboratory of Korean Tuberculosis Institute. DNA was extracted by bead-beater method and 561 bp fragment including pncA gene was amplified by PCR. The PCR product were digested by BstB I enzyme. SSCP was done using MDE gel. Of the 44 strains of M. tuberculosis, 22 strains were PZase-positive and other 22 strains were PZase negative. Results : Of the 22 PZase positive strains, 18 strains(82%) showed the same mobility compared with that of H37Rv and 4(18%) showed different mobility. Of the 22 PZase-negative strains, 19(86%) strains showed the same mobility pattern compared with that of H37Rv and 3(14%) showed different mobility. Naturally PZA-resistant BeG-French strain, BCG-Tokyo strain, and one M. bovis isolate showed the same band pattern each other, but their mobility were different from that of H37Rv. The results of PZase activity test and PCR-SSCP of pncA of M. tuberculosis were statistically significantly correlated each other (p<0.01). Conclusion : The PCR-SSCP after BstB I restriction of pncA gene of M. tuberculosis may be a useful method for the rapid detection of PZA-resistant M. tuberculosis.

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SOFT TISSUE PROFILE CHANGE PREDICTION IN MAXILLARY INCISOR RETRACTION BASED ON CEPHALOMETRICS (두부방사선 분석에 의한 상악전치부 후방이동시 연조직 변화 예측에 대한 연구)

  • Choi, Jin-Hee;Lee, Jin-Woo;Cha, Kyung-Suk
    • The korean journal of orthodontics
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    • v.27 no.1
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    • pp.65-78
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    • 1997
  • This study was carried out in order to determine soft tissue response to incisor movement and mandibular repositioning and to determine feasibility of predicting vertical and horizontal changes in soft tissue with hard tissue movement. For this study, cephalometric records of 41 orthodontically treated adult females who had Angle's Class II division 1 malocclusion were selected and stepwise multiple regression analysis was employed. Following conclusions were obtained by analysing the changes of soft tissue and hard tissue before and after treatment. 1. Hard tissue measurements that showed significant changes before and after treatment were horizontal and angular changes of maxillary incisor, horizontal,vertical and angular changes of mandibular incisor, overjet, overbite, interincisal angle, mandibular repositioning, A,B, skeletal convexity and soft tissue measurements that showed significant changes were horizontal, thickness and angular changes of upper lip, horizontal and angular changes of lower lip, interlabial angle, nasolabial angle labiomental angle, Sri, Ss, Si and soft tissue convexity(P<0.05). 2. All Soft tissue measurements changed significantly before and after treatment had between one and four hard tissue independent variables at statistically significant level, indicating that all soft tissue changes were direct relationship with hard tissue changes 3. Ova jet, horizontal change of maxillary incisor, horizontal change of maxillary root apex and horizontal change of pogonion entered into prediction equations most frequentely indicating that they were more significant variables in prediction of vertical and horizontal changes in the soft tissue with treatment, but vertical changes of mandibular incisor not entered any prediction equations, indicating that it was not considered a good predictor for soft tissue changes with maxillary incisor retraction. 4. Horizontal and vertical changes in subnasale were found to have most independent variables, significant at the 0.05 level in prediction-equations(${\Delta}$Sn(H):Ur, Is(H), Pg(H), UIA,${\Delta}$Sn(V): Is(H), Pg(H), overjet, A), indicating that subnasale changes are influenced by complex hard tissue interaction. 5. Multiple correlation coefficient($R^2$) of the soft tissue prediction equations ranges from 0.2-0.6.

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