• The Korean Journal of Pain
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• 제8권2호
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• pp.279-285
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• 1995

Extradural block is a form of treatment described as early as the beginning of the present centuries. It has since had positive criticism from a number of authors in different countries. Epidural injections of steroids with or without local anesthetic have become an occasional method of conservative treatment in sciatica & lumbago, especially in acute case. We assess the results of continuous epidural block with steroids and local anesthetics in sciatica & lumbago. From July 1994 to June 1995, we treated 46 case of lumbago and sciatica using continuous epidural block with steroids and local anesthetics. After placement of 17-Gauge Tuohy needle in the epidural space by the technique of loss of resistance, 0.25% bupivacaine 5 cc and triamcinolone 40 mg was administered and then epidural catheter was placed and connected to multiday infusor(Paragon) using 1% lidocaine with continuous infusion rate of 1 ml/hour. Usually, the catheter was removed after 1~2 weeks and then treated with the physical therapy. At the time of patient's discharge, 69.5% of all cases showed excellent or good results. Of particular note, 26 of the 46 cases were followed up by telephone. At present, in using Of particular note, 26 of the 46 cases were followed up by telephone. At present, in using continuous epidural block procedure, a relief in symptoms showed in 65.5% of these 26 cases. Continuous epidural block provides shortening of the recovery time from pain, avoidance of long period bed rest and early physical therapy and exercise. Therefore, continuous epidural block is simple and safe in the treatment of lumbago and sciatica, especially in acute phase.

• Tuberculosis and Respiratory Diseases
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• 제38권1호
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• pp.65-69
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• 1991

Primary liposarcoma of the mediastinum is a very rare and relatively slow growing tumor. Since the original description by Pallase and Roubier in 1916, there have been about 55 reported cases in world literature until 1985. Recently, we experienced one case of a primary mediastinal liposarcoma with malignant effusion. A 51-year-old man complained of dyspnea and chest discomfort. The chest plain films and computerized tomogram showed a huge mass of the posterior mediastinal space. The needle aspiration biopsy was done in the huge mass and the histologic examination revealed mediastinal round-cell type liposarcoma. Patient refused surgery or chemotherapy after establishing the diagnosis. About 6 months later, the metastatic pleural effusion was noted. After discharge, he was lost to follow up since then. The clinical and therapeutic features of the previously reported cases of primary liposarcoma arising in the mediastinum have been reviewed. Surgery may served to establish a tissue diagnosis, to relieved the patient's symptoms and result occasionally in a cure but radiotherapy or chemotherapy is ineffctive.

• 한국임상수의학회지
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• 제30권2호
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• pp.131-133
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• 2013

9 년령 23 kg의 암컷 진도견이 2개월 동안의 안구 분비물을 주요증상으로 본원에 내원하였다. 초기 안검사에서 좌측 아래 안구 결막 부위에서 크기 2 cm의 길게 돌출 된 종괴를 발견하였다. 다른 안구 및 주위 조직의 이상소견을 확인하기 위해 안구초음파를 실시 하였고 모두 음성으로 판명되었다. 또한 흉 복부에 실시한 X-ray 검사에서도 특이 소견이 관찰되지 않았다. 세포학적 검사에서 다수의 원형세포와 중등도의 호산구 (eosinophils)가 관찰되었다. 종괴는 외과적으로 절제되었고 조직학적 검사를 통해 비만세포종 (mast cell tumor)로 진단되었다. 수술 후 6개월 뒤 실시한 흉복부 X-ray 및 초음파 검사에서 종양의 전이 또는 재발은 관찰되지 않았다.

• The Korean Journal of Pain
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• 제1권1호
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• pp.34-46
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• 1988

Intractable pain from advanced carcinoma of the upper abdomen is difficult to manage. One method used to control pain associated with these malignancies is to block off the splanchnic nerve. In 1919 Kappis described a technique by which the splanchnic nerve of the upper abdomen could be anesthetized, using a percutaneous injection. This method has been used for the relief of upper abdominal pain due to hematoma and cancer of the pancreas, stomach, gall bladder, bile duct, and colon. During the Period from November 1968 to January 1986, this method was used in 208 cases of malignancy at Severance Hospital and clinically evaluated. Patients were retroactively grouped according to the stage of development of technique used. Twelve patients who received the treatment in the period from November 1968 to March 1977 were designate4i as group 1, 26 patients from April 1977 to April 1979 as group 2, and 170 from May 1979 to January 1986 as group 3. The results are as follows: 1) The number of patients receiving splanchnic nerve block has been increasing since 1977. 2) A total of 208 patients, including 133 males and 75 females, ranging in age from 18 to 84 and averaging 51. 3) The causes of pain were stomach cancer 90, pancreatic cancer 69, and miscellaneous cancer 49 cases respectively. 4) There were 57.7% who had surgery. and 3.7% of whom had chemotherapy before the splanchnic nerve block was done. 5) These blocks were carried out with the patient in the prone position as described by Dr. Moore. For group 2 and 3, C-arm image intensifier was used. In group 1, a 22 gauze loom long needle was inserted at the lower border of the 12th rib on each aide about 7\;cm from the midline. The average distance from the midline was $6.60{\pm}0.61\;cm$ on the left side and $6.60{\pm}0.83\;cm$ on the right side in group 2, and $5.46{\pm}0.76\;cm$ on the left side and $5.49{\pm}0.69\;cm$ on the right side in group 3. The average depth to which the needle was inserted was $8.60{\pm}0.52\;cm$ on the left side and $8.74{\pm}0.60\;cm$ on the right side in group 2, and $8.96{\pm}0.63\;cm$ on the left side and $9.18{\pm}0.57\;cm$ on the right side in group 3. 6) The points of the inserted needles were positioned in the upper quarter anteriorly, 51.8% on the left side and 54.4% n the right side of the L1 vertebra by lateral roentgenogram in group 3. The inserted needle points were located in the upper and anterolateral part, of the L1 vertebra 68.5% on the left side and 60.6won the right side, on the anteroposterior rentgenogram in group 3. The needle tip was not advanced beyond the anterior margin of the vertebral body. 7) In some case of group 3, contrast media was injected before the block was done. It shows, the spread upward along the anterior mal gin of the vertebral body. 8) The concentration and the average amount of drug used in each group was as follows: In group 1, $39.17{\pm}6.69\;ml$ of 0.5% -l% lidocaine or 0.25% bupivacaine were injected for the test block and one to three days after the test block $40.00{\pm}4.26\;ml$ of 50% alcohol was injected for the semipermanent block. In group 2, $13.75{\pm}4.88\;ml$ of 1% lidocaine were used as the test block and followed by $46.17{\pm}4.37\;ml$ of 50% alcohol was injected as the semipermanent block. In group 3, $15.63{\pm}1.19\;ml$ of 1% lidocaine for test block followed by $15.62{\pm}1.20\;ml$ of pure alcohol and $16.05{\pm}2.58\;ml$ of 50% alcohol for semipermanent block were injected. 9) The result of the test block was satisfactory in all cases. However the semipermanent block was 83.3 percent of the patients in group 1 who received relief from pain for at least 2 weeks after the block, 73.1% in group 2, and 91.8% in group 3. In these unsuccessful cases, 2 cases in group 1 were controlled by narcotics but 7 cases in group 2 and 14 cases in group 3 received the same splanchnic nerve block 1 or 2 times again within 2 weeks. But, in some cases it was 3 to i months before the 2nd block and in 1 cases even 7 years. 10) The most common complications of splanchnic nerve block were hypotensino(25.5%) occasional flushing of the face, nausea, vomiting, and chest discomfort. 11) For the patients in group 3, the supplemental block most commonly used was a continuous epidural block; it was used as a diagnostic block and to afford relief from pain before the splanchnic nerve block was done. 12) The interval between the receiving of the alcohol block and discharge was from 5 to 8 days in 61 cases(31.1%) and from 1 to 2 days in 48 cases(24.5%). From the above results, it can be concluded that the splanchnic nerve block done in the prone position with pure and 50% alcohol immediately after an effective test block with 1% lidocaine under C-arm fluoroscopic control is satisfactory and reliable. How to minimize the repeat block is still a problem to be solved.

• Archives of Plastic Surgery
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• 제33권6호
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• pp.764-768
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• 2006

Purpose: Parotid neoplasia are relatively frequent, representing approximately 3% of all tumors in the head and neck regions. But incomplete resection and misdiagnosis of parotid gland is followed by multiple tumor invasion, tumor recurrence, and other iatrogenic tumor formation. In patients undergoing parotidectomy for confirmed or suspected malignancy, the traditional or modified rhytidectomy incision may prove suboptimal because it does not easily lend itself to a continuous neck dissection. Similarly, patients with tumors of the anterior accessory lobe or patients with large anterior tumors may also require the modified Blair incision for adequate surgical exposure. This report serves to revisit the topic of accessory and parotid gland neoplasms to emphasize proper management, particularly the surgical aspects, so that consequences of recurrence are avoided. Methods: This is a retrospective review of our experience with two cases of parotid tumors; one accessory parotid gland neoplasm and one parotid gland neoplasm. We report the case of parotid tumor and epidermal cyst in a 54-year old male patient and the case of case of recurrent parotid tumor with local invasion in 30-year old male patient. Results: All were removed through a modified Blair incision. Pathologic report notified that One was found pleomorphic adenoma and epidermal cyst, and the other one pleomorphic adenoma with subcutenous invasion. The patients recovered well without any complication such as infection, hematoma, facial nerve palsy, and necrosis of skin flap. Patients were discharge POD#7. Patients were followed up to for 1 year and they have no sign of recurrence. Conclusions: A high index of suspicion, prudent diagnostic skills(including fine-needle aspiration biopsy, CT, US), and meticulous surgical approach are the keys to a successful management of these lesions. We experienced two cases of parotid neoplasia, in the treatment of tumor reccurence & iatrogenic tumor arising from the parotid gland and are presented with the review of literatures.

• 대한간호
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• 제36권2호
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• pp.73-83
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• 1997

Bed rest is recommended to prevent postlumbar puncture headaches(PLPHA), but the period of bed rest varies in the literature from 6 hours to 24 hours. In clinical practice the period of bed rest varies but nursing methods for adults and children have little difference. In Seoul National University Hospital, children have been given at least 6 hours bed rest after a lumbar puncture. Pediatric oncology patients require a lumbar puncture for an initial diagnosis, follow up treatment or administration of chemotherapeutic agent. But it is difficult for young children to lie supine or to refrain from their usual activities in any way, and unpleasant problems related to a shortage of beds often occurs during discharge or in an outpatient setting. The purpose of this study is to substantiate the preventive effect of PLPHA by the period of bed rest, to identify the other factors that influence PLPHA, and to use the nursing methods proper to children. The subjects were 65 children, ages 1-17, undergoing treatment in the children's cancer center at SNUCH during the period June 1, 1995, to Aug. 31, 1995. The team nurses asked questions about PLPHA of the parents and children in order to fill out a questionnaire. The data were evaluated by percent, t-test, Chi-square test and Mann-Whitney U test. Result; 1. There was no significant difference relating the bed rest time spent to the occurrence of postspinal headaches (t-test). 2. There was a significant risk of PLPHA in the children who were irritable before procedure and/or had experienced previous PLPHA(p<0.05, ${x^2}-test$). 3. The following factors were not found to be associated with increased risk of PLPHA: previous puncture experience, giving analgesics, the choice of puncturist, inpatient/outpatient status, gauge of needle, purpose, the amount of CSF removed, gender, diagnosis, the number of peripheral WBCs, previous lumbago experience after LP, position after bed rest, age, the number of aural puncture at the time. A longer period of bed rest is unlikely to be more effective to prevent PLPHA and seems impractical. A shorter period will save time and effort. Perhaps it will also allay some of the fears which surround LP. So 1 hour bed rest after LP is suggested and nursing methods for emotional support should be investigated to reduce PLPH.

• Tuberculosis and Respiratory Diseases
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• 제72권5호
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• pp.441-447
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• 2012

Background: Chest tube drainage (CTD) is an indication for the treatment of pneumothorax, hemothroax and is used after a thoracic surgery. But, in the case of incomplete lung expansion, and/or persistent air leak from CTD, medical or surgical thoracoscopy or, if that is unavailable, limited thoracotomy, should be considered. We evaluate the efficacy of bronchoscopic injection of ethanolamine to control the persistent air leak in patients with CTD. Methods: Patients who had persistent or prolonged air leak from CTD were included, consecutively. We directly injected 1.0 mL solution of 5% ethanolamine oleate into a subsegmental or its distal bronchus, where it is a probable air leakage site, 1 to 21 times using an injection needle through a fiberoptic bronchoscope. Results: A total of 15 patients were enrolled; 14 cases of spontaneous pneumothorax [idiopathic 9, chronic obstructive pulmonary disease (COPD) 3, post-tuberculosis 2] and one case of empyema associated with broncho-pleural fistula. Of these, five were patients with persistent air leak from CTD, just after a surgical therapy, wedge resection with plication for blebs or bullae. With an ethanolamine injection therapy, 12 were successful but three (idiopathic, COPD and post-tuberculosis) failed, and were followed by a surgery (2 cases) or pleurodesis (1 case). Some adverse reactions, such as fever, chest pain and increased radiographic opacities occurred transiently, but resolved without any further events. With success, the time from the procedure to discharge was about 3 days (median). Conclusion: Bronchoscopic ethanolamine injection therapy may be partially useful in controlling air leakage, and reducing the hospital stay in patients with persistent air leak from CTD.

• 디지털융복합연구
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• 제14권7호
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• pp.309-319
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• 2016

보건의료데이터의 질적 수준을 향상시키기 위해서는 데이터 질 관리 알고리즘을 개발할 필요성이 있다. 이에 본 연구에서는 질환의 유병률, 입원율이 높은 고혈압 환자의 당뇨질환 동반에 관련된 데이터 질 관리 알고리즘을 개발하고자 하였다. 이를 위해 2011년, 2012년 퇴원손상심층조사 자료 중 고혈압 환자 61,199건을 추출하여 분석대상으로 하였다. 데이터 마이닝의 대화식 의사결정나무 방법과 Outlier Detection 방법론을 통해 데이터 질 관리 알고리즘 개발한 결과 고혈압 환자가 당뇨병을 동반상병으로 가지는데 영향을 미치는 요인으로는 성별, 연령, 당뇨병성 사구체 장애, 당뇨병성 망막병증, 당병성 다발성 신경병증 등이 있었다. 의사결정나무 결과에 따라 당뇨병을 동반상병으로 가질 확률 값이 80% 이상이거나, 20% 이하인 집단을 Outlier(극단치)로 정의하고, 고혈압 환자의 당뇨 동반에 대한 극단치를 가지는 6개 집단을 발견하였다. 이와 같이 Outlier(극단치) 집단에 포함되는 실제 데이터를 확인하여 데이터의 질적 수준을 향상 시킬 필요가 있다.

• 한국정보통신학회논문지
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• 제11권12호
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• pp.2335-2342
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• 2007

최근에 레이저를 임상치료에 응용하는 사례가 증가하고 있다. 그러나 전기적 관점에서 레이저 자극이 경락에서 어떠한 전기적 반응을 유도할 수 있는지에 대한 연구가 미흡하고, 명확한 치료효과에 대한 임상보고가 발표되지 않고 있다. 본 논문에서는 레이저자극과 수기자극이 경락전위 형성에 미치는 영향을 비교 관찰하여 전기적 관점에서 침술과정 및 침술효과에 대한 객관적 근거를 제시하고자 하였다. 수양명대장경상의 삼간혈(LI3)을 각각 자극했을 경우, 삼간혈(LI3)과 합곡혈(LI4)에서의 전위변화를 측정하였다. 그 결과, 레이저 자극 시, 평균 피크전위는 $7.53{\pm}3.44{\mu}V$로 매우 낮게 나타났고, 자극전후 전위패턴에 차이가 없어서 레이저 자극에 대한 유효한 전기반응으로 간주하기 어렵다. 접지조건에 대한 수기자극에서는 평균피크전위가 $2.65{\pm}1.53mV$로 매우 높게 측정되었고, 개인별, 접지조건에 따라 전위크기와 패턴이 다양하게 나타나고 전위패턴은 주로 캐패시터의 충방전 전위와 매우 비슷하게 나타났다. 또한, 절연자침의 경우에서는 접지조건에 관계없이 평균 피크 전위가 $0.25{\pm}0.16mV$로 수기자극 전위에 비하여 매우 낮게 나타났으며, 이는 침자극에 대한 유효한 전기 반응으로 간주하기 어렵다. 따라서, 전기적 관점에서 침술과정과 침술효과는 시술자와 피시술자간의 생체이온전하의 이동에 의한 에너지 교감현상임을 확인하고, 수기자극은 경락의 전기반응을 유도하는 반면, 레이저 자극은 경락의 전기적 반응을 유도하기 어렵다는 것을 확인하였다.

• Journal of Radiation Protection and Research
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• 제44권3호
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• pp.118-126
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• 2019

Background: Government conducts environmental radioactivity surveillance for verification purpose around nuclear facilities based on the Nuclear Safety Law and issues a surveillance report every year. This study aims to evaluate the short and the long-term fluctuation of radionuclides detected above MDC and their origins using concentration ratios between these radionuclides. Materials and Methods: Sample media for verification surveillance are air, rainwater, groundwater, soil, and milk for terrestrial samples, and seawater, marine sediment, fish, and seaweed for marine samples. Gamma-emitting radionuclides including $^{137}Cs$, $^{90}Sr$, Pu, $^3H$, and $^{14}C$ are evaluated in these samples. Results and Discussion: According to the result of the environmental radioactivity verification surveillance in the vicinity of nuclear power facilities in 2017, the anthropogenic radionuclides were not detected in most of the environmental samples except for the detection of a trace level of $^{137}Cs$, $^{90}Sr$, Pu, and $^{131}I$ in some samples. Radioactivity concentration ratios between the anthropogenic radionuclides ($^{137}Cs/^{90}Sr$, $^{137}Cs/^{239+240}Pu$, $^{90}Sr/^{239+240}Pu$) were similar to those reported in the environmental samples, which were affected by the global fallout of the past nuclear weapon test, and Pu atomic ratios ($^{240}Pu/^{239}Pu$) in the terrestrial sample and marine sample showed significant differences due to the different input pathway and the Pu source. Radioactive iodine ($^{131}I$) was detected at the range of < $5.6-190mBq{\cdot}kg-fresh^{-1}$ in the gulfweed and sea trumpet collected from the area of Kori and Wolsong intake and discharge. A high level of $^3H$ was observed in the air (Sangbong: $0.688{\pm}0.841Bq{\cdot}m^{-3}$) and the precipitation (Meteorology Post: $199{\pm}126Bq{\cdot}L^{-1}$) samples of the Wolsong nuclear power plant (NPP). $^3H$ concentration in the precipitation and pine needle samples showed typical variation pattern with the distance and the wind direction from the stack due to the gaseous release of $^3H$ in Wolsong NPP. Conclusion: Except for the detection of a trace level of $^{137}Cs$, $^{90}Sr$, Pu, and $^{131}I$ in some samples, anthropogenic radionuclides were below MDC in most of the environmental samples. Overall, no unusual radionuclides and abnormal concentration were detected in the 2017's surveillance result for verification. This research will be available in the assessment of environment around nuclear facilities in the event of radioactive material release.