• 구강회복응용과학지
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• 제33권3호
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• pp.216-222
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• 2017

지적장애는 정신 발육이 항구적으로 지체 되어 지적 능력의 발달이 불충분하고 불완전한 장애이며, 지적장애를 가지면 자신의 일을 처리하는 것과 사회생활에의 적응이 상당히 곤란하다. 그렇기 때문에 환자 스스로 구강상태를 위생적으로 관리하는 것이 쉽지 않아 다발적 우식이 쉽게 관찰되며 치주질환 이환율이 높다. 본 증례의 환자는 지적장애 1급을 판정받은 33세 여환으로 치아 및 치주 건강이 좋지 않아 식사에 어려움이 있다는 주소로 내원하였다. 초진 구내 검사 시 환자는 치주염과 다발성 우식으로 수직고경이 감소되고 구치부 교합이 붕괴되어 있었다. 이를 가철성 국소의치 이용하여 교합을 재구성함으로써 심미적, 기능적으로 만족할 만한 결과를 얻었기에 보고하는 바이다.

• Journal of Oral Medicine and Pain
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• 제38권1호
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• pp.69-76
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• 2013

목적 : 측두하악장애 치료에서 기존의 다른 치료 방법이 동일한 경우, 초진 시에만 서면으로 된 주의사항을 보고 읽어주며 교육했을 때와 내원 시마다 자가평가 설문지를 통한 반복적 주의사항 교육을 시행했을 때의 치료효과 차이를 알아본다. 방법 : 2012년 10월부터 12월까지 부산대학교치과병원 구강내과에 내원한 측두하악장애 환자(n=62, 실험군)와 2011년 10월부터 12월까지 내원한 측두하악장애 환자(n=156, 대조군)를 대상으로 하였다. 측두하악장애로 진단된 후 내원횟수, 치료방법을 동일하게 시행한 환자를 표본으로 선정하였다. 실험군은 자가평가 설문지를 통한 반복적 주의사항 교육을 초진일, 2주 후, 4주 후 시행하였고 또한 Pain NRS(Numerical Rating Scale), MCO(Maximum comfortable opening), Noise NRS, LOM(Limitation of Mouth opening) NRS를 조사했다. 대조군은 초진 시만 주의사항 교육을 하였고, 실험군과 동일 항목을 조사하였다. 실험 군과 대조 군간의 조사항목의 1,2회 내원 시 차이와 1,3회 내원 시 차이를 전체, 연령, 성별, 골 변화 유무별로 독립표본 T검정을 시행하였다. 결과 : 반복적인 주의사항 교육으로 인한 주의사항 준수는 약물치료를 중단한 후에도 MCO개선을 유지 및 증가 시켰다(p=0.001). 반복적인 주의사항 교육으로 인한 주의사항 준수로 인한 MCO개선 효과는 남자에서 두드러졌으며(p=0.001) 젊은 연령에서 크게 나타났다(p=0.004) 결론: 측두하악장애 환자의 행동조절을 위한 주의사항 교육은 반복적으로 시행할수록 치료효과가 크게 나타난다.

• 대한소아신경학회지
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• 제26권4호
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• pp.215-220
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• 2018

목적: 열경련 환자의 경우 대부분 좋은 예후를 보이며 비열성 발작으로 가는 비율은 2-7%로 알려져 있다. 열경련이 6세 이후에도 지속되거나 새로 발생하는 경우 비열경련으로 가는 비율이 일반 열경련 환자에 비해 높은 것으로 알려져 있지만, 위험인자에 대해서는 알려진 바가 없다. 6세 이후 열경련에 대한 연구는 소수에서만 진행이 되었으며, 6세 이후 열경련 환자에 대한 비열성 발작의 위험인자를 알아보고자 하였다. 방법: 2011년 1월부터 2017년 6월까지 열경련으로 소아청소년과 신경분과 외래를 방문한 환자를 대상으로 하였으며, 그중 6세 이후에도 열경련이 지속되거나 새로이 발생한 환자들을 연구 대상으로 하였다. 정보 수집은 차트 리뷰 및 전화 조사를 통하여 시행하였다. 76명의 환자가 최종 연구 대상으로 선정되었으며, 비열성 발작으로 가는 위험 인자를 확인하기 위하여 로지스틱 회귀분석을 시행하였다. 결과: 열경련으로 방문한 896명의 환자 중, 83명에서 6세 이후에 열경련이 발생하였다. 이 중 3명은 뇌파 이상 소견 및 지속되는 열경련으로 항경련제를 복용하였고, 4명은 6세 이전에 비열성 발작이 최소 1회 이상 발생하여 연구 대상에서 제외하였다. 최종 76명이 연구 대상으로 선정되었다. 열경련의 시작 나이를 6세 기준으로 나누었을 때, 6세 전에 열경련이 시작된 군에서 열경련 가족력 및 복합열경련의 빈도가 높게 보고 되었으나, 이외 뇌파 검사 및 다른 주요 임상 변수들은 통계적인 차이를 보이지 않았다. 21%(16/76)에서 추후 비열성 발작이 발생하였으며, 비열성 발작으로의 진행에 영향을 주는 독립 인자로 뇌파 이상 소견이 확인되었다. 결론: 6세 이후 열경련 군에서 열경련의 시작 나이는 특별한 임상적인 의미를 갖지 않았다. 뇌파 이상 소견이 있는 경우 비열성 발작으로 가는 비율이 통계적으로 의미 있게 높게 나타났다. 6세 이후 열경련 환자에서 예후를 예측하는데, 뇌파 시행은 의미 있는 검사 방법이 될 수 있겠다.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제8권1호
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• pp.92-100
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• 1997

뚜렛장애는 운동틱과 음성틱이 복합적으로 나타나는 만성적인 질환으로써 임상적인 특성, 동반된 행동상의 문제들에 대해 전세계적으로 많은 연구가 이루어지고 있다. 이 연구의 목적은 한국의 뚜렛장애 환자의 임상적인 특성과 동반된 행동상의 특징을 비교적 다수 환자집단을 대상으로 연구한 것이다. 연구대상은 157명의 뚜렛장애 환자로서 1988년부터 1994년까지 연세대학교 정신과 뚜렛클리닉을 방문한 환자들이었다. 진단을 위해 DSM-III-R의 진단기준을 사용하였다. 인구학적 자료, 증상, 경과 등 임상적인 특성, 가족력 및 과잉행동, 강박성, 충동성, 야뇨증, 자기파괴행동, 수면장애 등 동반된 행동상의 특징은 본 연구를 위해 고안된 반구조화된 설문지와 전반적 임상적 인상(global clinical impression)을 이용해 평가하였다. 연구결과는 다음과 같다. 환자들의 평균연령은 14.49(${\pm}7.99$)세였다. 남자가 138명(87.9%), 여자는 19명(12.1%)으로 남녀의 성비가 약 7：1의 비율로 남자가 많았다. 133명(84.7%)은 오른손잡이였고 24명(15.3%)은 양손잡이거나 왼손잡이였다. 평균발병연령은 8.85(${\pm}4.56$)세였고 발병연령의 범위는 2세에서 16세였다. 반수 이상의 환자가 6세에서 10세 사이에 발병하는 양상을 보였다. 발명연령에 있어 두번의 높은 발병빈도가 관찰되었는데 처음에는 6세경에 높은 양상을 보였고 이후 10세 무렵에 다시 한번 높은 발병빈도가 관찰되었다. 이러한 경향은 남녀간에 공통적이었다. 처음 증상중 가장 흔한 것은 눈깜박임으로 55% 이상의 환자에서 나타났다. 다음으로는 고개 돌리기, 음성틱 등이었다. 환자들이 발병후 내원할 때까지 보였던 모든 틱증상의 빈도를 보면 전체 환자중 129명(82.2%)에서 눈깜박임이 있었고 91명(57.9%)이 고개짓, 83명(52.7%)이 어깨 움추리기 혹은 돌리기, 51명(32.6%)이 팔흔들기가 있었다. 101명(64.3%)은 증상이 신체의 상부에서 하부로 향했고 25명(15.9%)은 신체의 하부에서 상부로 증상이 진행하는 양상을 보였다. 나머지는 음성틱과 고개돌리기가 비슷한 시기에 나타나는 등 증상의 진행방향에서 상향성 혹은 하향성을 정하기 어려운 환자들이었다. 환자의 아버지중 19명(12%)이 강박장애의 병력이 있었고 17명(10.6%)은 틱장애의 병력이 있었다. 반면, 환자의 어머니중 7명(4.5%)이 강박장애의 병력이 있었고 4명(2.5%)은 틱장애의 병력이 있었다. 환자중 118명(75.1%)에서 과잉행동이 동반되었고 95명(60.5%)에서 강박증상이 동반되었고 55명(35.0%)에서 자기파괴적인 행동이 있었으며 46명(29.3%)에서 충동성이 동반되었고 35명(22.3%)에서 유뇨증이 관찰되었다. 환자의 발병연령과 내원시 연령, 병의 이병 기간, 강박증상의 정도 사이에 통계적으로 유의한 양성의 상관관계가 있었고 과잉행동성과 음성의 상관관계가 있었다. 과잉행동성과 충동성, 강박성, 야뇨증, 자기파괴적 행동사이에 통계적으로 유의한 양성의 상관관계가 있었다. 환자의 강박증상의 정도와 과잉행동성, 수면장애, 자기파괴적 행동 사이에 통계적으로 유의한 양성의 상관관계가 있었다. 본 연구 결과 저자들은 외래에 내원한 뚜렛장애 환자의 임상적 특성이나 동반된 행동상 문제들이 이전 연구와 크게 상이하지 않음을 확인할 수 있었으며 발병연령이 어릴수록 과잉행동성이 심했으며 발병연령이 늦을수록 강박성이 심했다. 과잉행동성과 충동성, 강박성, 야뇨증, 자기파괴적 행동 등은 상호 높은 관련성이 있었다.

• 대한간호학회지
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• 제30권6호
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• pp.1488-1502
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• 2000

This study, based on current home nursing services, aims at promoting measures for establishing a community-based home nursing system derived from the pilot home nursing demonstration project conducted by the Seoul Nurses Association. The study was based on an analysis of home nursing records from march 1993 to December 1999. The following is a summary analysis, based on individual characteristics of the patients, the organization, which recommended the service for their patients and personnel services. 1. The service has been used by many elderly people 60years of age or older(66.4%). and married people(60.9%). The average number of visits by service personnel for patients of city government was 23.5. This is 2.5 times as many visits by general patients. General patients(20.2%) had only one visit from service personnel, while 65.5% of patients of city government had 10 or more visits. Particularly, for government recommended patients, 72.7% of the patients were recommended by nurses, while only 21.9% where referred to the services by doctors. The main focus of a home nursing service was to maintain present health status (53.4%), and hospice(11.6%). Also to increase hospital-based home nursing services focused on recovery(55.9%) and maintain present health conditions (19.0%). 2. For general patients, 42.0% of patients were suffering from problems related to CVA, 11.3% from high blood pressure, and for patients referred from city, 21.2% from skeletal muscular disease. Results of home nursing services 29.4% of patients were able to recover or maintain their health status, but 48.9% of the patients died. Another main point of community-based home nursing services is medication(6.7%), other basic nursing services(6.1%), special treatment, instructions on how to use medical devices(5.9%), change of physical posture(4.6%), and training on changing physical positions(4.7%). As mentioned above there were some differences between the characteristics of patients who used the pilot home nursing service conducted by the Seoul Nurses Association and those hospital-based service users. The results are believed to be useful to support a community-based home nursing service model. Particularly, patients under medical supervision and patients recommended by government-run health clinics show a higher frequency and longer use of home nursing services compared to general patients or hospital-based home nursing service users. According to the study, nurses accounted for a large number of recommendations for home nursing services. Many patients with CVA, high blood pressure, skeletal muscular disease and bedsores used community-based home nursing services, while others used the service for minor treatments or maintaining their current health status. Based on the study, the researchers make several suggestions to establish a community- based home nursing service system. First, different ways of setting up a community-based home nursing system have to be mapped out based on the evaluation of the pilot home nursing service conducted by the Seoul Nurses Association. Secondly, a new, community-based, home health care nursing service model, and reimbursement payment system have to be developed. This is based on the outcome of the analysis, and implemented policy. Accordingly, efforts are needed to develop a community- based home nursing system with an intermediary role to promote the visiting nursing services of government-run health centers.

• Journal of Acupuncture Research
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• 제18권6호
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• pp.1-13
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• 2001

Objective : To broaden understanding about relationship between Meridian Tendino-musculature and muscles in a lumbar area and to evaluate the effect of Meridian Tendino-musculature acupuncture and release therapy on acute lumbar sprain. Materials and Methods : From Oct. 1st, 2000 to Mar. 31th, 2001, 692 outpatient's chart of Kyung Won University Hospital were reviewed. Out of them, 39 outpatients were selected. they had low back pain, were diagnosed with acute lumbar sprain, showed only straightened curvature on lateral view of lumbar spine X-ray and get the Tendino-musculature acupuncture and release therapy. Results : 1. On patients' first visit, 72% had GrIII and Gr.IV predominantly. 2. Major muscles related with low back pain were divided into two groups. One was Quadratus lumborum group and the other was Rectus abdominis group. In the correlation with Meridian Tendino-musculature, the former was mainly related with Chok-taeyang(B) and slightly related with Chok-soyang(G), Chok-taeum(SP), the latter was mainly related with Chok-taeyum(SP), Chok-yangmyong(S) and slightly related with Chok-taeyang(B), Chok-soyang(G). 3. In the evaluation of treatment effect, Exellent was 27(69%), Good was 10(6%), Fair was 2(5%) and Bad was 0(0%). Fair rate reached 100% eventually. 4. Most of Gr.Ⅲ, Gr.Ⅳ patients who had severe conditions that almost every R.O.M. was limited and Milgram test positive was shown on the physical examination, were fully recovered and lived normal daily life without admission by Meridian Tendino-musculature acupuncture and release therapy within 3 to 5, 4 to 7 days, respectively, since they had started to get their outpatient treatment. 5. Two patients was troubled with pain induced, by twitching response and acupuncure stimuli, which lasted around acupunctured muscle for about a day after treatment, so they coudn't endure the pain and quitted treatment in spite of Fair condition. conclusion : Meridian Tendino-musculature acupuncture and release therapy was found to be helpful to patients who wish to recover from their back pain induced by acute lumbar sprain as soon as possible, but the treatment actually had some problems to be overcome such as pain during or after the treatment. therefor, in order to make this treatment method more available, we should pay more attention to improving treatment appliance and acupuncture technique.

• Journal of Oral Medicine and Pain
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• 제26권2호
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• pp.133-146
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• 2001

This study was performed to predict the conservative treatment outcome of TMD patients by investigating the prognostic factors ; symptom duration, history of previous treatment, history of previous medication, history of trauma, disability of daily activity, severity of pain, noise, limitation of mouth opening(LOM) and maximum comfortable opening(MCO). Two hundreds and fifty-four subjects were selected for this study among the TMD patients who had visited the Dept. of Oral Medicine BNUH and been treated conservatively with medication, physical therapy, behavioral treatment, and splint therapy from 1991 to 2000. The subjects were divided into two groups improved or unimproved according to the treatment response following six months of conservative treatment. Those who showed less than 1 on NAS for pain, TMJ noise, and opening limitation belonged to the improved group and those who showed more than 2 on NAS belonged to the unimproved group. The two groups were compared with respect to symptom severity, number of diagnosis, history of trauma, previous treatment, previous medication, and disability of daily activity. A prognostic equation with the factors revealed to be significantly related to the prognosis of conservative treatment was obtained. The obtained results were as follows ; 1. In improved group, mean duration of history was 12 months, mean treatment duration of a patient was 4 months an mean number of treatment was about 10 times. In other words, in unimproved group, mean duration of history was 27.4 months, mean treatment duration of patient was 10.5 months and mean number of treatment was 19 times. 2. In unimproved group, multiple diagnosis, chronicity, disability of daily activity were significantly greater than that of the improved group. 3. Patients in unimproved group revealed severe noise at first visit and smaller maximum comfortable opening comparatively. 4. Prognostic factors such as duration of treatment, number of treatment, multiplicity, and chronicity and disability of daily activity showed a significant relation in prediction of improvement. 5. Prognostic equation with significant variables is as follows ; Y = 1.984 - 0.251Noise + 0.068MCO - 0.673Multiplicity. - 0.958Chronicity - 0.065Disability. Classification accuracy of 70.3 %, sensitivity of 71.4% and specificity of 66.7% were shown. 6. Prognostic equation with all factors is as follows : Y = 1.599 - 0.038Pain - 0.256Noise - 0.006Limitation + 0.068MCO - 0.580Multiplicity - 1.025Chronicity - 0.720Disability - 0.329Medication - 0.087Treatment + 0.740Trauma. Classification accuracy of 70.3 %, sensitivity of 73% and specificity of 64.3% were shown. 7. Prognostic value of the improved group with significant factors was $1.0446{\pm}1.0726$ and prognostic value of the unimproved group with significant factors was $-0.013{\pm}1.0146$. Prognostic value of the improved group with all factors was $1.0465{\pm}1.0849$ and prognostic value of the unimproved group with all factors was $-0.057{\pm}1.0611$.

• 대한한방부인과학회지
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• 제24권4호
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• pp.126-149
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• 2011

Purpose: KCDO-3(Korean Classification of Diseases(Oriental Medicine)-third edition) being used in January, 2010 accepted the KCD(Korean Classification of Diseases) and added disease pattern and syndrome of oriental medicine. But, the diagnoses of oriental medicine are too uncertain to express in A00-Z99(KCD). In this case, you should choose in U codes under the KCD use guidelines, but U codes are not capable of representing the symptoms too. So, we suggest the use criteria and consider the weakness of the U codes with medical records of patients who visited with amenorrhea or oligomenorrhea. Methods: We referred medical records of patients who visited oriental obstetrics and gynecology from January 1st to December 31st, 2010. From among them, we set up 122 patients who related with emmeniopathy as target group and searched codes distribution based on medical records. And we described that the process of choosing appropriate codes based on the medical records of 49 amenorrhea or oligomenorrhea patients. Results and Conclusions: The emmeniopathy is divided into menstrual disorder, amenorrhea and systemic disorders at the period of menstruation. And emmeniopathy is expressed in some codes such as N91, N92, N93, N94, U321, U77. When a patient visit hospital, a doctor should choose causal codes when there is confirmed diagnosis. Otherwise, a doctor chooses symptom codes. And if there are more than two diagnosis consistent with definition of chief condition, a doctor should code the first listed diagnosis as a chief condition. Because KCD-5 is classified according to western medical diagnosis, it is difficult to choose in KCD-5 when we diagnosed with disease pattern and syndrome of oriental medicine. But U codes are also deficient to express various condition of emmeniopathy. So we should add 'deficiency and detriment of the thoroughfare and conception vessels', 'prolonged menstruation' and various systemic disorders at the period of menstruation.

• Journal of Korean Neurosurgical Society
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• 제29권3호
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• pp.324-329
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• 2000

Objective : Psychological factors may have a major influence on the outcome of treatment for back pain. We investigated the relationship between the outcome and some psychological factors, such as self-reported pain intensity, disability, sleep disturbance and fatigue. Method : The study was conducted as a survey using a questionnaire and telephone interviews. The survey included consecutive 294 patients who visited the neurosurgical out-patient department complaining of low back pain and contacted by telephone on average seven months after the first visit. Pain intensity was measured by visual analog scale, and disability was assessed by Waddell's chronic disability index. Results : The outcome of treatment for back pain was recovered in 36.7%, improved in 30.6%, almost same in 28.6%, and aggravated in 4.1%. Overall rate of improvement was 67.3%. The rate of improvement was related to the duration, patterns and intensity of the symptom, and Waddell index. It was not influenced by the doctors, special studies, and methods of treatment. When the duration was more than 6 months, there were the symptoms of both back and legs, and the self-reported Waddell index was 1-3, the rate of improvement was relatively low. Although the intensity of the pain and disability was closely related to the degree of sleep disturbance, fatigue, appetite, or indigestion, the outcome of treatment for back pain was not always bad in patients with high psychological stress. Actually the outcome of the patients who complained severe pain and disability was better than the outcome of the others. Conclusion : The outcome of the back pain can be predicted by the duration, patterns and intensity of the symptom, and Waddell index. The multidisciplinary treatment will be necessary for the patients whose expected outcome is not good to reduce not only the physical symptoms but also the psychological stress.

• Allergy, Asthma & Immunology Research
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• 제10권6호
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• pp.675-685
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• 2018

Purpose: This study aims to determine the efficacy and safety of house dust mite (HDM)-sublingual immunotherapy (SLIT) in elderly patients with AR. Methods: A total of 45 patients aged ${\geq}60years$ with HDM-induced AR who had ${\geq}3$ A/H ratio on skin prick test and/or ${\geq}0.35IU/L$ to both Dermatophagoides farinae and Dermatophagoides pteronyssinus by ImmunoCAP were enrolled in 4 university hospitals. To evaluate additional effects of HDM-SLIT, they were randomized to the SLIT-treated group (n = 30) or control group (n = 15). Rhinoconjunctivitis total symptom score (RTSS), rhinoscopy score, Korean rhinoconjunctivitis quality of life questionnaire, rhinitis control assessment test, asthma control test scores, and adverse reactions, were assessed at the first visit (V1) and after 1 year of treatment (V5); for immunological evaluation, serum levels of HDM-specific immunoglobulin A/IgE/IgG1/IgG4 antibodies and basophil response to HDMs were compared between V1 and V5 in both groups. Results: There were no significant differences in demographics, RTSS, skin reactivity to HDMs, or serum total/specific IgE levels to HDMs (P > 0.05, respectively) between the 2 groups. Nasal symptom score and RTSS decreased significantly at year 1 in the 2 groups (P < 0.05). There were no significant differences in percent decrease in nasal symptom score and RTSS at year 1 between the 2 groups (P > 0.05); however, rhinoscopic nasal symptom score decreased significantly in the SLIT-treated group (P < 0.05). Immunological studies showed that serum specific IgA levels (not specific IgE/IgG) and CD203c expression on basophils decreased significantly at V5 in the SLIT-treated group (P = 0.011 and P = 0.001, respectively), not in the control group. The control group required more medications compared to the treatment group, but there were no differences in adverse reactions. Conclusions: It is suggested that HDM-SLIT for 1 year could induce symptom improvement and may induce immunomodulation in elderly rhinitis patients.