• Korean Journal of Bronchoesophagology
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• v.11 no.1
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• pp.15-20
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• 2005

Background : It is well-known that esophageal perforation (EP) is difficult in diagnosis and has high mortality rate despite proper management. There are disputes in regarding the reatment in cases of delayed diagnosis although in the early diagnosed cases, operation is recommended without arguments. Methods: From April, 2001 to December, 2004, nine patients who were diagnosed as EP in our hospital were analyzed retrospectively about the causes, the interval between the cause and the treatment, and operation methods. Results: There were 8 male and one female with men age of 49.3 years (range: 25-67 years). The causes of EP included perforations following operations of corvical spine in three cases, spontaneous perforation(Boehaave syndrome) in two cases, foreign bodies in two cases, operation of esophageal diverticulum in one case and blunt trauma bytraffic accident in one case. Mean interval between the first treatments and the causes was 11.6 days (range: 2-30 days). The sites of perforation were upper third of esophagus in three cases, middle third in three cases and lower third in three cases. All except two cervical cases presented as mediastinitis or empyema at the time of diagnosis. Primary repair and irrigation had been performed in 7 cases but five cases out of them required more than two procedures. Conclusions : More than one procedure wasrequired in the treatment of EP because of contaminations and infections which had been spread at the time of initial manifestatios, howeverprimary closure and massive irrigation is the best method in order to preserve esophagus unless the remaining esophagus is extensively damaged.

• Journal of the Korea Society of Computer and Information
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• v.20 no.11
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• pp.175-181
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• 2015

In this paper, based on the reference, we try to review the second issues about opening medical market and health care privatization by each topic and propose the measures and alternatives. Currently, in Korea, connection with launch of the WTO system and force of the FTA, the medical industries getting liberalization and globalization. Thus, it is expected to plunge to full-free competition system, and Korean medical institutions started the global competition which completely different dimension. It means that according to the liberalization of the healthcare market the real problem can be caused and also, the incessant discussion and effort for the implementation of international community are needed. Regard to attracting foreign patients and opening medical markets, the government also spreading the continued advancement strategy politically until now. However, generating problems with implication is inevitable and measures and alternatives to it are also needed. In accordance with the opening, the accompanying suggestions is medical privatization, that is, whether the health care pursue the profit not the not-for-profit and the current hospitals in Korea they are leaved as non-profit hospitals and let the make the subsidiary as general commercial enterprises, it seems indirect. However, it is like a healthcare privatization virtually thus, implication seem be large. Of course, through the public opinion and legal reservation, the liberalization and privatization of medical market can be delayed or not forced. It would be not fit in the flow of the inevitable globalization, it can be inhibited national interest and economic development also, and it can be the critical implications which shake the health system and collapse of the domestic health care market.

• Health Policy and Management
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• v.2 no.2
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• pp.194-220
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• 1992

In recent years there has been a rapid influx of high cost MRI equipment into Korea. This diffusion has raised concerns about the changes it will bring for the health care utilization. Therefore, the purpose of this study is to identify socio-economic characteristics of MRI uses in Korea. A structured questionnaire was designed for this purpose, and 1, 091 users were surveyed at the 35 MRI units of 33 hospitals during a week, sometimes March 1992. The study reveals that high cost technology such as MRI, CT scanner is so prevalent in Korea. This is particularly the case in metropolitan areas. Among others, Seoul has the highest percentage of MRI equipment, 51.05%, Pusan 12.10% and Kwangju 11.9%. Unfortunately, most high cost technology equipments are foreign products. Thus, hospitals with such a high cost technology have difficulties in maintenance of the equipment. The average performance of MRI equipment has declined from 10.2 cases per day in 1988 to 7.16 cases in March 1992. Due to the rapid increase, the performance of MRI equipment seems to be deterioration. Male usere are dominant in the case of MRI use. The utilization rate has positively increased with the rise of educational level of users. The same is true for the level of income; the MRI utilization rate by income level shows that it is negatively proportional to income, which indicates that the poor have difficulties in the use of high cost technology. Particularly, the cost of MRI is so high that ordinary patients are unable to pay for it. For example, 86.3% of respondents have answered that the cost is too high even though they are insured by health insurance. This is the first empirical study on the use status of MRI. The information obtained in this study is sufficient to maintain that the Korean health insurance programme is urgently in need of improving the insurance benefit schemes. The easiest way to do this is to include provision of high cost technology service into the benefit package.

• Journal of radiological science and technology
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• v.44 no.5
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• pp.451-457
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• 2021

Recently, the number of interventional procedures has increased dramatically as an alternative of invasive surgical procedure and patient radiation exposure is also increasing accordingly. In this study, we evaluated the patient dose of major interventional procedures nationwide and we established our Korean database. With these results, we tried to suggest the reference dose level for major interventional procedures. We evaluated patent dose data in the field of interventional radiology from foreign countries. Measurement of radiation dose exposure for 11 major interventional procedures was conducted using embedded DAP meters in 10,006 patients from 47 hospitals, and reference level of each interventional procedure was suggested. The DRLs of each intervenional procedure are as follows: TACE 206(Gy·cm²), AVF 12(Gy·cm²), LE intervention 43(Gy·cm²), TFCA 122(Gy·cm²), Cerebral aneurysm coil embolization 214(Gy·cm²), PTBD 22(Gy·cm²), Biliary stent 60(Gy·cm²), PCN 7(Gy·cm²), Hickman catheter 2.1(Gy·cm²), Chemoport 1.4(Gy·cm²), BAE 104(Gy·cm²). Compared with the previously established DRL in 2012, the radiation dose decreased in all 10 interventional procedures. In the future, continuous publicity and education on the radiation dose reduction will be needed.

• The Journal of Internal Korean Medicine
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• v.42 no.3
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• pp.293-307
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• 2021

Objectives: This study investigates the effects and safety of Bojungikgi-tang for stress urinary incontinence by systemic review and meta-analysis of randomized controlled trials (RCTs). Methods: RCTs were selected from articles published until December 2019 in seven domestic and foreign databases. The quality of the literature was evaluated using Cochrane's risk of bias (RoB) tool, and RevMan 5.3 was used to synthesize the results. Results: A total of 694 patients with stress urinary incontinence participated in eight RCTs. Meta-analysis showed that the total effective rate of treatment that combines pelvic floor muscle training (PFMT) and Bojungikgi-tang was significantly higher than that of PFMT alone. The volume of urine leakage per hour after the combined treatment was significantly lower than that of PFMT alone. The International Consultation on Insurance Questionnaire-Short Form (ICIQ-SF) scores from combining PFMT and Bojungikgi-tang were significantly lower than those for PFMT alone. Conclusion: This study suggests that Western medical treatment combined with Bojungikgi-tang for urinary incontinence from stress might be more effective in improving symptoms than conventional Western medical treatment alone. However, the number of studies included in the meta-analysis was insufficient, and the quality of the selected literature was generally low. Therefore, high-quality clinical studies on herbal medicine treatment for urinary incontinence would be required in the future.

• Journal of Korean Medicine Rehabilitation
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• v.32 no.3
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• pp.55-64
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• 2022

Objectives The objective of this study was to assess the effectiveness of acupotomy for carpal tunnel syndrome. Methods Based on seven domestic and foreign databases. We analyzed the randomized controlled trials using acupotomy for carpal tunnel syndrome. The treatment group was treated with acupotomy and the control group was no restrictions on treatment methods. Results In this study, the effect of acupuncture treatment for carpal tunnel syndrome was investigated. Each study reported that acupotomy could be an effective treatment for carpal tunnel syndrome. However, as a result of meta-analysis of Levine carpal tunnel syndrome questionnaire scores, visual analog scale, and sensory nerve conduction velocity, the results were more clinically significant than those of the control group. Due to the small number of randomized controlled trial studies and the nature of acupotomy treatment, blinding of interventions was impossible, resulting in a high risk of bias. Conclusions In this regard, it is thought that well-planned randomized controlled studies on patients with carpal tunnel syndrome are needed in the future to secure the clinical evidence for acupotomy treatment.

• Journal of Acupuncture Research
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• v.39 no.1
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• pp.10-16
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• 2022

This study aimed to analyze the status of adverse events (AEs) in the treatment of musculoskeletal conditions/diseases using thread embedding acupuncture (TEA). Five electronic databases were searched to retrieve data on clinical studies published in the last 5 years (2016 to 2021). Of the 151 studies retrieved, 22 studies analyzed AEs and were selected for this review. There were no AEs reported in 6 studies (27.3%); of the remaining 16 studies, 4 studies (18.2%) reported AEs that were not related to TEA. The most common AEs reported in the Chinese studies were redness of skin with/without swelling and tingling sensation, and in the Korean studies they were stiffness, a foreign body sensation, and bruising. The percentage of patients with AE experience was 5.1% in the Chinese studies and 19.9% in the Korean studies. The discrepancies between the findings in the Chinese and Korean studies may be attribute to differences in the diameter of needles, thread materials, TEA treatment procedure, and evaluation methods for AEs. Most of the reported AEs were of a mild status and did not last for a long time. However, further research on the clinical course after TEA treatment is needed.

• Korean Journal of Radiology
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• v.23 no.1
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• pp.139-149
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• 2022

Objective: To compare the effects of bone suppression imaging using deep learning (BSp-DL) based on a generative adversarial network (GAN) and bone subtraction imaging using a dual energy technique (BSt-DE) on radiologists' performance for pulmonary nodule detection on chest radiographs (CXRs). Materials and Methods: A total of 111 adults, including 49 patients with 83 pulmonary nodules, who underwent both CXR using the dual energy technique and chest CT, were enrolled. Using CT as a reference, two independent radiologists evaluated CXR images for the presence or absence of pulmonary nodules in three reading sessions (standard CXR, BSt-DE CXR, and BSp-DL CXR). Person-wise and nodule-wise performances were assessed using receiver-operating characteristic (ROC) and alternative free-response ROC (AFROC) curve analyses, respectively. Subgroup analyses based on nodule size, location, and the presence of overlapping bones were performed. Results: BSt-DE with an area under the AFROC curve (AUAFROC) of 0.996 and 0.976 for readers 1 and 2, respectively, and BSp-DL with AUAFROC of 0.981 and 0.958, respectively, showed better nodule-wise performance than standard CXR (AUAFROC of 0.907 and 0.808, respectively; p ≤ 0.005). In the person-wise analysis, BSp-DL with an area under the ROC curve (AUROC) of 0.984 and 0.931 for readers 1 and 2, respectively, showed better performance than standard CXR (AUROC of 0.915 and 0.798, respectively; p ≤ 0.011) and comparable performance to BSt-DE (AUROC of 0.988 and 0.974; p ≥ 0.064). BSt-DE and BSp-DL were superior to standard CXR for detecting nodules overlapping with bones (p < 0.017) or in the upper/middle lung zone (p < 0.017). BSt-DE was superior (p < 0.017) to BSp-DL in detecting peripheral and sub-centimeter nodules. Conclusion: BSp-DL (GAN-based bone suppression) showed comparable performance to BSt-DE and can improve radiologists' performance in detecting pulmonary nodules on CXRs. Nevertheless, for better delineation of small and peripheral nodules, further technical improvements are required.

• Journal of Chest Surgery
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• v.43 no.6
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• pp.705-709
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• 2010

Background: Esophageal injury requires early and proper management. We want to determine the results of various esophageal injuries. Material and Method: We respectively analyzed 22 patients who were managed for esophageal injury between 1999 and 2009. Based on the medical records, we reviewed the causes of injury, the diagnoses, the treatment methods, the complications and the prognosis. Result: The main causes of esophageal injury were a foreign body in 9 cases (41%) and vomiting in 5 cases (23%). We treated the patients with esophageal primary repair in 12 cases (55%), abscess drainage in 4 cases (18%) and conservative management in 6 cases (27%). There was esophageal leakage in 7 cases (32%) and death occurred in 3 cases (14%). Conclusion: For minor esophageal injury, conservative management was sometimes possible to treat the esophagus, yet aggressive and urgent surgical treatment should be applied for cases of major esophageal injury, including mediastinal abscess.

• Journal of East-West Nursing Research
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• v.3 no.1
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• pp.27-38
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• 1998

This study was carried out to understand the general conditions about management of hypertension and the differences in opinions between the Eastern-Western Nursing Sciences. In this context, this study was aimed to find out a possible integration of the Eastern-Western Nursing Sciences for the management of hypertension and to suggest a distinct frame of Korean nursing intervention method which is unique for the hypertensive patients by combining two hypertensive management systems originated from the Western type, "mainly classified by stage", and the Eastern type, "typically classified by form" as they are identified in the literature. From the research literature including both domestic and foreign, this study identified that exuberance of Yang of the Liver form mainly appeared to the patient who is at a border hypertension or the first stage of hypertension, Deficiency of Yin of the Liver and Kidneys form mostly appeared to the first stage and the second stage of Hypertension and Deficiency of the both of Yin and Yang form appeared to the third stage of Hypertension. These unifications of the types of Hypertension classified by stages and forms suggest the possibility not only of integration of the Eastern-western Medicine but also of establishment for the intervention of specific nursing management which is the united Eastern-western Nursing Science for the Hypertension. Hence, the new frame for the nursing management of Hypertensive patient is suggested as follows : 1) In case of the exuberance of Yang of the Liver form, as classified by form which is categorized to the border Hypertension or the first stage of Hypertension, nursing intervention should include general therapy, cooking meal and neutral care to restrain the condition of the exuberance of Yang of the liver. 2) In case of the deficiency of Yin of the liver and the Kidneys form, as classified by form which is categorized to the second stage of Hypertension, nursing intervention should include both the general and drug therapy and their use in combination with cooking meal and neural care to restrain the condition of the deficiency of Yin of the Li ver and Kidneys. 3) In case of the deficiency of both of Yin and Yang form, as classified by form which is categorized to he third stage of Hypertension should include both the general therapy and drug therapy and their use in combination with cooking meal and neural care to restrain the condition of deficiency of the both of Yin and Yang. In addition, using this basic frame of Hypertensive management, a specific way of nursing intervention, which is suitable for exuberance of Yang of the Liver form, deficiency of Yin of the Liver and Kidneys form, and deficiency of both of the Yin and Yang form and classified by Korean herbal medicine related to hypertension, should be pursued continuously in the future.