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Clinical Case Report of PPI-refractory Gastro-Esophageal Reflux Disease (GERD) with Korean Medicine Treatment - A Focus on Evaluation of the Abdominal Examination (한의 복합치료로 호전된 불응성 위식도역류질환 (PPI-refractory GERD) 환자 1례 - 복진소견 평가를 중심으로 -)

  • Lee, Jae-hong;Cho, Soo-ho;Ko, Seok-jae;Park, Jae-woo
    • The Journal of Internal Korean Medicine
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    • v.38 no.5
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    • pp.727-735
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    • 2017
  • This case report describes a 60-year-old man who had reflux symptoms despite treatment with proton pump inhibitors (PPIs). Korean traditional medicine, including a herbal prescription, acupuncture, and moxibustion was administered to the patient during his 19 days of hospitalization. The visual analogue scale (VAS), gastrointestinal scale (GIS), and gastrointestinal symptom rating scale (GSRS) scores were assessed on the dates of admission and discharge. An abdominal examination, which is one of the Korean medicine diagnostic tools, was performed every day to evaluate the treatment progress. During the treatment, the improvement of symptoms was clinically correlated with abdominal examination outcomes. We suggest that administration of traditional Korean Medicine on PPI-refractory GERD patients could be effective and we recommend utilization of the abdominal examination as an assessment tool for Korean Medicine treatment.

Primary Choriocarcinoma of the Lung - Case report - (폐에 발생한 원발성 융모막 상피종 - 1예 보고 -)

  • 최명석
    • Journal of Chest Surgery
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    • v.23 no.5
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    • pp.1003-1008
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    • 1990
  • Primary choriocarcinoma of the lung is extremely rare and have been reported ten and several cases only in the literature. It is very difficult to confirm the "Pure primary pulmonary choriocarcinoma" clinically, so most cases that have been reported in the literature confirmed by autopsy and the prognosis is relatively poor compared with metastases. We experience one case of the primary pulmonary choriocarcinoma. She was 53 year old multiparous woman[4 \ulcorner0 \ulcorner2 \ulcorner0] who complain right chest pain for 4 years. On plain film and computerized tomogram of the thorax at admission, 2.5cmx3.5cmx5 cm sized, well demarcated ovoid mass was founded on the right middle lobe just below the parietal pleura and growing rapidly on plain film to 5cm x 6.5cm x 7cm after 15 days. We confirm the choriocarcinoma in the lung by percutaneous needle aspiration biopsy and strongly suspect primary after various examination for rule out metastases from the ovary or uterus. We perform middle lobe lobectomy because that can not confirm the primary or the metastases because there are not complete histological examination by bilateral ovariectomy and hysterectomy, and under the belief that extragestational or extragonadal primary choriocarcinoma is more resistant to the chemotherapy, and could be reduce the duration of hospitalization and the amount of chemotherapy used to achieve remission On 14th postoperative day, serum p-HCG level was returned to normal limit, and perform chemotherapy two times on 3rd and 5th week for prevention surgical traumatic hematogenous metastases or undetected microfocus, but the patient expire on 68th postoperative day due to intracerebral hemorrhage in the intracranial choriocarcinoma which strongly suspected surgical traumatic hematogenous metastases.etastases.

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Gastric Phytobezoar Treated by Oral Intake and Endoscopic Injection of Coca-Cola (코카 콜라 경구 투여와 내시경적 주입법을 이용한 위석의 치료 1 예)

  • Moon, Hee-Jung;Lee, Sang-Hoon;Lee, Jun-Young;Kim, Dong-Hee;Lee, Ji-Eun;Yang, Chang-Hun;Eun, Jong-Ryul;Kim, Tae-Nyeun;Lee, Heon-Ju;Jang, Byung-Ik
    • Journal of Yeungnam Medical Science
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    • v.23 no.2
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    • pp.247-251
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    • 2006
  • Bezoars are collections or concretions of indigestible foreign material that accumulate and coalesce in the gastrointestinal tract; they usually occur in patients who have undergone gastric surgery and have delayed gastric emptying. Treatment options include dissolution with enzymes, endoscopic fragmentation with removal or aspiration, and surgery. Recently, the efficacy of nasogastric lavage or endoscopic infusion of Coca-Cola for the dissolution of phytobezoar have been reported. We report a case of phytobezoar successfully treated by oral administration and endoscopic injection of Coca-Cola. A 62-year-old woman was referred to Yeungnam University Hospital for epigastric pain. Upper gastrointestinal endoscopy revealed one very large, dark-greenish, solid bezoar in the stomach with gastric ulcer and duodenal bulb deformity. We performed endoscopic injection of Coca-Cola into the bezoar. The patient was instructed to drink four liters of Coca-Cola per day. At endoscopy two days later, the phytobezoar was easily broken into pieces. At endoscopy on the $11^{th}$ day of admission, the phytobezoar was decreased in size and removed by endoscopic fragmentation with a polypectomy snare. At follow up endoscopy after 13 days, the bezoar was completely dissolved.

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Colon Perforation in Hyperimmunoglobulin E Syndrome - A Case Report - (Hyperimmunoglobulin E 증후군에서의 결장천공 - 증례보고 -)

  • Oh, Jung-Tak;Kim, In-Gyu;Han, Seok-Joo;Kim, Ho-Guen;Hwang, Eui-Ho
    • Advances in pediatric surgery
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    • v.2 no.2
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    • pp.151-155
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    • 1996
  • Hyperimmunoglobulin E syndrome is a relatively rare primary immunodeficiency syndrome characterized by recurrent infection, abscess formation and marked elevation of serum IgE level. The common infectious organism is Staphylococcus aureus and recurrent infection indicates some defects in the immunologic system. Although the infection can affect various organs, gastrointestinal tract involvement is rare and only one case of colon perforation has been previously reproted. Herein we report another one case of colon perforation which ocurred in an 8-year-old girl with hyper immunoglobulin E syndrome. The patient was admitted to the hospital due to an abscess on right neck. The diagnosis of hyper immunoglobulin E syndrome was made because she had eczematoid dermatitis on the face, pneumatocele on left upper lung field and markedly elevated serum IgE level(>15,000 IU/ml) with a past histories of frequent scalp abscesses and otitis media. Abdominal pain developed on the 13th day of admission and abdominal plain X-ray revealed free air. An exploratory laparatomy was performed and two free perforations of the transverse colon were noted. Segmental resection and double barrel colostomy were performed. Colostomy closure was done 4 month later and she had no gastrointestinal problem during a follow up period of 15 months.

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The Empirical Exploration of the Conception on Nursing (간호개념에 대한 기초조사)

  • 백혜자
    • Journal of Korean Academy of Nursing
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    • v.11 no.1
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    • pp.65-87
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    • 1981
  • The study is aimed at exploring concept held by clinical nurses of nursing. The data were collected from 225 nurses conviniently selected from the population of nurses working in Kang Won province. Findings include. 1) Nurse's Qualification. The respondents view that specialized knowledge is more important qualification of the nurse. Than warm personality. Specifically, 92.9% of the respondents indicated specialized knowledge as the most important qualification while only 43.1% indicated warm personality. 2) On Nursing Profession. The respondents view that nursing profession as health service oriented rather than independent profession specifically. This suggests that nursing profession is not consistentic present health care delivery system nor support nurses working independently. 3) On Clients of Nursing Care The respondents include patients, family and the community residents in the category of nursing care. Specifically, 92.0% of the respondents view that patient is the client, while only 67.1% of nursing student and 74.7% of herself. This indicates the lack of the nurse's recognition toward their clients. 4) On the Priority of Nursing care. Most of the respondents view the clients physical psychological respects as important component of nursing care but not the spiritual ones. Specially, 96.0% of the respondents indicated the physical respects, 93% psychological ones, while 64.1% indicated the spiritual ones. This means the lack of comprehensive conception on nursing aimension. 5) On Nursing Care. 91.6% of the respondents indicated that nursing care is the activity decreasing pain or helping to recover illness, while only 66.2% indicated earring out the physicians medical orders. 6) On Purpose of Nursing Care. 89.8% of the respondents indicated preventing illness and than 76.6% of them decreasing 1;ai of clients. On the other hand, maintaining health has the lowest selection at the degree of 13.8%. This means the lack of nurses' recognition for maintaining health as the most important point. 7) On Knowledge Needed in Nursing Care. Most of the respondents view that the knowledge faced with the spot of nursing care is needed. Specially, 81.3% of the respondents indicated simple curing method and 75.1%, 73.3%, 71.6% each indicated child nursing, maternal nursing and controlling for the communicable disease. On the other hand, knowledge w hick has been neglected in the specialized courses of nursing education, that is, thinking line among com-w unity members, overcoming style against between stress and personal relation in each home, and administration, management have a low selection at the depree of 48.9%,41.875 and 41.3%. 8) On Nursing Idea. The highest degree of selection is that they know themselves rightly, (The mean score measuring distribution was 4.205/5) In the lowest degree,3.016/5 is that devotion is the essential element of nursing, 2.860/5 the religious problems that human beings can not settle, such as a fatal ones, 2,810/5 the nursing profession is worth trying in one's life. This means that the peculiarly essential ideas on the professional sense of value. 9) On Nursing Services. The mean score measuring distribution for the nursing services showed that the inserting of machine air way is 2.132/5, the technique and knowledge for surviving heart-lung resuscitating is 2.892/s, and the preventing air pollution 3.021/5. Specially, 41.1% of the respondents indicated the lack of the replied ratio. 10) On Nurses' Qualifications. The respondents were selected five items as the most important qualifications. Specially, 17.4% of the respondents indicated specialized knowledge, 15.3% the nurses' health, 10.6% satisfaction for nursing profession, 9.8% the experience need, 9.2% comprehension and cooperation, while warm personality as nursing qualifications have a tendency of being lighted. 11) On the Priority of Nursing Care The respondents were selected three items as the most important component. Most of the respondents view the client's physical, spiritual: economic points as important components of nursing care. They showed each 36.8%, 27.6%, 13.8% while educational ones showed 1.8%. 12) On Purpose of Nursing Care. The respondents were selected four items as the most important purpose. Specially,29.3% of the respondents indicated curing illness for clients, 21.3% preventing illness for client 17.4% decreasing pain, 15.3% surviving. 13) On the Analysis of Important Nursing Care Ranging from 5 point to 25 point, the nurses' qualification are concentrated at the degree of 95.1%. Ranging from 3 point to 25, the priorities of nursing care are concentrated at the degree of 96.4%. Ranging from 4 point to 16, the purpose of nursing care is concentrated at the degree of 84.0%. 14) The Analysis, of General Characteristics and Facts of Nursing Concept. The correlation between the educational high level and nursing care showed significance. (P < 0.0262). The correction between the educational low level and purpose of nursing care showed significance. (P < 0.002) The correlation between nurses' working yeras and the degree of importance for the purpose of nursing care showed significance (P < 0.0155) Specially, the most affirmative answers were showed from two years to four ones. 15) On Nunes' qualification and its Degree of Importance The correlation between nurses' qualification and its degree of importance showed significance. (r = 0.2172, p< 0.001) 0.005) B. General characteristics of the subjects The mean age of the subject was 39 ; with 38.6% with in the age range of 20-29 ; 52.6% were male; 57.9% were Schizophrenia; 35.1% were graduated from high school or high school dropouts; 56.l% were not have any religion; 52.6% were unmarried; 47.4% were first admission; 91.2% were involuntary admission patients. C. Measurement of anxiety variables. 1. Measurement tools of affective anxiety in this study demonstrated high reliability (.854). 2. Measurement tools of somatic anxiety in this study demonstrated high reliability (.920). D. Relationship between the anxiety variables and the general characteristics. 1. Relationship between affective anxiety and general characteristics. 1) The level of female patients were higher than that of the male patient (t = 5.41, p < 0.05). 2) Frequencies of admission were related to affective anxiety, so in the first admission the anxiety level was the highest. (F = 5.50, p < 0.005). 2, Relationship between somatic anxiety and general characteristics. 1) The age range of 30-39 was found to have the highest level of the somatic anxiety. (F = 3.95, p < 0.005). 2) Frequencies of admission were related to the somatic anxiety, so .in first admission the anxiety level was the highest. (F = 9.12, p < 0.005) 0. Analysis of significant anxiety symptoms for nursing intervention. 1. Seven items such as dizziness, mental integration, sweating, restlessness, anxiousness, urinary frequency and insomnia, init. accounted for 96% of the variation within the first 24 hours after admission. 2. Seven items such as fear, paresthesias, restlessness, sweating insomnia, init., tremors and body aches and pains accounted for 84% of the variation on the 10th day after admission.

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Analysis of Nursing Activities and Cost of Nursing Service Based on the ABC System (활동기준원가계산(ABC)을 이용한 간호활동 분석 및 간호서비스 원가분석;일 산부인과 간호단위를 중심으로)

  • Kang, Kyeong-Hwa
    • Journal of Korean Academy of Nursing Administration
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    • v.5 no.2
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    • pp.389-400
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    • 1999
  • The purpose of this study is to examine a possibility of applying the ABC system to analyze the cost of nursing service on one obstetrics and gynecology (OB/GYN) unit in a major medical center. The activities of nurses on an OB/GYN unit were analyzed for 4 days for 96 hours. 2 week days and 2 days on weekend. Total cases included in the study were activities of 12 charge nurses and 12 staff nurses. Activities were categorized into direct and indirect activities in order to calculate the cost of activities. Nursing activities were defined multidimesionally in order to utilize the ABC system. The 60 nursing activities were classified into the direct nursing activities and the indirect nursing activities based on a literature review, interview, and survey results. The direct activities were further categorized into the single nursing activities and the multiple nursing activities. The indirect activities were classified into the indirect nursing service activities and the general management activities. The major findings of this study were as follows : 1. There were differences in activities according to the positions and duties of the nurses. The charge nurses mostly performed the indirect nursing service activities and the general management activities. Almost all of their indirect nursing activities spent on each patient were similar. The staff nurses performed the single nursing activities and the multiple nursing activities. 2. The activities of staff nurses included medication, patient assessment, rounding and organizing the unit. patient education, nursing treatment, admission and discharging of patients. There was no differences in types and amount of time spent between the nurses on day-time duty and evening-time duty, but the patient assessment activity increased during the night-time. 3. The cost of post partum nursing services for women who had a normal vaginal delivery using the ABC system included the cost incurred by direct nursing activities provided by the staff nurses (85.9%), indirect nursing activities incurred by the staff nurses(19.0%) and the nursing activities by the charge nurses and the head nurse(14.1%). The ABC system is a relatively new method of cost analysis. The results of this study can provide the nursing and hospital managers with useful information on cost control. It is suggested that more studies should be done using the ABC system and extend the scope of studies to include value analysis to aid the Activity-Based Management(ABM) and/or the reengineering of hospital process.

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Acupuncture Treatment in Feline Horner's Syndrome: Case Report (고양이 Horner's syndrome에 대한 침치료(針治療) 증예보고(症例報告))

  • Hsu, Chin-Yuan;Hsu, Chin-ling;Hsu, Chin-Hwang;Liao, Jim-Cai;Chueh, Hao-Jen;Cheng, Han-Wen;Jun, Hyeong-Kyou;Kim, Duck-Hwan
    • Journal of Veterinary Clinics
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    • v.24 no.2
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    • pp.214-217
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    • 2007
  • A about 2-month- old, mixed female cat was referred to Yeon Chang Veterinaly Clinic in Taiwan. Because this patient was wandering cat, precise history was not blown. At first admission, miosis, ptosis and protrusion of the nictitating membrane was observed in the right sided eye, and also slight miosis was found in the left sided eye. The patient was diagnosed into feline HS. Oculo-AP and injection-AP with dexamethasone were applied to this patient. Oculo-AP at Shang Jiao regions of both eyes was done for 10 minutes. In addition, injection-AP with dexamethasone (0.2 ml/acupoint) at BL01-Jing Ming, BL02-Zan Zhu and ST01-Cheng Qi. After AP treatment, prolapse of the nictitating membrane was amazingly disappeared and pupil was dilatated at session 1. Ocular findings at session 2 (one day after session 1) were maintained with nearly normal state. Accordingly, the present patient was a case with feline HS that showed favorable therapeutic effect by AP treatment.

Primary neurofibroma of the Diaphragm (횡격막에 발생한 신경섬유종 1례)

  • 유회성
    • Journal of Chest Surgery
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    • v.8 no.2
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    • pp.149-152
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    • 1975
  • In spite of great advances in surgical treatment during past several decades, surgery of the trachea failed to develop correspondingly, partly because of relative rarity of the tracheal lesions and partly because of difficulties in surgical technique and anesthesia. Surgical diseases of the trachea are largely obstructions due to neoplasm or cicatrical stenosis and tracheal malacia. The present treatment of respiratory failure, using cuffed endotracheal and tracheostomy tubes, has produced, apparently with increasing frequency, tracheal stenosis, tracheomalized tracheal erosion. Surgery is presently the only reasonable way to treat stenotic lesions of the tracheobronchial tree. In the case of tumors, the current trend has been that of radical excision. Primary end-to--end reconstruction of the trachea has been generally recognized as the ideal method of repair following resection. However, for decades it was believed that a maximum of four tracheal rings only might be excised and primary healing achieved with safety. A great variety of procedures, developed by numerous investigations and directed at tracheal substitution, have almost invariably met with discouraging results. A meticulous study done by Grillo and associates on autopsy specimens has shown that an average 6.4cm of mediastinal trachea can be safely resected by full mobilization of the right lung and transplantation of the left main bronchus into the bronchus intermedius. Recently, we experienced a case of successful resection of a tumor of the tracheal carina and primary tracheo-left main bronchial anastomosis at the Department of Thoracic & Cardiovascular Surgery, the National Medical Center in Seoul. The patient, a 29-year-old man, was admitted to the hospital with complaints of dyspnea and cough. On admission, chest film showed hydropneumothorax on the right. After closed thoracostomy, hydropneumothorax disappeared, but hazy densities, developed in the right middle and lower lung fields, resisted to treatment. Bronchoscopy uncovered irregular tumor covering the carina and the right main bronchus, and biopsy indicated well differentiated squamous Cell carcinoma. Operation was performed on July 2, 1975. A right postero-lateral thoracotomy was used. Excision involved the lower trachea, the carina, the left main bronchus and the right lung. This was followed by direct anastomosis between the trachea and the left main bronchus. Bronchography was done on 17th postoperative day revealed good result of operation without stricture at the site ofanastomosis. About one month after the operation symptoms and signs of bronchial irritation with dyspnea developed, and these responded to respiratory care. On 82nd postoperative day, sudden dyspnea developed at night and the patient expired several hours later. Autopsy was not done and the cause of death was uncertain.

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Portal Vein Thrombosis in a Dog with Dirofilariasis (심장사상충에 감염된 개에서 발생한 문정맥혈전증)

  • Yun, Seok-Ju;Cheon, Haeng-Bok;Han, Jae-Ik;Kang, Ji-Houn;Chang, Jin-Hwa;Na, Ki-Jeong;Chang, Dong-Woo
    • Journal of Veterinary Clinics
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    • v.27 no.5
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    • pp.600-604
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    • 2010
  • A ten-year-old female mongrel dog was presented to Veterinary Medical Center, Chungbuk National University with the signs of anorexia, weakness, and hemoglobinuria. Patient had been diagnosed as dirofilariasis based on heartworm antigen test and treated with adulticide (melarsomine) at local hospital one day before admission. On laboratory examinations, there were hypochromic and microcytic regenerative anemia, thrombocytopenia, moderate neutrophilia, and increase ALT, AST, and ALP. Radiographic exam showed main pulmonary artery bulging, pulmonary infiltration and hypervascularity, reduced abdominal serosal detail and mild hepatomegaly. Abdominal ultrasonographic exam showed mild peritoneal effusion and large hyperechoic thrombi at trifurcation of the porta hepatica and the splenic vein. In addition, intraluminal low density area and intravascular filling defect were confirmed on contrast enhanced CT scanning at the same anatomic locations. Patient was treated with anticoagulant and thrombolytic therapy. On day 42 after treatment, complete resolution of thrombi was confirmed via ultrasonography and improvement of clinical signs was observed.

Estimation of Psychiatric Nursing Costs by Using the Resource-Based Relative Value Scale(RBRVS) (자원기준 상대가치를 이용한 정신과의 간호활동비용 산정)

  • Kim, Eun-Kyung;Kwon, Young-Dae;Kim, Yoon
    • Journal of Korean Academy of Nursing
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    • v.30 no.6
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    • pp.1580-1591
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    • 2000
  • This study was conducted to assess the amount of nursing services for psychiatric inpatients and to estimate psychiatric nursing costs by using the RBRVS. Full details of medical services, including physician and nursing services, for psychiatric inpatients were surveyed and data of general characteristics of hospitals and patients were also collected. The cost of nursing activities was estimated by the multiple conversion factor which was drawn from the Korean RBRVS Development Project to the RBRVS score of each nursing activities, which was drawn from the results of Korean Nurses Association (KNA)'s projects about nursing RBRVS development and cost of nursing activities. The data about 89 inpatients from 3 general hospitals with psychiatric departments were analyzed. The total cost of nursing activities for each patient per admission day was from KRW 22,185 to KRW 27,954 by hospital, and KRW 25,220 in average. The percent of nursing cost to the total cost of medical services was from 36% to 48% by characteristics of patients and 41.4% in average. The cost of nursing activities estimated in this study was between the existing NHI fee schedule and the one suggested by KNA. It is considered as appropriate and acceptable level compared to the total amount of medical services. In the process of KNA's activities to get nursing fee in NHI fee schedule, results of additional studies to estimate the cost of nursing activities balanced with total cost of medical services in every departments should be found and utilized.

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