• 한국간담췌외과학회지
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• 제28권1호
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• pp.80-91
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• 2024

Backgrounds/Aims: Optimal intravenous fluid management during the perioperative period for patients undergoing pancreaticoduodenectomy (PD) within the framework of enhanced recovery after surgery (ERAS) is unclear. Studies have indicated that excessive total body salt and water can contribute to the development of oedema, leading to increased morbidity and extended hospital stays. This study aimed to assess the effects of an intravenous therapy regimen during postoperative day (POD) 0 to 2 in PD patients within ERAS. Methods: A retrospective interventional cohort study was conducted, and it involved all PD patients before and after implementation of ERAS (2009-2017). In the ERAS group, a targeted maintenance fluid regimen of 20 mL/kg/day with a sodium requirement of 0.5 mmoL/kg/day was administered. Outcome measures included the mmol of sodium and chloride administered, length of stay, and morbidity (postoperative pancreatic fistula, POPF; acute kidney injury, AKI; ileus). Results: The study included 169 patients, with a mean age of 64 ± 11.3 years. Following implementation of the intravenous fluid therapy protocol, there was a significant reduction in chloride and sodium loading. However, in the multivariable analysis, chloride administered (mmoL/kg) did not independently influence the length of stay; or rates of POPF, ileus, or AKI (p > 0.05). Conclusions: The findings suggested that a postoperative intravenous fluid therapy regimen did not significantly impact morbidity. Notably, there was a trend towards reduced length of stay within an increasingly comorbid patient cohort. This targeted fluid regimen appears to be safe for PD patients within the ERAS program. Further prospective research is needed to explore this area.

• Journal of Yeungnam Medical Science
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• 제24권2호
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• pp.170-178
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• 2007

성인에서 항체 보유율이 급감하는 것에 비례하여 급성 A형 간염 환자는 증가하고 있다. 대구지역에서의 급성 A형 간염의 역학과 임상 양상에 관한 자료를 얻고자 하였다. 1998년 1월부터 2007년 6월까지 영남대학교병원에 급성 간염으로 입원하여 IgM anti-HAV 양성으로 급성 A형 간염이 확진된 55명의 환자들(남/녀 34/21)의 의무기록을 후향적으로 검토하였다. 평균 연령은 $29.7{\pm}10.3$세(범위 17~65세)였고, 20대와 30대에 78.2%가 발생하였다. 만성 B형 간염이 4명 (7.3%)에서 동반되어 있었으나, 모두 비증식상태로 임상경과는 양호하였다. 1998년부터 2002년 사이에 9.1%가 발생한 데 반해 2003년부터 2007년 6월까지 90.1%가 발생하였고, 계절적으로는 3~6월 사이에 31명 (56.1%)으로 가장 많이 발생하였다. 여행력이 있는 7명(12.7%)을 제외하고는 감염원을 추정하기가 힘들었다. 임상증상은 식욕부진과 오심, 구토38예(69.1%), 열/오한 27명(49.1%), 전신근육통 26명(47.3%), 체중감소 26명(47.3%), 피로감 22명(40.0%), 복통이 20예(36.4%), 설사 5명(9.1%), 소양감 3명(5.5%) 등이었다. 54명은 합병증 없이 자연회복되었으나 1명은 전격성 간염이 발생하여 간이식을 받고 회복되었다. 평균 재원일은 $8.6{\pm}3.4$일(범위 3~20일)이었다. 성인에서의 급성 A형 간염은 입원으로 인한 사회, 경제적 비용이 적지 않고 때로는 치명적인 결과를 초래할 수도 있으므로 능동면역을 받지 않은 30대 이전의 젊은 연령에서는 항체의 확인과 함께 능동면역을 고려해야 할 것으로 생각한다.

• 대한정형외과 초음파학회지
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• 제2권2호
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• pp.85-89
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• 2009

목적: 견관절의 극상건에 발생한 급성 석회화 건염에 대하여 초음파를 이용한 스테로이드 국소 주사 요법을 시행하고 임상적 결과를 알아보고자 하였다. 대상 및 방법: 2007년 1월부터 2009년 4월까지 증상이 있는 50세에서 70세 사이의 견관절 극상건의 급성 석회화 건염 20례를 대상으로 하였으며, 평균 연령은 58.2세, 평균 추시 기간은 18개월(12개월~24개월)이었으며, 우측이 18례이며, 모두 극상건에 칼슘 침착이 있었다. 석회화 부위에 5-12MHz 고해상도 초음파 영상을 이용하여 18게이지 바늘로 다발성 천공을 한 후 건 주변에 2% lidocaine 1cc와 depomedrol 40mg/ml 1cc를 혼합한 국소주사를 시행하였다. 치료효과의 평가 항목으로 UCLA견관절 평가 양식, 운동 범위, VAS 점수를 이용하였다. 통계학적 검정은 SAS를 이용하여 ANOVA와 Tukey's post-hoc test로 유의 수준 5%에서 유의성을 조사하였다. 결과: 주사 직 후 10분이내에 전예에서 압통점이 소실되었으며, UCLA견관절 평가 양식에서 시술 전에는 15례에서 보통(fair), 5례에서 불량(poor)의 양상을 보였으나, 시술 후 16례에서 우수(excellent), 4례에서 양호(good)의 결과를 보였으며 보통(fair)이나 불량은(poor)은 관찰되지 않았다. 시술 후 전례가 양호 이상의 결과를 보였고, 운동 기능의 제한은 없었으며, VAS 점수는 시술 전 평균 8.9(8~10)이었으나 시술 후 평균 0.5(1~2)로 유의하게 향상되었다(p<0.0001). 합병증은 1례도 없었다. 결론: 초음파를 이용한 다발성 천공술 후 스테로이드 국소주사 요법은 극상근 석회화 건염의 급성 통증기에 이용할 수 있는 유용한 치료 방법 중의 하나이다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제7권1호
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• pp.1-7
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• 2004

목 적: Alvarado score는 성인에서 급성 충수돌기염 환자의 조기 진단에 용이하고 오진율을 줄이는 유용한 진단법으로 알려져 있다. 저자들은 급성 복통이 주소인 소아 환아에서 급성충수돌기염 진단에 alvarado score의 유용성에 대하여 알아보고 진단의 정확성에 대하여 평가하고자 연구를 하였다. 방 법: 2002년 6월부터 2003년 5월까지 조선대학교 부속 병원 응급실을 방문한 복통을 호소하는 소아 170명 중 충수돌기염의 강하게 의심되는 122명을 대상으로 전향적으로 조사하였다. 복통을 주소로 방문한 환아의 나이, 임상증상, 임상징후, 혈액학적 검사결과를 분석하여 Alvarado score를 산출하고 진단을 위해 복부초음파 검사나 전산화 단층 촬영을 시행하고 수술을 시행한 경우 조직학적 진단을 하여 확진하였으며 수술하지 않은 군은 12시간의 추적 관찰로 확진하였다. 방사선학적 진단과 수술 결과 등을 비교하여 확진군과 오진군의 Alvarado score를 비교 분석하였다. 결 과: 응급실에 복통이 주소인 환아 중 충수돌기염이 강하게 의심되었던 환아는 122명이었다. 122명의 환아 중 남아는 67명(54.9%), 여아는 55명(45.1%)이었다. 조직검사를 통해 충수돌기염으로 진단 받은 환자는 수술한 105명 중 92명으로 87.6%에 해당하였고 충수돌기염으로 수술한 환자들의 오진율은 12.4%였다. 평균 Alvarado score는 충수돌기염 군은 $5.40{\pm}1.24$, 충수돌기염이 아닌 군은 $3.73{\pm}1.82$이었다(p<0.05). Alvarado score 6점 이상인 경우 소아 충수돌기염을 진단하는데 민감도가 86.4%, 특이도는 80.0%였다. 소아 충수돌기염을 진단하는데 복부 초음파검사나 전산화단층촬영의 진단의 민감도는 92.5%였다. 결 론: 복부초음파검사나 전산화 단층 촬영 등과 함께 Alvarado score는 소아 충수돌기염의 진단에 유용하게 이용될 수 있을 것으로 생각된다.

• Journal of Acupuncture Research
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• 제33권2호
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• pp.211-220
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• 2016

Objectives : Facial nerve palsy is a rare but well-known complication that occurs after a tooth extraction. The paralysis follows the injection of a local anesthetic, but patients typically recover after a few hours. However, there are a number of reports of delayed paralysis, and the cause of delayed facial palsy remains uncertain. This study is the first case report detailing how Korean medicine can be used to treat facial nerve palsy following tooth extraction. This study reports our experience of a patient's favorable recovery. Methods : A 25-year-old male patient experienced acute facial palsy after four premolar teeth were extracted. He was hospitalized in the Pusan National University Korean Medical Hospital. We provided complex Korean traditional medical treatments such as acupuncture, cupping, use of a hot water steamer, and herbal medicine for 18 days. Results : Using the Yanagihara Grading Score, we found improvements in the patient's voluntary facial movement as his score increased from 22 to 34. Furthermore, his accompanying symptoms, such as dry eye and facial pain, disappeared. However, the patient reported transient pain around acupoints after the acupuncture intervention. Conclusion : Our study suggests that Korean medical treatments might be effectively used to treat facial nerve palsy after tooth extraction, although further research should be conducted due to the limited number of cases in this area.

• 대한한방소아과학회지
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• 제29권4호
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• pp.67-76
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• 2015

Objectives The purpose of this review is to investigate the domestic and foreign studies of pediatric Chuna treatment and propose the directions of future studies and clinical applications. Methods We searched for the study at RISS, KISS, DBPIA, Pubmed, CNKI by keywords, '추나', 'Osteopathic', 'Chiropractic', 'Manipulation', '推拿', '導引', '按摩', After 2010. Results 1. Selected 3 domestic studies were categorized as 1 survey study and 2 case reports. Selected 41 foreign studies from Pubmed were categorized as 15 systemic reviews, 8 survey studies, 12 case reports and 6 control studies. Selected 82 foreign studies from CNKI were categorized as 10 systemic reviews, 22 case reports and 50 control studies. 2. 2 clinical domestic studies researched on idiopathic Scoliosis. The foreign clinical studies from Pubmed are 18 cases, and those studies were categorized into Premature baby care (3), Infant colic (2), ADHD (2), Congenital talipes equinovarus (1), Somatic dysfuntion (1), Nonsynostotic occipital plagiocephaly (1), Conversion disorder (1), Lower back pain (1), Chronic bilateral dorsal foot pain and stiffness (1), plantar fasciitis (1), Migraine headaches (1), Cyclic vomiting syndrome (1), Acute otitis media (1) and Cerebral palsy (1). The other 72 foreign clinical studies were from CNKI, and they studied 39 different diseases. Systematically, they studied about digestive diseases (25), respiratory diseases (20), fever (6), musculoskeletal diseases (5), nervous system diseases (5), dermatology diseases (2) and other disease states. The Chuna treatment was used in variety of studies. 3. 2 clinical domestic studies adopted techniques of Osteopathy Chuna. The foreign clinical studies from Pubmed adopted techniques of Osteopathic manipulation (10) and Chiropractic manipulation (8). The other foreign clinical studies from CNKI adopted techniques of Acupressure (69), Abdominal manipulation (23), Spinal manipulation (21), Thoracic manipulation (11), Traction manipulation (2), Muscular manipulation (2), Squeezing Sha manipulation (1), Spine correction (1), Joint manipulation (1) and Fascia manipulation (1). Conclusions In addition to musculoskeletal disorders, variety of pediatric diseases could be treated with Chuna treatment instead of acupuncture.

• 대한한방내과학회지
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• 제30권2호
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• pp.438-449
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• 2009

Objectives: Deep vein thrombosis (DVT) is a common complication among stroke patients. The implication of DVT progressing into a fatal pulmonary embolism is one of the main reasons treatment cannot be delayed. However, when there is a contradiction for anticoagulants, such intracranial hemorrhage (ICH), it is difficult to determine the course of treatment. Our team reports a case with both acute DVT and ICH who improved with herbal medicine Hyulbuchuko-tang. Methods : A patient with a variety of thrombosis risk factors (atrial fibrillation, DVT, Cb-inf with intracranial hemorrhage due to thrombolytic complications) showed classic symptoms of DVT (pain, edema, discoloration), disorientation and chest discomfort. The patient was administered Hyulbuchuko-tang three times a day for 24 days without any anticoagulants. Conservative therapy including elastic stocking and leg elevation was co-administered. Laboratory tests and extremity vascular Doppler sonography were carried out 3 times during the treatment period. Results : After our treatment period, both popliteal vein DVT and calf vein DVT were not discovered by sonography, and thrombosis derived factors (eg. D-dimer, fibrinogen) decreased. There was no sign of edema or discoloration after treatment, and the patient no longer complained of leg pain, disorientation or chest discomfort. Conclusion : From these results, we suggest that there is a positive effect of Hyulbuchuko-tang on DVT. Hyulbuchuko-tang should be considered as a treatment option when western medical procedures are unavailable.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제23권5호
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• pp.430-438
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• 2020

Purpose: We investigated the clinical features and factors affecting the choice of treatment modality and the course of pediatric gallstone (GS) disease. Methods: We retrospectively analyzed the medical records of 65 patients diagnosed with GS using imaging studies between January 2009 and December 2017 were included. Results: This study included 65 patients (33 boys and 32 girls; mean age, 8.5±5.3 years; range, 0.2-18 years) who primarily presented with abdominal pain (34%), jaundice (18%), and vomiting (8%). Idiopathic GS occurred in 36 patients (55.4%). The risk factors for GS included antibiotic use, obesity, hemolytic disease, and chemotherapy in 8 (12.3%), 7 (10.8%), 6 (9.2%), and 4 patients (6.2%), respectively. We observed multiple stones (including sandy stones) in 31 patients (47.7%), a single stone in 17 (26.2%), and several stones in 17 (26.2%). GS with a diameter of <5 mm occurred in 45 patients (69.2%). Comorbidities included hepatitis, choledocholithiasis, cholecystitis, and acute pancreatitis in 20 (30.8%), 11 (16.9%), 11 (16.9%), and 4 patients (6.2%), respectively. Ursodeoxycholic acid (UDCA) was administered to 54 patients (83.1%), leading to stone dissolution in 22 patients (33.8%) within 6 months. Cholecystectomy was performed in 18 patients (27.7%) (mean age, 11.9±5.1 years). Most patients treated surgically had multiple stones (83%) and stones measuring <5 mm in size (89%), and 66.7% of patients had cholesterol stones. Conclusion: Cholecystectomy is feasible in patients with small-sized or large numbers of GS and those with persistent abdominal pain and/or jaundice. UDCA administration with close follow-up is recommended in patients with uncomplicated GS.

• Nutrition Research and Practice
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• 제5권5호
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• pp.450-454
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• 2011

The beneficial effects of total parenteral nutrition (TPN) in improving the nutritional status of malnourished patients during hospital stays have been well established. However, recent randomized trials and meta-analyses have reported an increased rate of TPN-associated complications and mortality in critically ill patients. The increased risk of complications during TPN therapy has been linked to the development of hyperglycemia, especially during the first few days of TPN therapy. This retrospective study was conducted to determine whether the amount of dextrose from TPN in the 1st week in the intensive care unit (ICU) was related to the development of hyperglycemia and the clinical outcome. We included 88 non-diabetic critically ill patients who stayed in the medical ICU for more than two days. The subjects were 65 ${\pm}$ 16 years old, and the mean APACHE (Acute Physiology and Chronic Health Evaluation) II score upon admission was 20.9${\pm}$7.1. The subjects received 2.3${\pm}$1.4 g/kg/day of dextrose intravenously. We divided the subjects into two groups according to the mean blood glucose (BG) level during the 1st week of ICU stay: <140 mg/dl vs ${\geq}$ 140 mg/dl. Baseline BG and the amount of dextrose delivered via TPN were significantly higher in the hyperglycemia group than those in the normoglycemia group. Mortality was higher in the hyperglycemia group than in the normoglycemia group (42.4% vs 12.8%, P=0.008). The amount of dextrose from TPN was the only significant variable in the multiple linear regression analysis, which included age, APACHE II score, baseline blood glucose concentration and dextrose delivery via TPN as independent variables. We concluded that the amount of dextrose delivered via TPN might be associated with the development of hyperglycemia in critically ill patients without a history of diabetes mellitus. The amount of dextrose in TPN should be decided and adapted carefully to maintain blood glucose within the target range.

• Radiation Oncology Journal
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• 제31권4호
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• pp.216-221
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• 2013

Purpose: The purpose of this retrospective study was to evaluate the efficacy and feasibility of short-course hypofractionated radiotherapy (RT) for the palliation of uterine cervical cancer. Materials and Methods: Seventeen patients with cancer of the uterine cervix, who underwent palliative hypofractionated 3-dimensional conformal radiotherapy between January 2002 and June 2012, were retrospectively analyzed. RT was delivered to symptomatic lesions (both the primary mass and/or metastatic regional lymph nodes). The total dose was 20 to 25 Gy (median, 25 Gy) in 5 Gy daily fractions. Results: The median follow-up duration was 12.2 months (range, 4 to 24 months). The median survival time was 7.8 months (range, 4 to 24 months). Vaginal bleeding was the most common presenting symptom followed by pelvic pain (9 patients). The overall response rates were 93.8% and 66.7% for vaginal bleeding control and pelvic pain, respectively. Nine patients did not have any acute side effects and 7 patients showed minor gastrointestinal toxicity. Only 1 patient had grade 3 diarrhea 1 week after completion of treatment, which was successfully treated conservatively. Late complications occurred in 4 patients; however, none of these were of grade 3 or higher severity. Conclusion: Short-course hypofractionated RT was effective and well tolerated as palliative treatment for uterine cervical cancer.