• The Journal of Korean Physical Therapy
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• v.15 no.3
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• pp.277-294
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• 2003

The present study attempted to investigate the angle of cervical vertebrae motions of thirty subjects who are seated in front of computers for a long time. The subjects were divided into Group A, B and C, which were for ultrasound treatment and relaxing exercise, for ultrasound treatment and massage, and relaxing exercise and massage respectively. This study made comparisons between groups of different ages and genders before treatment, between groups of different genders by segment before treatment, and between before and after treatment for each group. It also made multiple comparison based on the variance analysis among groups and comparison between Group A and B. From the results of this study, following conclusions were drawn. 1. When comparing the total means of different age groups, female subjects' angle of motions was wider than male subjects' in all age groups except the group at the age of 30-34. 2. When comparing the total means of different segments of cervical vertebrae, female subjects' angle of motions was wider than male subjects' in segment C3-4, C4-5 and C5-6. 3. Group A showed a significant difference from Group B and C in segment C4-5, and only Group C showed a significant difference in the other segments(p<0.05). 4. When comparing the total angle of cervical vertebrae motions between Group A and Group B, there was a slight but not significant difference in the angle(p<0.05).

• Journal of Korean Neurosurgical Society
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• v.42 no.6
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• pp.446-449
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• 2007

Objective : Persistent trigeminal artery variant (PTAV) is an anastomosis between the internal carotid artery (ICA) and the cerebellar artery without any interposing basilar artery segment. We discuss its probable embryological origin and emphasize clinical implications. Methods : Retrospectively 1250 conventional cerebral angiograms and 2947 cranial magnetic resonance angiographies (MRAs) were evaluated for the patients with PTAV. Results : Five patients (four men and one woman, 23 to 76 years of age, median age 65 years) had a PTAV. Three patients who underwent MRA had a PTAV (3/2947=0.1%). Four of the patients who underwent cerebral angiography had a PTAV (4/1250=0.32%). Two of 143 patients who underwent both conventional angiography and cranial MRA showed PTAV. The PTAV was an incidental finding in all five patients. The PTAV originated from the cavernous segment of the left ICA in four patients and from the cavernous segment of the right ICA in one patient. The terminal branch of the PTAV was the anterior inferior cerebellar artery (AICA) and superior cerebellar artery (SCA) in two patients and the AICA only in the other three patients. Conclusion : Neurosurgeons should be aware of possible presence of PTAV. Manipulation of this vessel during a surgical approach to the parasellar region and percutaneous gasserian ganglion procedure may result in hemorrhage or ischemia.

• Korean Journal of Head & Neck Oncology
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• v.21 no.2
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• pp.190-195
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• 2005

Background and Objectives: Fibula is the flap of choice for reconstruction of wide mandible defects after tumor ablation surgery. In mandible reconstruction, restoring the mandible frame to provide mandibular contour and dental arch while restoring masticatory function are important. Even though vascularized fibula can be osteotomized freely, proper design and flap insetting is not easy because of its three dimensional structure and difference in design according to the defect sites. We reviewed patients who underwent mandible reconstruction with fibular flaps according to the defect sites and suggest proper modification methods of fibular flap according to the various defects sites after tumor ablation surgery. Materials and Methods: Twelve consecutive mandible reconstruction with fibular free flaps were performed for defects after tumor ablation surgery. Patients were classified into 4 groups according to the type of mandibular defect(Group 1 : defect on central segment including symphysis, Group 2 : defect on lateral segment(with or without central segment) confined to body, Group 3 : defect on body and ascending ramus that does not include the condyle, Group 4 : defect including the condyle). Results: We suggest different modification methods of fibular free flap for each patient group. Group 1, 3 ; contour by using multiple closing wedge osteotomy. Group 2 ; single or double barrel reconstruction without wedge osteotomy. Group 4 ; contour using single or multiple wedge osteotomy and condylar reconstruction with costochondral graft. Conclusion: Fibular free flaps can be contoured to any desired shape after multiple osteotomies to restore various mandibular defects. It is a reliable and versatile method for reconstruction of mandibular defects after tumor ablation surgery.

• Journal of Yeungnam Medical Science
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• v.40 no.2
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• pp.202-206
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• 2023

Cesarean scar pregnancy (CSP) is a rare complication that occurs in less than 1% of ectopic pregnancies, and uterine didelphys is one of the rarest uterine forms. We report a successful laparoscopic excision and repair of CSP in a woman with uterine didelphys and a double vagina. A 34-year-old gravida one, para one woman with a history of low transverse cesarean section presented to our hospital with a suspected CSP. She was confirmed to have uterine didelphys with a double vagina during an infertility examination 7 years earlier. Magnetic resonance imaging showed a 2.5-cm gestational sac-like cystic lesion in the lower segment of the right uterus at the cesarean scar. We decided to perform a laparoscopic approach after informing the patient of the surgical procedure. The lower segment of the previous cesarean site was excised with monopolar diathermy to minimize bleeding. We identified the gestational sac in the lower segment of the right uterus, which was evacuated using spoon forceps. The myometrium and serosa of the uterus were sutured layer-by-layer using synthetic absorbable sutures. No remnant gestational tissue was visible on follow-up ultrasonography one month after the surgery. This laparoscopic approach to CSP in a woman with uterine didelphys is an effective and safe method of treatment. In women with uterine anomalies, it is important to confirm the exact location of the gestational sac by preoperative imaging for successful surgery.

• Journal of Medicine and Life Science
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• v.21 no.2
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• pp.31-39
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• 2024

This study was conducted to determine whether level-1 emergency medical technicians (EMTs) can adequately recognize ST-segment elevation myocardial infarction (STEMI) in the emergency department (ED) and whether their ability to do so differs from that of emergency medicine physicians (EMP). From December 2022 to November 2023, patients aged 20 years or older visiting the ED with chief complaints suggesting acute coronary syndrome (ACS) were enrolled. As soon as the patient arrived at the ED, a level-1 EMT conducted a 12-lead electrocardiogram (ECG) to assess STEMI; an EMP subsequently assessed whether to activate the percutaneous coronary intervention team. Demographic characteristics, test results, and final diagnoses were collected from the medical records. Among the 723 patients with case report forms, 720 were included in the analysis. These were categorized as follows: 117 (16.3%) with STEMI, 159 (22.1%) with non-ST-segment elevation ACS, and 444 (61.7%) with other conditions. STEMI was correctly recognized in 100 patients (91.7%) by level-1 EMTs and in 104 patients (95.4%) by EMPs (kappa=0.646). EMTs with less than 1 year of ED work experience correctly recognized 60 out of 67 STEMI patients (89.6%), which was comparable with the EMPs who recognized 65 out of 67 STEMI patients (97.0%, kappa=0.614). EMTs with more than 1 year of ED work correctly recognized 40 out of 42 STEMI patients (95.2%), and therefore performed better than EMPs, who recognized 39 out of 42 STEMI patients (92.9%, kappa=0.727). The level-1 EMTs adequately recognized STEMI using a 12-lead ECG and were in substantial agreement with the evaluations of the EMPs.

• The Journal of the Korea Contents Association
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• v.19 no.10
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• pp.198-205
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• 2019

The purpose of this study was to identify whether cutaneous sensory (CS) changes induced by mechanical intervention(MI) increases the trigger point threshold and muscle tone of the same spinal segment to neck disc patients. Thirty persons with Neck disc patients were recruited in this experiment. The subjects consisted of 10 men and 20 women. The mechanical stimulus group induced CS changes for 5 minutes using the Graston instrument and the control group received no action. The CS changes were estimated by using the Von Frey Filament, PPT changes were measured by using the pressure threshold meter and msucle tone changes were measured by using Myotone pro. CS threshold increased significantly when MI was applied (p<0.05). On the same spinal segment, increases in the right infraspinatus PPT and muscle tone was observed (p<0.05) and decreases in the right trapezius PPT was observed(p<0.05). However, the PPT and muscle tone changes in other muscles were not significantly different. Furthermore, the control group CS, PPT and muscle tone were not significantly different. As a result, CS changes induced by MI make to change PPT and muscle tone on the same spinal segment. Therefore, application of MI to the same spinal segment may be of clinical significance as a new rehabilitation method for increasing pain threshold, muscle tone and pain control in neck disc patients.

• Journal of Korean Neurosurgical Society
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• v.59 no.6
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• pp.564-569
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• 2016

Objective : This study used the intradural procedural time to assess the overall technical difficulty involved in surgically clipping an unruptured middle cerebral artery (MCA) aneurysm via a pterional or superciliary approach. The clinical and radiological variables affecting the intradural procedural time were investigated, and the intradural procedural time compared between a superciliary keyhole approach and a pterional approach. Methods : During a 5.5-year period, patients with a single MCA aneurysm were enrolled in this retrospective study. The selection criteria for a superciliary keyhole approach included : 1) maximum diameter of the unruptured MCA aneurysm <15 mm, 2) neck diameter of the MCA aneurysm <10 mm, and 3) aneurysm location involving the sphenoidal or horizontal segment of MCA (M1) segment and MCA bifurcation, excluding aneurysms distal to the MCA genu. Meanwhile, the control comparison group included patients with the same selection criteria as for a superciliary approach, yet who preferred a pterional approach to avoid a postoperative facial wound or due to preoperative skin trouble in the supraorbital area. To determine the variables affecting the intradural procedural time, a multiple regression analysis was performed using such data as the patient age and gender, maximum aneurysm diameter, aneurysm neck diameter, and length of the pre-aneurysm M1 segment. In addition, the intradural procedural times were compared between the superciliary and pterional patient groups, along with the other variables. Results : A total of 160 patients underwent a superciliary (n=124) or pterional (n=36) approach for an unruptured MCA aneurysm. In the multiple regression analysis, an increase in the diameter of the aneurysm neck (p<0.001) was identified as a statistically significant factor increasing the intradural procedural time. A Pearson correlation analysis also showed a positive correlation (r=0.340) between the neck diameter and the intradural procedural time. When comparing the superciliary and pterional groups, no statistically significant between-group difference was found in terms of the intradural procedural time reflecting the technical difficulty (mean${\pm}$standard deviation : $29.8{\pm}13.0min$ versus $27.7{\pm}9.6min$). Conclusion : A superciliary keyhole approach can be a useful alternative to a pterional approach for an unruptured MCA aneurysm with a maximum diameter <15 mm and neck diameter <10 mm, representing no more of a technical challenge. For both surgical approaches, the technical difficulty increases along with the neck diameter of the MCA aneurysm.

• The Korean Journal of Pain
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• v.7 no.2
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• pp.287-291
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• 1994

A 49 years old male patient was admitted to our neuro-pain clinic with symptoms of left 11th intercostal neuralgic pain and low back pain that developed 2 months prior to admission. Upon initial physical examination, motor weakness or sensory deficit were absent. Intercostal neuralgic pain improved significantly after we performed thoracic root thermocoagulation. However on the afternoon of the procedure the patient started to experience voiding difficulty, saddle anesthesia and rapidly progressing motor weakness and hypoesthesia that involved the lower back area and the lower extremities for three days. Based on these symptoms spinal cord compression was suspected and subsequently plain T-L spine X-rays and T-L spine MRI were performed. A spinal tumor that appeared metastatic in origin was seen at the T11 and T12 level. Liver ultrasonography demonstrated the presence of a $4{\times}4cm$ sized ill defined mass in the posterior segment of the right lobe. The patient was diagnosed to have hepatocellular carcinoma after needle aspiration biopsy and cytologic studies. Further orthopedic surgery was recommended but as the patient rejected any further treatment and examination, it was not possible to confirm the primary focus of the tumor. However as metastasis of a primary liver tumor to the spine is a rare occurrence, some other primary focus of metastasis or even a malignant primary tumor of the spine is more likely to explain this patient's condition.

• Journal of Korean Academy of Nursing
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• v.16 no.3
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• pp.108-122
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• 1986

Changing concepts of health care, are stimulating the demand for health care, thereby orienting society to health care rights to such an extent that they are deemed as fundamental ones inalienable to man. Concomitantly, qualitative as well as quantative improvement is being sought in the nursing service field. Today, efforts are being made in various areas, especially to qualitatively improve nursing services. A second issue concerns proper staffing. It is important to study staffing, in as much as it continues to be the most persistent and critical problem facing hospital nursing administrators today. It involves quantity, quality, and utilization of nursing personnel. A great deal of attention has been focused on this problem since mid 1930's when nursing services began to be felt as an important segment of hospital operation representing the largest single item of hospital budgets. Traditionally, the determination and allocation of nursing personnel resources has relied heavily on gloval approaches which make use of fixed staff-to-patient ratios. It has long been recognized that these ratios are insensitive to variations between institutions and among individual patients. Therefore, the aim of this thesis is to point to the urgent need for the development of methodology and criteria suited to the reality of Korea. The present research selected one place, the W Christian Hospital, and was conducted over a period 10 days from January, and nurses who were them on duty in their unit. The total num-her of patients surveyed was 1,426 and that of 354. The research represents many variables affecting the direct patient care time using the result from the direct observation method, then using a calculation method to estimate the relationship between the patients care time and selected variables in the hospital setting. The amount of direct patient care time varies with many factors, such 89 the patients age. diagnosis and time in hospital. Differences are also found from hospital, clinic to clinic, ward to ward, and even shift to shift. In this research, the calculation method of estimating the required member of nursing staff is obtained by dividing the time of productive patient care activity(with the time of patient care observed), by the sum of the productive time that each the staff can supply, i.e., 360 minutes, which is obtained by deducting the time for personal activities. The results indicate a substantial difference between the time of productive patient care observed directing and the time of the productive patient care estimated using calculating method. If we know accurately the time of the direct patient care on a shift, there required number of staff members calculated if the proper method can be determinded should be able the time of the direct patient care be estimated by the patient classification system, but this research has shown this system to be in accurate in Korea. There are differences in the recommended time of productive patient care and the required number of nursing staff depending upon which method is used. The calculated result is not very accurate, so more research is needed on the patient classification system.

• Archives of Reconstructive Microsurgery
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• v.21 no.1
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• pp.14-20
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• 2012

Purpose: Defect after ablation of hypopharyngeal cancer often requires reconstruction by free tissue transfer. Since neo-hypopharynx is totally buried, various methods have been suggested for monitoring. We propose a modified design of anterolateral thigh (ALT) free flap for reconstruction of pharyngolaryngectomy defect, which has an exteriorized part for clinical monitoring and allows for primary closure. Materials and Methods: Three consecutive patients with hypopharyngeal cancer were reconstructed with ALT flap with modified design: 1) distal part of flap was elongated into fusiform shape and used as exteriorized monitoring segment with a deepithelized bridge and 2) proximal part was designed as curve so the maximum width of the flap was reduced to less than 10 cm. Results: Patient 1, 2 had uneventful postoperative course with healthy skin color and fresh pin prick bleeding. In patient 3, defect after cancer ablation was shorter than usual and deepithelized bridge was longer. When the general hemodynamic status of the patient was aggravated in postoperative course, the color of monitoring skin was changed. Viability of the whole flap was confirmed by endoscopy. However, leakage developed after 3 weeks and repair was necessary. In all patients the donor sites were closed primarily. Conclusion: By the modified design of ALT flap, clinical monitoring can be possible by examining exteriorized monitoring flap and also donor site can be closed primarily. However possibility of false positive exists and technical caution and patient selection is needed because of danger of leakage.