• Tuberculosis and Respiratory Diseases
• /
• 제55권4호
• /
• pp.408-412
• /
• 2003

본례에서는 자연적으로 발생한 기흉으로 발견된 이상성 폐 모세포종을 수술과 cisplatin에 의한 화학요법을 시행하여 성공적으로 시험하였기에 문헌 고찰과 함께 보고하는 바이다.

• Tuberculosis and Respiratory Diseases
• /
• 제71권1호
• /
• pp.1-7
• /
• 2011

Many findings suggest that chronic obstructive pulmonary disease (COPD) imposes an enormous burden on patients, health-care professionals and society. COPD contributes to morbidity and mortality and to a significant use of health-care resources. In spite of a higher prevalence of COPD in Korea, the result of COPD treatment is not effective. The purpose of this article was to review recent advances in the study of COPD in Korea with the aim of improving effective management. This review highlights articles pertaining to the following topics; prevalence, assessment of COPD, risk factors for hospitalization, co-morbid diseases, phenotypes, and treatment issues.

• Journal of Chest Surgery
• /
• 제53권4호
• /
• pp.211-216
• /
• 2020

Esophageal fistulas may occur in an advanced stage or as a potentially life-threatening complication of treatment. They can be divided into esophageal-respiratory and esophageal-aorta fistulas. The diagnosis is confirmed with fluoroscopy using dilute barium oral contrast, followed by thin-section computed tomography, which defines the precise location and extent of the fistula. Flexible esophagoscopy and bronchoscopy are required for confirmation and anatomic assessment of the suspected fistula and provide additional information for treatment planning. Contamination is traditionally controlled by surgical exclusion, along with a jejunal feeding tube. Currently, fully covered self-expanding metal stents are the primary treatment option.

• Pediatric Infection and Vaccine
• /
• 제14권1호
• /
• pp.47-54
• /
• 2007

목 적 : 소아의 바이러스에 의한 급성 하기도 감염시간기능 이상을 동반하는 경우가 많다. 저자들은 바이러스성 하기도 감염시 간기능 이상이 질병의 중증도에 미치는 영향과 원인 바이러스, 연령별 분포에 대하여 알아보고자 본 연구를 시행하였다. 방 법 : 2003년 1월부터 2005년 6월까지 급성 하기도 감염으로 한림대학교 강남성심병원 소아과에 입원한 환아들의 비인두 분비물을 Hep-2세포를 이용하여 배양하였으며 의무기록지를 후향적으로 검토하였다. 비말 흡인 검사를 통한 바이러스 배양검사에서 양성결과가 나온 환아를 환자군(AST 혹은 ALT >45)과 대조군(AST 혹은 ALT ${\leq}45$)으로 나누어 연령, 성별, 진단명, 발열 기간, RR(Respiratory Rate)점수, RDAI(Respiratory Distress Assessment Instrument)점수, 산소흡입 여부, 입원 기간 등과 원인바이러스를 비교 분석하였다. 결 과 : 바이러스가 검출된 181례 중에서 기저 질환이 동반되거나 간독성 약제를 복용한 16례는 제외되었고, 환자군이 28례(17.0%), 대조군이 137례(83.0%)였다. 환자군과 대조군에서 연령, 성별 간에 유의한 차이는 없었으며 발열 기간, RR score, RDAI score, 산소흡입 여부, 입원 기간 등의 임상양상에서 유의한 차이점은 없는 것으로 나타났다(P>0.05). 바이러스 배양 결과 환자군에서는 RSV 17례(60.7%), parainfluenza virus 4례(14.3%), influenza B virus 4례(14.3%), adenovirus 3례(10.7%), influenza A virus 1례(3.6%)였고 대조군에서는 RSV 78례(56.9%) parainfluenza virus 28례(20.4%), influenza A virus 13례(9.5%), influenza B virus 9례(6.6%), adenovirus 6례(4.4%), coxsackie virus 3례(2.2%)로 양 군 간에 의미있는 차이는 없었으며 연령별 분포에서도 양 군 간에 큰 차이는 없었다. 결 론 : 본 연구에서 호흡기 바이러스 감염으로 진단된 환아 165례 중 환자군이 28례(17.0%)였고 대조군과의 비교 분석 결과 간기능 이상이 병의 중증도와 임상양상에 큰 영향을 미치지 않으며 원인 바이러스와 연령별분포 경향에서도 큰 차이는 없는 것으로 나타났다.

• Journal of Trauma and Injury
• /
• 제25권2호
• /
• pp.49-56
• /
• 2012

Purpose: For determining the prognosis of critically injured patients, transporting patients to medical facilities capable of providing proper assessment and management, running rapid assessment and making rapid decisions, and providing aggressive resuscitation is vital. Considering the high mortality and morbidity rates in critically injured patients, various studies have been conducted in efforts to reduce those rates. However, studies related to diagnostic factors for predicting severity in critically injured patients are still lacking. Furthermore, patients showing stable vital signs and alert mental status, who are injured via a severe trauma mechanism, may be at a risk of not receiving rapid assessment and management. Thus, this study investigates diagnostic factors, including physical examination and laboratory results, that may help predict severity in trauma patients injured via a severe trauma mechanism, but showing stable vital signs. Methods: From March 2010 to December 2011, all trauma patients who fit into a diagnostic category that activated a major trauma team in CHA Bundang Medical Center were analyzed retrospectively. The retrospective analysis was based on prospective medical records completed at the time of arrival in the emergency department and on sequential laboratory test results. PASW statistics 18(SPSS Inc., Chicago, IL, USA) was used for the statistical analysis. Patients with relatively stable vital signs and alert mental status were selected based on a revised trauma score of more than 7 points. The final diagnosis of major trauma was made based on an injury severity score of greater than 16 points. Diagnostic variables include systolic blood pressure and respiratory rate, glasgow coma scale, initial result from focused abdominal sonography for trauma, and laboratory results from blood tests and urine analyses. To confirm the true significance of the measured values, we applied the Kolmogorov-Smirnov one sample test and the Shapiro-Wilk test. When significance was confirmed, the Student's t-test was used for comparison; when significance was not confirmed, the Mann-Whitney u-test was used. The results of focused abdominal sonography for trauma (FAST) and factors of urine analysis were analyzed using the Chi-square test or Fisher's exact test. Variables with statistical significance were selected as prognostics factors, and they were analyzed using a multivariate logistics regression model. Results: A total of 269 patients activated the major trauma team. Excluding 91 patients who scored a revised trauma score of less than 7 points, 178 patients were subdivided by injury severity score to determine the final major trauma patients. Twenty-one(21) patients from 106 major trauma patients and 9 patients from 72 minor trauma patients were also excluded due to missing medical records or untested blood and urine analysis. The investigated variables with p-values less than 0.05 include the glasgow coma scale, respiratory rate, white blood cell count (WBC), serum AST and ALT, serum creatinine, blood in spot urine, and protein in spot urine. These variables could, thus, be prognostic factors in major trauma patients. A multivariate logistics regression analysis on those 8 variables showed the respiratory rate (p=0.034), WBC (p=0.005) and blood in spot urine (p=0.041) to be independent prognostic factors for predicting the clinical course of major trauma patients. Conclusion: In trauma patients injured via a severe trauma mechanism, but showing stable vital signs and alert mental status, the respiratory rate, WBC count and blood in the urine can be used as predictable factors for severity. Using those laboratory results, rapid assessment of major trauma patients may shorten the time to diagnosis and the time for management.

• 기본간호학회지
• /
• 제18권3호
• /
• pp.373-382
• /
• 2011

Purpose: The purpose of this study was to assess the educational needs of ICU nurses based on an analysis of importance, frequency, and difficulty for ICU nursing practice. Method: A cross-sectional survey was conducted using a questionnaire with 80 questions in 14 ICU nursing categories. Data were collected from August to October 2009. A total of 295 ICU nurses from five hospitals who had minimum of one year clinical experience participated. Data were analyzed with using descriptive statistics. Results: For importance, emergency care had the highest score, followed by physical assessment, communication, cardiovascular care, and ICU basic nursing. Regarding the frequency, physical assessment had the highest score, followed by communication, medication, ICU basic nursing, and respiratory care. Cardiovascular care was the most difficult task, followed by neurological care, emergency care, other ICU related nursing care, diagnostic test, and communication. Conclusion: The findings indicate a high educational need in the areas of communication, medication, physical assessment, diagnostic test, emergency care, and cardiovascular care. Thus the development of educational programs on communication, medication, physical assessment, diagnostic test, emergency care, and cardiovascular care are needed for ICU nurses.

• Safety and Health at Work
• /
• 제10권2호
• /
• pp.237-244
• /
• 2019

Background: Street vendors spend relatively more time near roadways and are vulnerable to air pollution related health disorders. However, there is limited information on the quality of the air they breathe. The objectives of this present study were to calculate the mass concentration of atmospheric particulate matter (PM) in eight size fractions ($PM_{0.4-0.7}$, $PM_{0.7-1.1}$, $PM_{1.1-2.1}$, $PM_{2.1-3.3}$, $PM_{3.3-4.7}$, $PM_{4.7-5.8}$, $PM_{5.8-9.0}$, and $PM_{9.0--0{\mu}m}$) at commercial (CML) and residential site (RSL) in Dehradun city from November 2015 to May 2016. To estimate the corresponding respiratory deposition dose (RDDs) in alveolar (AL), tracheobronchial (TB), and head airway (HD) region on street vendors working at CML and RSL. To find the association of atmospheric PM with RDDs and the incidence of respiratory related disorders among street vendors. Methods: Andersen cascade impactor was employed for calculating the PM mass concentration. Questionnaire based health survey among street vendors were carried out through personal interview. Results: A significant difference (p < 0.05; t-test) between the mean $PM_{0.4-10{\mu}m}$ mass concentration at CML and RSL was observed with ($mean{\pm}SD$) $84.05{\pm}14.5$ and $77.23{\pm}11.7{\mu}g\;m^{-3}$, respectively. RDDs in AL, TB and HD region at CML was observed to be 9.9, 7.8, and 7.3% higher than at RSL, respectively. Health survey revealed 1.62, 0.96, 0.04, and 0.57 times higher incidence of cold, cough, breathlessness, and chest pain, respectively with street vendors at CML compared to RSL. Conclusion: The site characteristics plays a major role in the respiratory health status of street vendors at Dehradun.

• 보건행정학회지
• /
• 제25권4호
• /
• pp.323-332
• /
• 2015

Background: Antibiotic resistance has been becoming serious challenge to human beings. Overuse of antibiotics, especially, for infants is concerned, but studies are very few for the prescribing pattern of antibiotic use for infants. This study analyzes prescribing patterns of antibiotics in outpatients of preschool children with acute respiratory tract infections in South Korea. Methods: Data are used from 2011 Health Insurance Review & Assessment Services-pediatric patients sample. Inclusion criteria is outpatient children (0 to 5 years) with top five frequent diseases. Prescription rates are analyzed by types of disease, provider, specialty, region, and ages. Binary or multinomial logit models are used to analyze determinants of providers' prescription pattern. Results: The main findings are as follows. First, distributions of prescription rates are shown as L-shape or M-shape depending on the types of disease. Second, the prescription variation is so large among providers, where providers are polarized as a group with low prescription rates and the other group with high prescription rates, though the shapes are shown diversified across types of disease. Third, prescription rates appear to be lower in pediatrics and higher in ENT (ear-nose-throat). Fourth, broad spectrum antibiotics are widely used among children. Finally, the logit analysis shows similar results with descriptive statistics, but partly different results across types of disease. Conclusion: Antibiotics for respiratory tract infections of infants are used excessively with a large variation among providers, and especially broad spectrum antibiotics are used. The prescription guideline for antibiotics should be provided for each specific disease to reduce antibiotic resistance in the future.

• 약학회지
• /
• 제56권2호
• /
• pp.126-135
• /
• 2012

Purpose: To develop therapeutic duplication criteria for the drugs used for respiratory diseases. Method: Therapeutic duplication was defined as "more than 2 drug ingredient-usage in which each has the same therapeutic effect and combination therapy does not confer additional therapeutic benefit". Respiratory system drugs approved in Korea were examined for the study. The WHO's Anatomical Therapeutic Chemical Classification System was used for grouping of the corresponding drug ingredients. The principles and recommendations on combination usage or multiple drug regimens were reviewed by using the clinical practice guidelines, textbooks, product labelings, and clinical articles. Clinical expert group consultation was performed and expert opinions were incorporated into the final criteria. Results: Nine hundred sixty two drug products with Korean Food and Drug Administration classification codes of 141, 149, 222, and 229 were evaluated, of which 87 active ingredients were composed. The drug ingredients were classified into 12 groups (antihistamines, oral nasal decongestants, leukotriene receptor antagonists, inhaled anticholinergics, inhaled corticosteroids, oral ${\beta}2$-agonists, long-acting ${\beta}2$-agonists, short-acting ${\beta}2$-agonists, xanthines, antiallergics, mucolytics and cough suppressants). The use of more than 2 drug ingredients including the same group was therapeutic duplication, and thus combination should be recommended not to be used. Conclusion: Twelve drug groups were identified as therapeutic duplication criteria. Combination therapy within each group should not be used otherwise therapeutic benefits outweigh potential risks.

• Tuberculosis and Respiratory Diseases
• /
• 제79권3호
• /
• pp.158-164
• /
• 2016

Background: One to three percent of cases of acute tuberculosis (TB) require monitoring in the intensive care unit (ICU). The purpose of this study is to establish and determine the mortality rate and discuss the causes of high mortality in these cases, and to evaluate the clinical and laboratory findings of TB patients admitted to the pulmonary ICU. Methods: The data of patients admitted to the ICU of Yedikule Chest Diseases and Chest Surgery Education and Research Hospital due to active TB were retrospectively evaluated. Demographic characteristics, medical history, and clinical and laboratory findings were evaluated. Results: Thirty-five TB patients (27 males) with a median age of 47 years were included, of whom 20 died within 30 days (57%). The Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores were significantly higher, and albumin and $PaO_2/FIO_2$ levels were significantly lower, and shock, multiple organ failure, the need for invasive mechanical ventilation and drug resistance were more common in the patients who died. The mortality risk was 7.58 times higher in the patients requiring invasive mechanical ventilation. The SOFA score alone was a significant risk factor affecting survival. Conclusion: The survival rate is low in cases of tuberculosis treated in an ICU. The predictors of mortality include the requirement of invasive mechanical ventilation and multiple organ failure. Another factor specific to TB patients is the presence of drug resistance, which should be taken seriously in countries where there is a high incidence of the disease. Finding new variables that can be established with new prospective studies may help to decrease the high mortality rate.