• Journal of Korean Neurosurgical Society
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• 제64권2호
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• pp.217-228
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• 2021

Objective : Given the high risk of rebleeding and recurrence of blood blister-like aneurysms (BBAs), we treated ruptured BBAs of the internal carotid artery (ICA) with stent-assisted coil embolization (SAC). This study aimed to evaluate the efficacy and safety of SACs. Methods : We retrospectively reviewed clinical and radiological data from eight patients with ruptured BBAs of the supraclinoid ICA. The modified Rankin Scale (mRS) was used to assess clinical outcomes, while radiological outcomes were evaluated on angiographs. For a pooled analysis, data from literature reporting the outcomes of ruptured BBAs treated with SAC were collected and analyzed in conjunction with our data. Results : In our cohort, the mean Raymond classification score was 1.57±0.53 immediately after initial endovascular treatment. There were no perioperative complications or rebleeding events during the follow-up period. The mean mRS score at patient discharge was 1.00±0.81 and improved to 0.28±0.48 by the last follow-up day. The recurrence rate was 25% with an asymptomatic presentation and successful treatment with multiple stent insertion. Pooled analysis of 76 cases of SAC revealed a complete occlusion rate immediately after treatment of 54.8%, rebleeding rate 7.94%, and recurrence rate 24.2%. Good clinical outcomes with mRS score 0-2 were observed in 89.9% by the last clinical follow-up. Total mortality rate was 7.7%. Conclusion : This treatment appears to not only minimize the hemodynamic burden on the fragile dome specific to this type of aneurysm, but also provides an opportunity for safe and effective treatment in recurrent cases.

• 한국콘텐츠학회논문지
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• 제20권12호
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• pp.112-122
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• 2020

본 연구는 재난주관방송사인 KBS의 코로나19 관련 보도의 '유형 및 형식', '전문성', '감염병 관련 사안'이 어떻게 나타나는지 '발각', '확산', '회복'이라는 세 시기를 중심으로 살펴보았다. 총 473개의 언론보도를 분석한 결과, 세 시기 모두 감염병 사실을 있는 그대로 알리는 '스트레이트 보도'와 '정보전달 프레임'이 높게 나타났으며 위험 상황을 전달함에 있어서도 '감정적 전달'보다는 '사실전달' 프레임의 비중이 높았다. 하지만 2기에서 감염병 원인을 특정 개인이나 집단에 귀인시키는 '도덕적 평가 프레임'의 비중이 상대적으로 높게 나타났으며, 여전히 전문기자보다 비전문 기자의 비율이 압도적으로 높은 것으로 드러났다. 한편 감염병 관련 사안은 '감염 관리'에 대한 내용이 가장 많았고, '대처'에 관한 정보는 상대적으로 적었다. 본 연구는 위 결과를 바탕으로 향후 감염병 보도를 함에 있어 '보도의 심층성 및 전문성 고양', '특정 주체에게 도덕적 책임을 귀인시키는 보도 행태의 지양', 그리고 '다양한 감염병 관련 정보의 종합적 제시'라는 함의를 제언하였다.

• 셀메드
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• 제11권4호
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• pp.17.1-17.4
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• 2021

Episiotomy is the commonest obstetrics intervention in the world to reduce severe perineal injuries. Its prevalence is 43% to 100% in primiparous women in Asia. Further, worldwide approximately 10-95% of pregnant women undergo episiotomy incision during birth. Delay in wound healing probably increases the risk of wound infection, changes the muscular structure, and ultimately causes muscle tone loss. So, wound care is of specific significance to postnatal maternal outcomes. Hence, this case study aimed to evaluate the effect of Marham-i-Raal in episiotomy wound healing and pain relief. The study was conducted in eleven postpartum primi or multipara pregnant women aged between group 19 and 35 years with term gestational age, singleton pregnancy in a cephalic presentation who had a normal vaginal delivery with mediolateral episiotomy, without a perineal tear, and perineal hematoma. Externally, application of Marham-i-Raal 2g on episiotomy incisional wound, twice a day for 10 days was advised. Wound healing of episiotomy and pain intensity was assessed with REEDA ["redness, oedema, ecchymosis, discharge and approximation of the edges"] scoring and VAS scoring for pain intensity respectively. At one hour (baseline), the REEDA mean score of eleven patients was 3.90±1.04 whereas on day 7-10 it was 0.18±0.40 with statistically significant difference (p<0.001). The VAS mean score at one hour was 6.90±1.22 whereas on day 7-10 it was 0.72±0.78 with a statistically significant difference (p<0.001). Marham-i-Raal would be effective in episiotomy wound healing and reducing pain intensity. Further, randomized double-blind controlled trials in large sample size are recommended.

• Archives of Plastic Surgery
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• 제50권3호
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• pp.315-324
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• 2023

Hemoglobinopathies such as sickle cell disease (SCD) are traditionally considered a relative contraindication to free tissue transfer, due to concerns that erythrocyte sickling will increase the risk of microvascular thrombosis and flap failure. This article describes a case report with the successful use of free tissue transfer in a patient with SCD and provides a systematic literature review on free tissue transfer in SCD. A retrospective chart review was performed of a patient with SCD who underwent free tissue transfer at the authors' institution. A systematic literature review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed using the keywords "free tissue transfer," "free flap," or "microsurgery" and "sickle cell" on PubMed, Ovid/Medline, and Scopus. A 29-year-old male with delayed presentation of an electrical burn to the face and scalp underwent wound closure with a free anterolateral thigh flap. Key management principles included red blood cell transfusion to keep hemoglobin S under 30% and hemoglobin greater than 10 g/dL, maintenance of hydration, normothermia, adequate analgesia, and postoperative anticoagulation. Systematic literature review identified 7 articles describing 13 cases of free tissue transfer in 10 patients with SCD, with combined complete free flap success in 10 of the 13 flaps. Free tissue transfer can be successfully performed in patients with SCD. However, evidence on the optimal management of this unique patient population in the perioperative period after free tissue transfer is limited to case reports in the literature.

• Annals of Occupational and Environmental Medicine
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• 제35권
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• pp.13.1-13.12
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• 2023

Background: Indoor air pollution can cause and exacerbate asthma. We report a previously undescribed case of occupational asthma related to indoor air pollution in a worker at an indoor air gun shooting range and highlight the potential risk of developing occupational asthma in this environment. Case presentation: A 31-year-old man presented with dyspnea, cough, and sputum and was diagnosed with asthma complicated by pneumonia. Objective evidence of asthma was obtained by performing a methacholine bronchial provocation test. It was suspected that the patient had occupational asthma, which began one month after changing jobs to work within the indoor air gun shooting range. The highest peak expiratory flow (PEF) diurnal variability on working days was 15%, but the highest variation was 24%, with 4 days out of 4 weeks having a variation of over 20% related to workplace exposure. Conversely, the diurnal variability on the rest days was 7%, and no day showed a variation exceeding 20%. The difference in the average PEF between working and rest days was 52 L/min. PEF deterioration during working days and improvement on rest days were noted. Conclusions: The results obtained from the in-depth analysis of the PEF were adequate to diagnose the patient with occupational asthma. Exposure to indoor air pollution and lead and the patient's atopy and allergic rhinitis may have contributed to the development of occupational asthma.

• Korean Journal of Radiology
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• 제20권5호
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• pp.729-738
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• 2019

Objective: To assess the effects of iterative model reconstruction (IMR) on image quality for demonstrating non-calcific high-risk plaque characteristics of coronary arteries. Materials and Methods: This study included 66 patients (53 men and 13 women; aged 39-76 years; mean age, 55 ± 13 years) having single-vessel disease with predominantly non-calcified plaques evaluated using prospective electrocardiogram-gated 256-slice CT angiography. Paired image sets were created using two types of reconstruction: hybrid iterative reconstruction (HIR) and IMR. Plaque characteristics were compared using the two algorithms. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the images and the CNR between the plaque and adjacent adipose tissue were also compared between the two reformatted methods. Results: Seventy-seven predominantly non-calcified plaques were detected. Forty plaques showed napkin-ring sign with the IMR reformatted method, while nineteen plaques demonstrated napkin-ring sign with HIR. There was no statistically significant difference in the presentation of positive remodeling, low attenuation plaque, and spotty calcification between the HIR and IMR reconstructed methods (all p > 0.5); however, there was a statistically significant difference in the ability to discern the napkin-ring sign between the two algorithms (χ² = 12.12, p < 0.001). The image noise of IMR was lower than that of HIR (10 ± 2 HU versus 12 ± 2 HU; p < 0.01), and the SNR and CNR of the images and the CNR between plaques and surrounding adipose tissues on IMR were better than those on HIR (p < 0.01). Conclusion: IMR can significantly improve image quality compared with HIR for the demonstration of coronary artery and atherosclerotic plaques using a 256-slice CT.

• Pediatric Infection and Vaccine
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• 제23권1호
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• pp.31-39
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• 2016

목적: 국내 소아에서 발생한 PCP의 예후와 관련된 인자들과 PCP 예방요법의 효과를 분석하였다. 방법: 2002년 1월부터 2015년 4월까지 최근 13년간 서울아산병원 어린이병원에서 면역형광법 및 PCR 검사를 통해 PCP로 확진된 18세 이하 환자들의 의무기록을 후향적으로 분석하였다. PCP 예방요법 유무에 따른 임상경과의 차이 및 PCP 관련 사망의 위험 요소를 분석하였다. 결과: 총 24명의 PCP 확진 환자의 진단시 나이는 5세 3개월(범위, 3개월-18세)였고, 모두 기저질환을 동반하였으며, 23명(95.8%)은 혈액질환 또는 조혈모세포이식(15명), 고형장기 이식(4명) 및 일차성 면역결핍 질환(4명) 등의 면역저하 환자였다. PCP 진단시 기침과 빈호흡이 가장 흔한 증상이었으며(각각 92%), 79%에서 발열이 동반되었다. 호흡부전 및 다발성 장기부전으로 발현한 경우는 19명(79%) 및 6명(25%)이었고, PCP 경과 중 8명(33%)은 기계환기가 필요하였으며 PCP 관련 사망률은 21% (5명)였다. 진단시 다발성 장기부전 동반이 통계적으로 유의한 사망 예측 인자였다(OR, 17.1 [95% CI 1.13-257.67]; P=0.04). 진단 1개월 이내에 적절한 PCP 예방요법이 시행된 경우는 12명(50%)였고, PCP 예방요법을 시행한 군에서 진단시 다발성 장기부전 동반이 적었으며(P=0.014), 치료 중 기계적 환기요법의 사용한 경우 및 재원일수가 유의하게 적었다(각각 P=0.027, 0.021). 고찰: PCP 진단시 다발성 장기부전이 동반된 경우 사망률이 높았으며, PCP 예방요법을 시행한 군에서도 PCP가 발생하였으나 상대적으로 양호한 임상 경과를 보였다. 추후 소아의 PCP 발생의 위험 요인 및 적절한 예방요법의 구축을 위한 장기적인 전향적 연구가 필수적이다.

• Clinical and Experimental Pediatrics
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• 제48권1호
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• pp.63-67
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• 2005

목 적 : HSP는 촉진성 피부 자반, 위장관 증상, 관절 증세, 신장침범을 특징으로 하는 전신성 혈관질환이다. 일반적으로 예후는 위장관 합병증과 신염의 중증도에 의해 결정된다. 본 연구에서는 위장관 증상과 다른 임상적 소견 및 검사소견과의 통계학적 상관관계를 분석하여 예후를 판정하고 복부초음파 검사소견을 알아보아 진단 및 합병증 발생, 특히 비전형적인 임상경과 시 조기 발견에 도움을 주고자 시행하였다. 방 법 : 1994년 1월부터 2004년 6월까지 원광대학교병원 소아과에서 치료받았던 177명의 환아를 대상으로 후향적으로 차트를 분석하여 위장관 증상이 있는 경우를 복부 양성군, 없는 경우를 복부 음성군으로 분류하여 통계적 분석을 시행하였으며 복부초음파 검사소견을 알아보았다. 결 과 : 대상 환아의 남녀 비는 1.5 : 1였고 주된 발생연령은 5-8세(53%)였다. 위장관 증세는 117례(66%)에서 호소하였으며 이 중 복통(98%)이 가장 흔하였으며 복부압통(38%), 구역과 구토(30%), 혈변(8.5%), 설사(3.4%), 반사압통(3.4%) 등이었고 장중첩증 5례, 급성 충수염 2례도 있었다. 복부 양성군에서 음성군에 비해 신장침범과 재발의 위험성이 증가하였으나 두 군간에 다른 임상적 및 검사 소견에서는 차이가 없었다. 복부 양성군에서 복부 초음파검사를 시행하였던 98례 중 소장 벽의 비후(71%)가 가장 흔하였고 십이지장, 공장, 회장 순으로 침범하였으며, 또한 소장 확장(42%), 림프절 비대(47%), 복수(25.5%) 등의 소견을 보였다. 결 론 : HSP 환아에서 위장관 증세는 신장침범이나 재발의 위험도를 증가시키며 복부초음파 검사는 비전형적 임상경과를 보이는 경우 조기진단과 중증의 위장관 합병증 발견에 도움 될 것으로 사료된다.

• Tuberculosis and Respiratory Diseases
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• 제68권1호
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• pp.10-15
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• 2010

Background: Lung cancer is the most common cause of cancer mortality in Korea. The TNM stage at presentation in patients with non-small cell lung cancer (NSCLC) has the greatest impact on prognosis. Patients who undergo a complete resection for NSCLC are likely to develop recurrent and/or metastatic disease. There are several factors influencing the development of recurrence. We explored risk factors of recurrence in patients with stages I and II NSCLC, who had undergone curative resection. Methods: We reviewed patients who had complete surgical resection as definitive treatment for stage I or II. Patients followed up for more than 36 months. We evaluated several factors which might have relationship with recurrence, such as patient's demographic factors, TNM staging, pathologic finding, tumor markers and surgical technique. Results: A total of 75 patients were enrolled for analysis, of whom 58 were men and 17 were women with mean age of 61 (range, 37 to 76) years. The average size of tumors was 3.9 cm (0.7 to 10 cm). There were 64 patients with stage I NSCLC and 11 with stage II NSCLC. Among 64 patients with stage I NSCLC, 35 patients showed recurrences whereas 8 patients have recurred in stage II NSCLC. Grade of differentiation of tumor was closely related to the recurrence. Seventy-five percent of patients who had poor tumor differentiation experienced a recurrence. In contrast, 3 patients of twelve had recurrences, who revealed differentiation in their tissue (p<0.05). Conclusion: Tumor differentiation could be a predictive factor for tumor recurrence in patients who have undergone curative resection for stage I or II NSCLC.

• Journal of Trauma and Injury
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• 제24권1호
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• pp.18-24
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• 2011

Purpose: Missing cervical pathology after injury may lead to disability and influence long-term survival. Controversies continue to evolve concerning the initial screening methods used to predict cervical spine injury. Through a retrospective chart review, we attempted to analyze and propose factors predictive of cervical trauma. Methods: Of all the patients who had visited the Emergency Department of Korea University, from January 2009 to December 2009, a retrospective review of the clinical records of the 217 patients who had undergone cervical spine computed tomography was done. We investigated whether we could predict the need for cervical spine computed tomography shortly after presentation in trauma patients by comparing the group with fractures and group without fractures and by finding risk factors showing significant differences between the two groups that might be used as guides in decision making. Results: Of the 217 subjects who underwent cervical spine computed tomography scans, 33 were identified with fractures of the cervical spine while 184 were not. The most common mechanisms of trauma, in order, for those with fractures were falls, followed by traffic accidents. We found that the injury severity score, multiple injuries, a high-energy injury mechanism, neurologic deficit, and pain and tenderness of the cervical spine showed statistically significant differences between the two groups. Conclusion: Fractures of the cervical spine that are not observed with simple radiography occur with a relatively high frequency in trauma patients. Consideration should be given to the risk factors for cervical spine fracture, and if pertinent, cervical spine computed tomography should be performed with speed for early diagnosis of cervical spine fractures.