• The Korean Journal of Pain
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• 제6권2호
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• pp.255-257
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• 1993

Shoulder Hand Syndrome is used to describe painful disabilities of the upper extremity due to disturbances of sympathetic nerve supply. A 72 year old male developed hemiplegia on left side on the 5 days after open heart surgery of aortic valve replacement. Three months later, the patient complained of severe pain in the left upper extremity involving shoulder. The left hand showed swelling and flaccid paralysis. Thereafter the left stellate garglion block with 10 ml of l% lidocaine produced prompt pain relief. Thereafter the patient received 94 stellate ganglion block during 7 months which produced permanent remission of pain throughout a 1 year follow period. We recommand sympathetic block for of Shoulder Hand Syndrome following hemiplegia.

• Journal of Korean Neurosurgical Society
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• 제66권3호
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• pp.289-297
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• 2023

Technological advances in neonatology led to the improvement of the survival rate in preterm babies with very low birth weights. However, intraventricular hemorrhage (IVH) has been one of the major complications of prematurity. IVH is relevant to neurodevelopmental disorders, such as cerebral palsy, language and cognitive impairments, and neurosensory and psychiatric problems, especially when combined with brain parenchymal injuries. Additionally, severe IVH requiring shunt insertion is associated with a higher risk of adverse neurodevelopmental outcomes. Multidisciplinary and longitudinal rehabilitation should be provided for these children based on the patients' life cycles. During the infantile period, it is essential to detect high-risk infants based on neuromotor examinations and provide early intervention as soon as possible. As babies grow up, close monitoring of language and cognitive development is needed. Moreover, providing continuous rehabilitation with task-specific and intensive repetitive training could improve functional outcomes in children with mild-to-moderate disabilities. After school age, maintaining the level of physical activity and managing complications are also needed.

• Journal of Genetic Medicine
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• 제19권2호
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• pp.94-99
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• 2022

Lesch-Nyhan disease (LND) is a rare X-linked recessive inherited purine metabolic disorder that accompanies neurodevelopmental problems. Neurofibromatosis type 1 (NF1) is a relatively common autosomal dominant inherited genetic disorder characterized by tumors in various systems. Some children with NF1 also accompanies neurodevelopmental problems. Here, we describe a 5-year-old boy with a maternally inherited pathogenic variant in NF1 and hypoxanthine-guanine phosphoribosyltransferase (HPRT). He was referred for severe neurodevelopmental impairment and hyperuricemia. His mother was diagnosed with NF1 and the patient was also suspected of having NF1 because of cafe au lait macules. He had dystonia, rigidity, cognitive deficit, and speech/language impairment. Serum and urine uric acid concentrations were elevated. He had more severe neurodevelopmental delay than patients with only NF1, so his clinical symptoms could not be fully understood by the disease alone. To find the cause of his neurologic symptoms and hyperuricemia, the patient and his mother underwent a whole-exome sequencing test. As a result, the pathogenic variant c.151C>T (p.Arg51Ter) in HPRT1 was identified as hemizygote in the patient and heterozygote in his mother. The pathogenic variant c.7682C>G (p.Ser2561Ter) in NF-1 was identified as heterozygotes in both of them. Although the clinical symptoms of both diseases were overlapping and complicated, genetic testing was helpful for accurate diagnosis and treatment. Therefore, we suggest to consider preemptive genetic evaluation if there are symptoms not sufficiently explained by known existing diseases. And it is considered valuable to review this rare case to understand the clinical course and possible synergic effects of these diseases.

• 한국사회복지학
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• 제59권1호
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• pp.223-249
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• 2007

본 연구는 개인에 대한 직업재활서비스의 적격성이 장애 등급만으로 결정될 수 있는지를 탐색하기 위해 수행되었다. 이론적 검토를 통해 '기능제한(functional limitation)'개념이 이에 대한 대안이 될 수 있음을 확인하였고 변형바델지수(Modified Barthel Index)를 이용하여 기능제한 정도를 측정하였다. 전체 381명의 뇌성마비인을 대상으로 신체적 손상(impairment)과 기능제한 그리고 취업여부의 관계를 파악한 결과, 뇌성마비유형과 부위 등 신체적 손상과 관련된 변인은 취업여부에 직 간접적 영향을 미치지 않았으나 통증문제와 이동능력은 간접적인 경로를 통해, 자기관리능력은 직접적인 경로를 통해 취업여부에 영향을 미침을 알 수 있었다. 이러한 연구결과를 통해 향후 각종 장애관련 연구나 서비스 전달체계의 적격성을 파악하는 과정에서 무엇을 '장애'로 규정할 것인지에 대해 고민해야 하며, 그 대안으로 신체적 '기능제한' 정도를 개념화 하는 것에 대한 추가적인 연구가 수행되어야 함을 알 수 있었다.

• 대한치과마취과학회지
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• 제11권2호
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• pp.146-152
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• 2011

Background: Elderly patients with progressive dementia including Alzheimer's disease (AD) are more and more often scheduled to undergo general anesthesia for various pathologies including dental problem. But, there is high risk of deterioration of underlying mental diseases and other co-morbidities. So it is important to implement preventive strategies and take adequate measures to minimize negative perioperative events in these patients. Methods: We reviewed the 17 cases of 11 patients with AD who underwent ambulatory general anesthesia for dental treatment at the clinic for the disabled in Seoul National University Dental Hospital. Results: The mean age was 68 (57-81) years. All of them were diagnosed with AD and some had hypertsnsion, bronchiectasis, urinary incontinence. For anesthesia induction, 3 cases (1 patient) was needed physical restraint, but others showed good or moderate cooperation. Drugs used for anesthesia induction was thiopental (11 cases), propofol (3 cases) and sevoflurane (3 cases). All patients received nasotracheal intubation without difficulties. Mean total anesthetic time was 3 hour 44 min ${\pm}$ 60 min and staying time at PACU was 83 ${\pm}$ 34 min. All the patients except one who showed hypertension discharged without any complication. There was no death or long term hospitalization because of severe complications. Conclusions: If general anesthesia is needed, pertinent diagnostic tests and workup about other medical problems, and appropriate anesthetic planning are essential for safety.

• 한국실내디자인학회논문집
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• 제16권6호
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• pp.125-135
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• 2007

A study on child care centers has been developed with a focus on normal children. Also the child care centers which take care of children with disability are rare. In Seoul, Korea, only 2% of children with disability are taken care of in childcare centers. And even the disabled children at the child care centers are mostly mentally or emotionally disabled because the building, programs and services of the centers are restrictive to the children with severe physical disabilities. In Korea, it is not yet an obligation for child care centers to adopt Disability Accessibility Guidelines to make facilities accessible by the disabled. Also, Korea does not have specific design guidelines or legal standards. This study aims to review the domestic and foreign legal standards and design guidelines which are applicable to child care centers for children with disability through a reference review. Korean legal standards, and US's ABA and ADAAG were analyzed. Two representative references such as "Creating Inclusive Child Care Facilities" published in US and "Design for access and mobility requirement for Children and Adolescents with Physical Disabilities" published in Australia were reviewed. As a result, we categorized the guidelines according to contents such as locations, areas, space organizations, nursing spaces, sanitary spaces, and doors and corridors. The goal of this study is to provide the basic information to develop domestic design guidelines to ensure that the child care centers are welcoming and usable for everyone possible.

• Journal of Preventive Medicine and Public Health
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• 제39권6호
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• pp.511-519
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• 2006

Objectives : As the disabled have higher prevalence rates and earlier onsets of chronic diseases than the non-disabled, their participation in mass screening is important for the early detection and intervention of chronic diseases. Nevertheless, in Korea, the disabled have lower participation rates in mass screening services than the non-disabled. The purpose of the study was to find determinants for the participation in the National Health Insurance (NHI) mass screening program among the disabled. Methods : In this study, the NHI mass screening data of 423,076 disabled people, which were identified using the National Disability Registry (2003), were analyzed. Of the factors affecting the participation rates in mass screenings, the following variables were included for the analysis: socioeconomic stati, such as sex, age, category of health insurance program, region and income, disability characteristics, such as disability type, and severity. A multiple logistic regression analysis was used to evaluate the association between the participation rates, disability characteristics variables and demographic variables. Results : The participation rate in mass screening of the disabled was 41.3%, but was lower in females, an age of more than 70 years, self-employed and for those with an average monthly insurance premium over 133,500 Won and in metropolitan legions. The participation rate was 1.31 times lower in females than males (95% CI=1.29-1.33); 3.50 times lower in the elderly (more than 70 years) than the younger (95% CI=3.33-3.67); 1.43 times lower in those who live in metropolitan areas (95% CI=1.40-1.46); 2.59 times lower for those in a health Insurance program for the self-employed than for employees (95% CI=2.56-2.63), 1.19 times lower for the higher income (more than 133,500) than the lower income group (4,400-22,000) for the average monthly insurance premium (95% CI=1.15-1.23): 2.04 times lower for those with brain palsy and stroke disabilities than with auditory impairments (95% CI: 1.97-2.11) and 3.27 times for those with severe compared to mild disabilities (95% CI=3.15-3.40). Conclusions : The disabled with high severity, and locomotive and communication disabilities have lower participation rates in mass screening services in Korea.

• 대한장애인치과학회지
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• 제5권1호
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• pp.12-17
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• 2009

Background : To do dental treatments successfully for dentally disabled patients who are unable to cooperate to procedures needs deep sedation (DS) or general anesthesia (GA). But there are some difficulties in selecting DS because of some disadvantages such as airway problem etc. But, if we select appropriate cases, DS would be better than GA. Methods : We reviewed total 238 cases of patients who had received dental treatments under GA or DS at the clinic for the disabled in Seoul National University Dental Hospital from November 2007 to February 2009. To compare anesthesia condition between DS and GA, we reviewed preanesthesia evaluation sheet, anesthesia or sedation records and PACU sheets retrospectively. Results : The number of DS cases was 25 (11%) and that of GA was 218 (89%). To maintain DS, intravenous propofol was infused with syringe pump (100%), and sevoflurane (134 cases) or propofol (13 cases) were used for sedation induction. Mean total treatment time for DS was 36 min and 2 hour 25 min for GA. The recovery time at PACU was 44 min for DS and 80 min for GA. There were no severe complications in DS, but 18 cases showed nausea and vomiting in GA. Conclusion : Deep sedation for disabled dental patients should be selected for effective behavioral control in conjunction with general anesthesia, considering duration and pain-evoking potentials of dental treatment and type and severity of patients' disabilities altogether.

• 재활복지
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• 제17권4호
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• pp.127-149
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• 2013

본 연구는 실업의 장기화, 장애차별현상 등 장애인노동시장 문제의 해법을 모색하기 위해 장애차별변수를 활용하여 장애인의 실업탈출과 이와 관련된 요인을 살펴보고자 하였다. 이를 위해 장애인고용패널조사의 3차~5차의 자료를 활용하여 자료를 구성하고 실업탈출(취업)과 관련하여 사건사 분석을 실시하였다. 분석결과는 다음과 같다. 첫째, 실업기간에 따른 실업탈출가능성의 변화를 생명표 분석을 통해 분석한 결과, 최장 실업기간(25개월)까지 실업상태로 남아 있는 비율은 90.5%이고, 노동시장에 진입한 비율은 9.5%에 불과한 것으로 나타났다. 전반적으로 실업유지율은 매우 높게 나타났고, 실업탈출 가능성은 12개월까지 증가하다가 그 이후부터는 감소하는 추세를 보이는 것으로 나타났다. 둘째, 실업탈출에 영향을 요인을 파악하고자 콕스비례해저드모형을 이용하여 분석한 결과, 남성일수록, 비수급가구일수록, 경증일수록, 직장차별경험이 없을수록 실업탈출 가능성이 높아지는 것으로 나타났다. 이러한 결과를 통해 장애인의 실업탈출(취업)을 촉진하기 위해서는 우선 고용상에 발생하는 장애차별을 해소할 수 있는 장애인차별금지제도를 보다 강화해야 하며, 기초수급 장애인들의 근로를 유인할 수 있도록 현행 국민기초생활보장제도를 보완할 필요성이 있음을 제안하였다. 추가적으로 실업탈출에 어려움이 있는 여성장애인, 중증장애인 등과 같이 정책대상을 보다 세분화하여 개별욕구와 특성에 부합하는 고용서비스의 필요성을 제안하였다.

• 대한장애인치과학회지
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• 제3권2호
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• pp.75-79
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• 2007

Background: Down's syndrome, or trisomy 21, is the commonest congenital chromosome anomaly. With improvement in medical care, these patients increasingly reach adulthood in spite of their physical maldevelopment and mental retardation. And, the number of those who required general anesthesia for dental treatment is increasing. Methods: We reviewed the 26 cases of 22 patients with Down's syndrome who underwent outpatient general anesthesia for dental treatment at the clinic for the disabled in Seoul National University Dental Hospital. Results: The mean age was 22 years. They all had severe mental retardation and some had congenital heart anomaly, epilepsy, hypothyroidism, acute leukemia, autism, cleft palate, and chronic renal failure. For anesthesia induction, 4 cases was needed physical restriction, but others showed good or moderate cooperation. Drugs used for anesthesia induction was thiopental (17 cases) and sevoflurane (9 cases). All patients received nasotracheal intubation and 3 cases needed difficult airway management. Mean total anesthetic time was $166{\pm}60$ min and staying time at PACU was $92{\pm}48$ min. There was no death or long term hospitalization because of severe complications. Conclusion: If general anesthesia is needed, pertinent diagnostic tests and workup about anomaly, and appropriate anesthetic planning are essential for safety.