• Journal of Korean Academy of Nursing
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• v.45 no.3
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• pp.357-366
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• 2015

Purpose: This study was done to develop an evidence-based incontinence care protocol through an adaptation process and to evaluate the effects of the protocol. Methods: The protocol was developed according to the guideline of adaptation. A non-randomized controlled trial was used for testing the effects of the new Incontinence Care Protocol. A total of 120 patients having bowel incontinence with Bristol stool type 5, 6, and 7 and admitted to intensive care units were recruited to this study. The newly developed incontinence care protocol was used with patients in the experimental group and conventional skin care was given to patients in the control group. Outcome variables were incontinence-associated dermatitis (IAD) severity, pressure ulcer occurrence and severity. Results: The experimental group had significantly less severe IAD (t=6.69, p <.001), lower occurrence of pressure ulcers (${\chi}^2=7.35$, p =.007), and less severity of pressure ulcers (Mann-Whitney=86.00, p =.009) than the control group. Conclusion: Use of this incontinence care protocol has the effects of preventing pressure ulcers and inhibiting worsening of IAD and pressure ulcers. Therefore, this incontinence care protocol is expected to contribute to managing IAD and pressure ulcers.

• Journal of Korean Academy of Nursing
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• v.46 no.4
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• pp.562-571
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• 2016

Purpose: In this study the costs and benefits of a home health care program were examined to evaluate the economic feasibility of the program. Methods: The study participants included 349 patients in the community who had been registered at a home health care center for 5 years. The costs and benefits of the program were analyzed using performance data and health data. The benefits were classified as the effects of pressure ulcer care, skin wound care and catheters management. The program effect was evaluated on the change of progress using transition probability. Benefits were divided into direct benefit such as the savings in medical costs and transportation costs, and indirect benefits which included saving in productivity loss and lost future income. Results: Participants had an average of 1.82 health problems. The input cost was KRW 36.8~153.3 million, the benefit was KRW 95.4~279.7 million. Direct benefits accounted for 53.4%~81.2%, and was higher than indirect benefits. The net benefit was greater than 0 from 2006 to 2009, and then dropped below 0 in 2010. Conclusion: The average net benefit during 5 years was over 0 and the benefit cost ratoi was over 1.00, indicating that the home health care program si economical.

• Journal of Korean Foot and Ankle Society
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• v.23 no.4
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• pp.208-211
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• 2019

Diabetic foot ulcers can progress to the point where amputation is needed, and so these ulcers require active treatment. Skin grafts or flaps can be performed for coverage of this type of ulcer. Local flap surgery is relatively easy to perform and good results have been previously reported. We performed single-lobed rotation flap on 5 cases of forefoot ulcer around the site of weight bearing. The location of the foot ulcers was the medial part of the first metatarsophalangeal joint in all the patients. The mean size of the defect was 4.70 ㎠. Managing of ulcers, controlling of diabetes and infection, and improving of peripheral blood flow were performed before surgery. In two cases, infection progressed to the articular cartilage and so metatarsophalangeal joint fusions were performed simultaneously. All the cases were completely transplanted. There was no recurrence of the ulcers, and all the patients were able to walk.

• The Korean Journal of Physiology
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• v.10 no.2
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• pp.39-45
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• 1976

This study was conducted to see whether the hippocampectomy exerted facilitatory influence upon gastric ulceration in animals, and if so, whether the effect of hippocampectomy could be suppressed by adrenalectomy. 107 male rats were divided into 5 groups: rats that had over 90% of their hippocampal tissue removed through an opening on each side of the cerebral cortex(hippocampal group, N=21), rats that received bilateral adrenalectomy(adrenal group, N=29), rats that received adrenalectomy as well as hippocampectomy(hippocampo-adrenal group, N=10), rats that received damage to each side of the cortex over the hippocampus(cortical control group, N=20), and rats that had solely their head skin incised(normal control group, N=27). All rats were kept without restraint or food deprivation until on the 25th day after surgery, the stomach of each rat was inflated with 7ml of physiological saline and then removed under deep anesthesia. The mucosal surface was sketched under dissecting microscope, and enlarged photographs$(4{\times})$ were taken. The percentage of animals developing gastric ulcer in each animal group was calculated, the number of ulcer in each stomach was counted, and the total area of ulceration per stomach was measured on the Photograph with the aid of superimposed graph paper and expressed as permillage of total area of the glandular mucosa. Results obtained were as follows: 1. The percentage of animals developing gastric ulcer was significantly larger in the hippocampal group than they were in the hippocampo-adrenal, the adrenal, the cortical, and the normal control groups. 2. The mean number of ulcer per stomach was significantly larger in the hippocampal group than they were in the adrenal, the cortical control, and the normal control groups, while no significant difference existed between the hippocampal and the hippocampo-adrenal groups. 3. Total area of ulcer per stomach was significantly larger in the hippocampal group than they were in the cortical control and the normal control groups, but no significant differ-ence existed among the hippocampal, the adrenal, and the hippocampo·adrenal groups. 4. All measured values of the adrenal group were not significantly different from those of the hippocampo-adrenal, the cortical control, and the normal control groups. It is inferred from the above results that the hippocampus exerts an inhibitory influence upon gastric ulceration and that the hippocampal influence is mediated only partly through suppression of pituitary·adrenal activity.

• Archives of Plastic Surgery
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• v.34 no.4
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• pp.520-523
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• 2007

Purpose: Verrucous carcinoma is a rare, low-grade and well-differentiated squamous cell carcinoma, representing as a warty tumor. Estimation of the incidence for cutaneous lesions is not available because they are rare. We describe a case of verrucous carcinoma, a rare type, complication of a chronic pressure ulcer of duration more than 15 years. Methods: A 17-year-old boy presented with a large lesion involving the sacral area, which had been neglected for about 15 years. He had a history of surgical extirpation 2 years ago, but not cured. Examination revealed a cauliflower-like mass arising from an irregularly oval-shaped tumor which was $6.0{\times}4.5cm$ in size with signs of infection and ulcer. The lesion involved the sacrococcygeal area, spreading to both medial gluteal regions. The perianal skin did not appear to be directly affected. Results: A preoperative punch biopsy revealed a extremely well differentiated verrucous carcinoma. There were positive results in immunohistochemistry in the items of p53, p63, Ki-67. An 'en-bloc' excision of the tumor with the clinically normal surrounding tissue was carried out. Reconstruction was achieved by local regional flap. Histopathological findings of the excised area fully confirmed the preoperative biopsy report. It remained free of recurrence for a period of about 8 months. Conclusion: We believe that in patients with buttock involvement, regardless of the extent of such tumors, surgical therapy should be considered as the first-choice of treatment as reconstruction can be performed without excessive impairment for the patient.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.30 no.1
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• pp.1-9
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• 2017

Objectives : This study was performed to review the overseas clinical research trends on the effect of On cheong eum on skin disease. Methods : We searched articles in the Pubmed using keywords "On cheong eum", "On sei in", "Wen qing yin", "Jie du si wu tang" and "Jie du si wu decoction". We also searched in the China National Knowledge Infrastructure(CNKI) using key words "温清饮" and "解毒四物汤", We selected 5 studies after excluding non-clinical or unrelated studies. Results : One pre-post comparison study and four controlled clinical trials were performed. On cheong eum and modified On cheong eum were used for the treatment of skin disease-recurrent aphthous ulcer, psoriasis vulgaris, neurodermatitis, and skin pruritus. All of the studies showed positive results, and they reported that the treatment group had higher effective rate than control group. However, the quality of these clinical studies were not evaluated. Conclusions : According to this study, On cheong eum would be an effective and safe intervention in skin disease. Therefore, based on this study, more clinical research using On cheong eum should be performed in Korean medicine in the near future.

• Archives of Craniofacial Surgery
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• v.12 no.1
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• pp.53-57
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• 2011

Purpose: Pyoderma gangrenosum is a rare inflammatory, reactive dermatosis marked by painful cutaneous ulcer. The causes of pyoderma gangrenosum remain unclear. Gastrointestinal, hematological, rheumatological, and immmune disorders may be associated with pyoderma gangrenosum. The appearance of this disease may range from mild skin ulcers to life-threatening conditions. Generalized multiple ulcerative pyoderma gangrenosum is very rare. Here we report our experience with a case of multiple ulcerative pyoderma gangrenosum accompanied by ulcerative colitis. Methods: A 67-year-old man had cutaneous ulcers at multiple sites including the scalp, face, chest, abdomen, hands, and buttocks. He also developed gastrointestinal symptoms such as intermittent dyspepsia and bloody excrement. Debridement and irritation aggravated the disease progress. We gave a diagnosis of pyoderma gangrenosum with ulcerative colitis based on the clinical appearance and biopsy. The patient was treated with systemic intravenous steroid therapies and careful wound cares. Ulcers of the scalp and buttocks were treated with split thickness skin grafts. Results: Most of the multiple cutaneous ulcers were treated by systemic intravenous steroid therapies and wound cares. The rest of the ulcers were treated with skin grafts. Systemic intravenous steroid therapy was used to treat the ulcerative colitis. Conclusion: Generalized multiple ulcerative pyoderma gangrenosum is very rare. Without making an accurate diagnosis, hasty surgical treatments could aggravate the progression of the disease. Additionally, care should be taken to systemically treat underlying disease as well as administrating local treatments for the skin lesions. Intravenous systemic steroid therapy and skin grafts are useful treatments for generalized pyoderma gangrenosum.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.13 no.2
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• pp.20-50
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• 2000

This paper was written into condsideration records about the definition of "Ong-Jeo", the difference between "Ong" and "Jeo", the Western medical approach to "Ong-Jeo", and the etiology and pathologic mechanism of "Ong-Jeo". After this study, I report the following results from it. 1. "Ong" is an acute diapyesis disease which is found is in our skin and muscle and flesh. The chrateristics of this disease is that the affacted site is shine, no head, and the size is 3-4 chon. The prossess of the diesease shows that it is very quick, and very easily swell, and becomes pus easily, easily become to ulcer, easily converge. But this don't damage to the muscle and bone. 2. "Jeo" is the disease which damages bone-skeleton, muscle and flesh, and even destroy the stationary tissue. Jeo can be divided into two. One is called "Yudujeo" and it is acute diapydesis disease. The characteriscs of this disease is the miliary abscess, swell, has fever, and has an ache which is feeled spaned. And this is diffused into periphrey tissue and is diffused into deep site. After the ulcer, this becomes to shape the cellula. The size is more than 3-4 chon and this disease goes into chuk if this is serious. The other one is called "Mudujeo" and this disease is the ulcerative one in our joint and skeleton. The characteristic of this disease shows that the color of skin be not changed, and swell diffusely, and is not easily vanished, not easily becomes ulcerative, and not easily becomes converged. 3. "Ong-Jeo" is caused by the bacteriunm named by the "Golden and Yeollw Staphylococcus" in the Western medicine. "Ong" can be applicable to the carbuncle, acute diapyesis lymphadenitis, and some of cellulitis. "Jeo" can belong to cellulitis, and Mudujeo can belong to suppurative arthritis, suppurative osteomyelitis, tuberculous arthritis and osteomyelitis, and tuberculous lymphadenitis. 4. The etiologies of "Ong-Jeo" can be divided three, which are internal, external and other etiology which can not be clasiffied by two etiologies above. The internal etiology is seven emotion, and the external etiology is the six eumsa, unki, chunhang and so on. Other etiology is inadequate absorption of food, and excessive bang-sa. 5. The etiology of "Ong" is suppurative one which is choked between our skin and muscle and flesh, and is congested, become to hot, and finally erodes the muscle and flesh because of the inbalance of cirrculation in the enegy and blood. "Jeo" is the same as the Ong, but this is the suppurative disease which damages the muscle, flesh, and skeleton, and even damages into five Zang, the internal intestine.

• Archives of Plastic Surgery
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• v.35 no.3
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• pp.243-247
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• 2008

Purpose: For a proper wound care, the correct evaluation of wound is very important. Usually the evaluation of wound was subjective, and as a result, wound care was empirical. There were many attempts to objectify the wound evaluation, and one of them was measurement of the wound pH. The purpose of this study is to observe the wound pH changes during wound healing phase. Methods: From 2005 to 2007, we measured the pH values of 6 acute wounds, which were split thickness skin graft donor sites. In addition, we measured the pH values of 18 chronic wounds, which were 17 pressure sores and 1 tuberculosis ulcer. After pH meter ($SkinCheck1^{(R)}$, Hanna Instruments, Italy) was calibrated, wound pH was checked. Wound was cleansed with saline gauze and dressed with polyurethane foam dressing($Medifoam^{(R)}$, Biopol, Korea). Results: In split thickness skin graft donor sites, the pH raised(mean pH value: $7.45{\rightarrow}7.62$) when the wound was on the process of healing(*p=0.027, analysis of Wilcoxon signed-rank test). If wound became re-epithelialised, the pH value dropped to that of normal skin. However, we could not find a relation between time and the pH values in chronic wound. Conclusion: We could observe the consistent wound pH changes during wound healing phase in acute wound.

• Archives of Plastic Surgery
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• v.35 no.5
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• pp.615-618
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• 2008

Purpose: Pyoderma gangrenosum is a rare cutaneous ulcerative disease. First described in 1930, the condition is characterized by progressive ulceration with deeply undermined purple-red edge. The lower extremities are most commonly affected but other parts of the skin and mucous membranes may also be involved. Although medical treatments with topical wound therapy are commonly used, surgical intervention is still controversial. In this paper, we report an atypical case of pyoderma gangrenosum which was characterized by extensive soft tissue breakdown. Methods: A 27-year-old male patient was referred to our institution with a $7{\times}8cm$ sized deeply undermined ulceration with pus-like discharge and fever. Incision and drainage was performed at another clinic 3 days prior to admission to our institution. After a thorough physical examination and the MRI review, a diagnosis of necrotizing faciitis was made. Accordingly, fasciotomy and debridement was performed. However, the wound enlarged progressively and the patient remained highly febrile for 9 days after the treatment. Septic screening did not reveal any occult infection. After a secondary review of the case, the initial diagnosis of necrotizing fasciitis was rejected and changed to pyoderma gangrenosum. With the use of dexamethasone intravenously, the wound improved dramatically and the fever was eliminated. Steroid mediation was tapered with duration of 1 month. The wound was stabilized and subsequently covered with split-thickness skin graft. Results: Split-thickness skin grafting with 1 : 1.5 mesh was successfully taken. Conclusion: Initial clinical features of pyoderma gangrenosum are very similar to that of necrotizing fasciitis. High fever and progressive ulceration with severe pain could invite earlier surgical approach. The advancing wound margins (the well defined violaceous, undermined border and necrotic ulcer base) and lack of isolation of pathogenic organism was used to make the correct diagnosis of pyoderma gangrenosum. We achieved a good result with proper medication and split-thickness skin graft.