• 한국임상수의학회지
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• 제29권3호
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• pp.242-246
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• 2012

3살된 코리안 숏헤어 고양이(몸무게 5.2 kg)가 복수, 흉수, 호흡곤란으로 인해 강원대학교 수의과대학병원에 진료의뢰 되었다. 진단검사상, 유미성 흉수와 출혈성 복수, 심장비대, PW 도플러 초음파와 TDI 초음파의 restrictive filling pattern, 미비하게 비대된 좌심실 자유벽이 관찰되었다. 심장초음파 진단소견을 토대로 제한성 심근병증으로 잠정진단 내리게 되었다. 본 환자는 흉수를 제거하고 furosemide, enalapril, sildenafil, clopidogrel을 포함한 약물치료를 하였다. 이것은 국내에서 처음으로 발표하는 제한성 심근병증의 증례이다.

• 한국임상수의학회지
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• 제25권2호
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• pp.106-111
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• 2008

3년령 말티즈 개(2.5Kg)가 갑작스런 심잡음, 의기소침, 식욕결핍으로 내원하였다. 혈액검사상에서 백혈구증가증과 함께 발열이 관찰되었으며 심장청진시 좌측 심첨부에서 VI/VI holosystolic murmurs가 청진되었다. 심전도에서 좌심실의 종대소견이 보였다. 진단방사선상에서 좌심방과 좌심실의 확장, 이첨판 판막의 증식이 보였으며, 이로 인해 이첨판의 역류가 관찰되었다. 이러한 임상증상과 검사 결과를 바탕으로, 본 증례는 감염성 심내막염에 의한 증식성 이첨판 역류증이라 진단하였다. 환자는 광범위 항생제, 이뇨제, 항혈전제로 치료하였다.

• 한국임상수의학회지
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• 제25권2호
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• pp.126-130
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• 2008

6연령의 말티즈 견이 오른쪽 견갑부의 종괴로 내원하였다. 신체검사와 자기공명영상(MRI)의 평가, 전체혈구 계산 (CBC), 혈청화학검사, 미세흡인 생검(FNA), 조직학적인 평가가 이루어졌다. 전체혈구계산 검사에서는 정상범위를 나타내었으며, 혈청화학 검사상에서는 ALP의 증가를 보였다. 방사선 소견에서 견갑골의 완전한 골 융해 소견을 보였으며, 자기공명영상에서는 혼재된 신호강도를 보였다. 면역조직화학(염색과 Masson's trichrome 염색) 소견에 근거하여, 섬유육종으로 최종진단 되었다.

• Tuberculosis and Respiratory Diseases
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• 제68권3호
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• pp.140-145
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• 2010

Background: Pulmonary embolism (PE) is a common clinical problem in the West that is associated with substantial morbidity and mortality. The diagnostic modality has been changed since 2001. This study retrospectively reviewed the PE mortality with the aim of identifying the risk factors associated with mortality since the multidetector computed tomography (MDCT) was introduced. Methods: We analyzed 105 patients with acute PE proven by multidetector CT or ventilation perfusion scan. The primary outcome measure was the all-cause mortality at 3 months. The prognostic effect of the baseline factors on survival was assessed by multivariate analysis. Results: The main risk factors were prolonged immobilization, stroke, cancer and obesity. Forty nine percent of patients had 3 or more risk factors. The overall mortality at 3 months was 18.1%. Multivariate analysis revealed low diastolic blood pressure and the existence of cancer to be independent factors significantly associated with mortality. Forty two PE patients were examined for the coagulation inhibitors. Four of these patients had a protein C deficiency (9.5%), and 11 had a protein S deficiency (26%). Conclusion: PE is an important clinical problem with a high mortality rate. Close monitoring may be necessary in patients with the risk factors.

• 한국임상약학회지
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• 제6권2호
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• pp.7-13
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• 1996

The purposes of this study were to define the pharmacokinetic parameters of vancomycin in Korean neonates, to evaluate current neonatal vancomycin dosing guideline being used in a teaching hospital, and to develop the optimal vancomycin dosing guideline. The evaluation of 35 sets of peak and trough concentrations drawn on current dosing regimen showed that $29\%$ of peak concentrations and $46\%$ of though concentrations were within therapeutic range. Otherwise, pharmacokinetic parameters, based on 62 sets of peak and trough serum concentrations obtained from 39 neonates, showed that mean vancomycin clearance (CL), volume of distribution (Vd), and terminal elimination half-life were $0.13\pm0.08\;L/hr,\;0.94\pm0.48\;L,\;and\;5.6\pm2.13$ hours, respectively. Volume of distribution (Vd) normalized for body weight remained constant throughout PCA range, whereas the absolute CL (r=0.74) and normalized CL (r=0.36) showed high correlation with PCA. Also, the normalized CL showed a strong inverse correlation (r=-0.55) with serum creatinine concentrations (SrCr). Based on the high correlation among PCA serum creatinine concentration, CL, and the daily dosage requirements, the following dosing guideline for vancomycin in neonates was suggested: 10 mg/kg $12{\sim}18$ hourly for < 30 weeks PCA and < 0.6 mg/dl SrCr; 10 mg/kg 18 hourly for < 30 weeks PCA and $0.6{\sim}1.2$ mg/dl SrCr; 10 mg/kg 8 hourly for $30\sim44$ weeks PCA and < 0.6 mg/dl SrCr; 10 mg/kg 12 hourly for $30\sim44$ weeks PCA and $0.6{\sim}1.2$ mg/dl SrCr.

• 한국임상약학회지
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• 제24권3호
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• pp.206-212
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• 2014

Objectives: This was to evaluate the current usage of three erythropoietin stimulating agents (ESA) and their efficacy for management of anemia in peritoneal dialysis (PD) patients with chronic kidney disease. Methods: It was a retrospective comparative study through review of electronic medical records of chronic kidney disease patients undergoing PD at a tertiary teaching hospital from January 1998 to June 2013. Results: Average administration frequency was 1.66 times/week in EPO group, 0.75 times/week in DA group, and 0.19 times/week in MPG-EPO group. At the first 4 weeks, there were significant differences in mean hemoglobin levels between EPO and DA groups ($9.25{\pm}1.28g/dL$, $10.02{\pm}0.95g/dL$ each, p = 0.018) and also in hemoglobin response rates (10.0%, 45.2% each, p = 0.008), but since after 4 week, there had been no significant differences. There also showed no significant differences in achievement of hemoglobin target between the two groups. When converted to MPG-EPO in EPO/DA groups, there showed a slight increase in hemoglobin levels of both groups. MPG-EPO was the highest compared with two other drugs by the average cost based on the average weekly dose. Conclusion: EPO, DA, and MPG-EPO showed similar effects in treatment of anemia of PD patients based on hemoglobin target range (11.0~12.0 g/dL) which NFK-K/DOQI guidelines suggest. Though the average cost of MPG-EPO was higher than the other two drugs, the number of PD patients using MPG-EPO has increased and it is thought that long half-life and low administration frequency of MPG-EPO have improved the compliance of PD patients who have to self-administrate.

• 한국융합학회논문지
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• 제9권10호
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• pp.121-129
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• 2018

본 연구는 방사선학과 학생들의 전공 선택 만족도에 영향을 주는 요인을 파악하고 평가하였다. 방사선학과 학생 151명을 대상으로 설문 조사하여 t-test, 다중회귀분석을 실시하였다. 학과 선택 중 선호성과 현재 요인이 유의한 차이가 있었다. 임상실습에서는 실습환경, 실습지도, 실습시간과 평가, 실습 후 만족도, 취업과의 연계성이 유의한 차이가 있었다. 학과 교육 과정 요인에서는 교육 과정 구성, 교수 학습 및 평가, 지원 시설, 학제 만족, 교육 과정 만족이 유의한 차이가 있었다. 결과적으로, 학생들의 전공 선택 만족을 높이기 위한 시스템 개발과 교육의 질 향상을 위한 노력이 필요하다.

• 의학교육논단
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• 제20권2호
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• pp.72-77
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• 2018

Observation of the current Korean medical education and training system shows that certain negative traits of unchangeable solidification engraft themselves so deeply into the overarching system that they are now hampering the state of the national health welfare. Focusing only on undergraduate medical education, we can point out some glaring side-effects that should be of concern to any stakeholder. For instance, a graduate can legally begin his career as an independent practitioner immediately after passing the licensing exam and return to the old stuck school-year system of 2-year-premedical and 4-year-medical programs where outcome-based and integrated curricula are incomplete and unsatisfactory. In terms of learning opportunities, the balance between patient care and public health, as well as that between in-hospital highly specialized practice and community-based general practice, has worsened. Every stakeholder should be aware of these considerations in order to obtain the insight to forge a new direction. Moreover, our medical schools must prepare our students to take on the global roles of patient care within the Fourth Industrial Revolution, health advocacy for the imminent super-aged society, and education and research in the bio-health industry, by building and applying the concept of academic medicine. We will need to invest more resources, including educational specialists, into the current undergraduate medical education system in order to produce proper outcomes, smart curriculum, innovative methods of teaching and learning, and valid and reliable monitoring and evaluation. The improved quality of undergraduate medical education is the starting point for the success of the national system for public health and medical care as a whole, and therefore its urgency and significance should be emphasized to the public. The medical society should go beyond fixing what is broken and usher in a new era of cooperation and collaboration that invites other health professionals, governmental partners, law-makers, opinion leaders, and the general public in its steps toward the future.

• Asian Pacific Journal of Cancer Prevention
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• 제14권8호
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• pp.4847-4851
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• 2013

Objectives: To evaluate accuracy of FDG-PET CT in prediction of persistent disease in head and neck cancer cases and to determine prognostic value of metabolic tumor response. Materials and Methods: Between 2009 and 2011, 46 patients with squamous cell carcinoma of head and neck receiving PET-CT were treated with definitive radiotherapy, with or without chemotherapy. There were 29 nasopharyngeal, 11 hypopharyngeal, 3 oropharyngeal and 3 laryngeal cancer patients, with a median age of 50.5 years (range 16-84), 32 males and 14 females. All patients were evaluated with PET-CT median 3-5 months (2.4-9.4) after completion of radiotherapy. Results: After a median 20 months of follow up, complete metabolic response was observed in 63% of patients. Suspicious residual uptake was present in 10.9% and residual metabolic uptake in 26.0% of patients. The overall sensitivity, specificity, positive predictive value and negative predictive value of FDG-PET-CT for detection of residual disease was 91% and 81%, 64% and 96% respectively. Two year LRC was 95% in complete responders while it was 34% in non-complete responders. Conclusions: FDG PET CT is a valuable tool for assessment of treatment response, especially in patients at high risk of local recurrence, and also as an indicator of prognosis. Definitely more precise criteria are required for assessment of response, there being no clear cut uptake value indicating residual disease. Futhermore, repair processes of normal tissue may consume glucose which appear as increased uptake in control FDG PET CT.

• Asian Pacific Journal of Cancer Prevention
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• 제17권4호
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• pp.2329-2336
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• 2016

Background: Despite the existence of established guidelines advocating the use and value of chemotherapy order templates, chemotherapy orders are still handwritten in many hospitals in Lebanon. This manuscript describes the implementation of standardized chemotherapy order templates (COT) in a Lebanese tertiary teaching hospital through multiple steps. Initial Assessment: An initial assessment was conducted through a retrospective appraisal of completeness of handwritten chemotherapy orders for 100 adult patients to serve as a baseline for the project and identify parameters that might afford improvement. Choice of solution: Development of over 300 standardized pre-printed COTs based on the National Comprehensive Cancer Network templates and adapted to the practice culture and patient population. Implementation: The COTs were implemented, using Kotter's 8-step model for leading change, by engaging health care providers, and identifying and removing barriers. Evaluation: Assessment of physicians' compliance with the new practice (122 orders assessed) was completed through two phases and allowed for the identification of areas of improvement. Lessons Learned: Overall, COT implementation showed an average improvement in order completion from 49.5% (handwritten orders) to 77.6% (phase 1-COT) to 87.6% (phase 2-COT) reflecting an increase of 38.1% between baseline and phase 2 and demonstrating that chemotherapy orders completeness was improved by pre-printed COT. As many of the hospitals in Lebanon are moving towards standardized COTs and computerized physician order entry (CPOE) in the next few years, this study provides a prototype for the successful implementation of COT and demonstrates their role in promoting quality improvement of cancer care.