• Clinical and Experimental Pediatrics
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• 제50권12호
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• pp.1173-1179
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• 2007

The diagnosis of juvenile rheumatoid arthritis (JRA) is based on patient's age at disease onset, symptom duration, gender, and clinical manifestations. JRA is of unknown origin, begins under the age of 16, and persists for a minimum of 6 weeks. JRA is categorized into three principal types, systemic, oligoarticular and polyarticular. Infection, other connective tissue diseases, malignancy, trauma, and immunodeficiency are discussed as differential diagnoses for JRA. Because of joint damage, focusing on early diagnosis and intervention, a vigorous initial therapeutic approach must be taken in patients who have poor prognostic factors. A multidisciplinary team approach is also important for the care of patients with JRA.

• Tuberculosis and Respiratory Diseases
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• 제77권1호
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• pp.6-12
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• 2014

Severe sepsis is the most common cause of death among critically ill patients in non-coronary intensive care units. In 2002, the guideline titled "Surviving Sepsis Campaign" was published by American and European Critical Care Medicine to decrease the mortality of severe sepsis and septic shock patients, which has been the basis of the treatment for those patients. After the first revised guidelines were published on 2008, the most current version was published in 2013 based on the updated literature of until fall 2012. Other important revised guidelines in critical care field such as 'Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit' were revised in 2013. This article will review the revised guidelines and several additional interesting published papers of until March 2014, including the part of ventilator-induced lung injury and the preventive strategies.

• 한국항해항만학회지
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• 제42권4호
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• pp.291-298
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• 2018

본 연구는 선상 의료교육의 도움정도가 선원 및 의료관리자에게 얼마나 효과적인가를 분석하였다. 그리고 효과성의 측정치로 의료교육을 받고나서 느끼게 되는 선원 및 의료관리자의 주관적 평가인 만족도를 선정하였다. 자료의 수집기간은 2015년 10월부터 2018년 3월까지 약 2년 6개월 동안이었고, 총 310부의 설문지를 수집하여 표본으로 하였다. 다만, 본 연구에서 회귀분석 시 설문문항의 추가 및 수정으로 인해 96개의 표본만으로 회귀분석을 실시하였다. 본 연구는 선상 의료교육의 도움 정도(외상교육의 도움정도, 간호관리 교육의 도움정도, 심폐소생술 교육의 도움정도, 전반적인 교육내용의 도움정도)와 통제변수(총 승선경력, 연령, 최종학력, 교육년도)가 만족도에 미치는 영향을 밝히려고 했다. 분석결과는 다음과 같다. i) 외상교육의 도움정도가 높을수록 만족도는 높았다, ii) 전반적인 교육내용의 도움정도가 높을수록 만족도는 높았다, iii) 심폐소생술 교육의 도움정도가 높을수록 만족도는 높았다. iv) 총 승선경력이 많을수록 만족도가 낮았다, v) 최종학력이 높을수록 만족도는 높았다.

• Journal of Veterinary Science
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• 제23권6호
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• pp.70.1-70.13
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• 2022

Background: Fat stranding is a non-specific finding of an increased fat attenuation on computed tomography (CT) images. Fat stranding is used for detecting the underlying lesion in humans. Objectives: To assess the clinical significance of fat stranding on CT images for identifying the underlying cause in dogs and cats. Methods: In this retrospective study, the incidence, location, extent, distribution, and pattern of fat stranding were assessed on CT studies obtained from 134 cases. Results: Fat stranding was found in 38% (51/134) of all cases and in 35% (37/107) of tumors, which was significantly higher in malignant tumors (44%) than benign tumors (12%). Moreover, fat stranding was found in more than two areas in malignant tumors (16/33) and in a single area in benign tumors (4/4). In inflammation, fat stranding was demonstrated in 54% (7/13) in a single area (7/7) as a focal distribution (6/7). In trauma, fat stranding was revealed in 50% (7/14) and most were in multiple areas (6/7). Regardless of the etiologies, fat stranding was always around the underlying lesion and a reticular pattern was the most common presentation. Logistic regression analysis revealed that multiple areas (p = 0.040) of fat stranding and a reticulonodular pattern (p = 0.022) are the significant predictors of malignant tumor. Conclusions: These findings indicated that CT fat stranding can be used as a clue for identifying the underlying lesion and can be useful for narrowing the differential list based on the extent and pattern.

• Archives of Plastic Surgery
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• 제34권6호
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• pp.713-718
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• 2007

Purpose: The aim of this study is to develop and apply the critical pathway to the orbital wall fracture patients and to elucidate its effect. Methods: Critical pathway(CP) sheet and questionnaire were developed by a team approach. Critical pathway was applied to 7 orbital wall fracture patients (CP group) from April 2006 to September 2006. Length of hospitalization and cost for hospitalization of CP group were compared to those of the 10 patients who had same disease entities and treated by conventional regimen(control group). Results: Length of hospitalization in the CP group (7.20 day) were insignificantly shorter than that of control group(8.71 day). Mean cost for hospitalization of the CP group(776,398 won) were insignificantly lower than that of control group(1,028,531 won). The patients satisfaction for the explanation regarding operation procedure, therapeutic operation fee, length of hospitalization and medical personnel were all affirmative. Conclusion: Critical pathway that we developed for orbital wall fracture definitely improved the quality of treatment. Furthermore, other critical pathways should be developed for another facial trauma patients.

• 대한임상독성학회지
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• 제14권1호
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• pp.66-69
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• 2016

Some carnivorous gastropods have heat stable tetramine toxins in their salivary glands. This toxin is an autonomic ganglionic blocking agent that enables them to catch the prey easily by paralyzing their targets. Acute tetramine toxin poisoning in humans from eating whelks has been well described based on numerous cases, but is rare in Korea. Symptoms of tetramine poisoning include eyeball pain, blurred vision, headache, dizziness, muscular twitching, tingling of hands and feet, weakness, paralysis and sometimes collapse. Gastrointestinal symptoms, such as abdominal pain, nausea, and vomiting can also occur. However, intoxication is self-limiting and patients will usually recover in about 24 hours. Herein, we report 2 cases of tetramine poisoning after ingestion of Buccinum striatissinum as meat and soup.

• 한국응급구조학회지
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• 제25권3호
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• pp.189-200
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• 2021

Purpose: We aimed to provide effective emergency medical services (EMS) response strategies for coping with high acuity patients during the pandemic by analyzing the influence of the COVID-19 and social distancing on EMS. Methods: In this retrospective observational study, we analyzed the distribution of high acuity patients transported by Daejeon 1-1-9 EMS during the COVID-19 pandemic period, between February 1, 2020 and October 31, 2020 and the same period in 2019, as well as the level 3 social distancing enforced period, between July 27, 2020 and October 31, 2020. Results: The EMS dispatches decreased by 17% during the observed COVID-19 pandemic period compared to the same period in 2019. The number of cases with cardiac arrest and positive prehospital stroke scale rose by (p<.001). Patients with cardiac arrest, trauma, and positive prehospital stroke scale increased by during the level 3 social distancing period. Conclusion: Unlike the decreased EMS call volume and patient transports during the COVID-19 pandemic, cardiac arrest cases and the severity of high acuity patients tended to increase. We suggest that EMS systems should contrive a response strategy considering the collateral effect of major epidemics on the incidence rate of high acuity patients.

• 대한영상의학회지
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• 제81권4호
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• pp.852-862
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• 2020

인터벤션 색전술은 영상 유도하에 카테터를 출혈 부위에 위치하고, 젤폼 또는 코일 등의 색전 물질을 사용해서 출혈을 막는다. 의인성 외상을 치료하는 것 이외에, 수술이 불가능한 간 및 신장의 출혈(blush-bleeding) 및 혈관 손상을 진단하고 치료하는 데에 유용하다. 그러나 병원 일과 시간이 아닌 경우, 숙련된 인터벤션 의료팀이 항상 준비되어 있지는 않다. 이러한 상황에서 인터벤션 팀의 협업은 심각한 손상을 입은 환자를 빠르게 치료하는데 꼭 필요하다. 이 논문은 가상 투시장비 검사의 유용성에 대한 현재의 원칙과 기술을 검토하고 응급 인터벤션 시술에서 유용한 사례들을 제시하고자 한다.

• Journal of Clinical Nutrition
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• 제10권2호
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• pp.45-50
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• 2018

Purpose: Intense multidisciplinary team effort is required for the intestinal rehabilitation of patients afflicted with the short bowel syndrome (SBS). These include enteral and parenteral nutrition (PN) support, monitoring of complications related to treatment, and considering further medical or surgical options for intestinal adaptation. Methods: In the Intestinal Rehabilitation Team (IRT) at the Samsung Medical Center, we have experienced 20 cases of adult SBS requiring multidisciplinary intestinal rehabilitation. This study is a retrospective review of the collected medical records. Results: Of the 20 subjects treated, 12 patients were male and 8 patients were female. At the time of referral to the IRT, the mean age was 51.5 years, and the mean body weight was 50.1 kg, which was 90% of the usual body weight. The diseases or operative managements preceding massive bowel resection were malignancy in 11 cases, cardiac surgery in 2 cases, trauma in 2 cases and one case, each of tuberculosis, corrosive esophagitis, atrial fibrillation, simultaneous pancreas and kidney transplantation, and perforated appendicitis. Of these, there were 14 survivals and 6 mortalities. The fatalities were attributed to progression of disease, intestinal failure-associated liver disease, and sepsis (unrelated to intestinal failure) (2 cases each). Among the 14 surviving patients, 8 patients have been weaned off PN, whereas 6 are still dependent on PN (mean PN dependence 36%). Conclusion: This paper reports the results of multidisciplinary intestinal rehabilitation of adult short bowel patients treated at the Samsung Medical Center. Further studies are required to improve survival and enteral tolerance of these patients.

• The Korean Journal of Pain
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• 제31권3호
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• pp.155-173
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• 2018

Chronic postsurgical pain (CPSP) is an unwanted adverse event in any operation. It leads to functional limitations and psychological trauma for patients, and leaves the operative team with feelings of failure and humiliation. Therefore, it is crucial that preventive strategies for CPSP are considered in high-risk operations. Various techniques have been implemented to reduce the risk with variable success. Identifying the risk factors for each patient and applying a timely preventive strategy may help patients avoid the distress of chronic pain. The preventive strategies include modification of the surgical technique, good pain control throughout the perioperative period, and preoperative psychological intervention focusing on the psychosocial and cognitive risk factors. Appropriate management of CPSP patients is also necessary to reduce their suffering. CPSP usually has a neuropathic pain component; therefore, the current recommendations are based on data on chronic neuropathic pain. Hence, voltage-dependent calcium channel antagonists, antidepressants, topical lidocaine and topical capsaicin are the main pharmacological treatments. Paracetamol, NSAIDs and weak opioids can be used according to symptom severity, but strong opioids should be used with great caution and are not recommended. Other drugs that may be helpful are ketamine, clonidine, and intravenous lidocaine infusion. For patients with failed pharmacological treatment, consideration should be given to pain interventions; examples include transcutaneous electrical nerve stimulation, botulinum toxin injections, pulsed radiofrequency, nerve blocks, nerve ablation, neuromodulation and surgical management. Physical therapy, cognitive behavioral therapy and lifestyle modifications are also useful for relieving the pain and distress experienced by CPSP patients.