• Clinics in Shoulder and Elbow
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• 제13권2호
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• pp.286-292
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• 2010

목적: 관절의 적절한 기능을 위해서는 관절의 안정성과 운동 범위의 유지가 필요하다. 주관절과 연관된 환자의 주소의 대부분이 주관절의 강직이다. 최근 보고들에서 주관적의 강직에 대한 치료에서 우수한 결과가 보고되고 있다. 그러나 어떠한 술식을 선택하여야 하는 것은 결정하기 어렵다. 대상 및 방법: Morrey 등은 기능적인 운동 범위를 30-130도의 굴곡-신전 범위, 50도 회내전 및 50도 회외전이라고 하였다. 이 범위에서 일상 생활의 약 90%가 이루어 진다. 주관절 강직은 원인이 되는 외상과 주 병변의 위치에 따라서 분류할 수 있다. 관절 내 원인으로는 심각한 관절 내 불일치, 관절 내 유착 또는 관절 내 연골의 소실, 골극 형성에 의한 기계적 제한, 관절 내 유리체, 활액막의 과다 증식이 해당된다. 관절 외 원인으로는 외상 또는 탈구에 의한 심한 관절막의 유착, 측부 인대 또는 근육의 구축이 해당된다. 결과 및 결론: 신전 제한의 주 원인은 전방 관절막의 섬유화에 의한 구축이다. 이러한 병변은 전방 관절막 절제술이 도움이 된다. 굴곡 제한의 주 원인은 내측부 인대의 후방대의 구축이다.

• Journal of Trauma and Injury
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• 제25권4호
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• pp.196-202
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• 2012

Purpose: This study aimed to recognize the frequency of near-hanging patients with elevated Troponin-I (Tn-I), to obtain information necessary for treatment and prediction of prognosis by analyzing the clinical feature of near-hanging patients, and to evaluate the relevance of elevated Tn-I to abnormal result of other cardiac-related examinations. Methods: A retrospective review for the near-hanging patients, clinical record was conducted at two urban training hospitals between April, 2001 and December, 2011. We divided included patients into two groups, which one with elevated Tn-I level ($Tn-I{\geq}0.1ng/dL$) and one without it, and compared the differences in initial vital signs, cardiac enzyme tests, an electrocardiogram, echocardiography, chest X-ray, and the clinical outcomes. Results: A total of 39 patients were included, out of them, 14 patients showed rise in Tn-I level. The length of hospital stay and ICU hospitalization was more prolonged in the patient group with elevated Tn-I level than non-elevated group. As well as the incidence of endotracheal intubation and abnormal findings in echocardiography or chest X-ray was higher in the Tn-I elevated group, which is statistically significant. Conclusion: The rising of serum Tn-I level in near-hanging patients were not uncommonly observed. We believe that the cardiac-related test including Tn-I is necessary for near-hanging patients, and those who are shown abnormal result in cardiac-related test may need close observation and intensive care.

• Radiation Oncology Journal
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• 제31권3호
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• pp.155-161
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• 2013

Purpose: To evaluate the treatment outcomes of preoperative versus postoperative concurrent chemoradiotherapy (CRT) on locally advanced rectal cancer. Materials and Methods: Medical data of 114 patients with locally advanced rectal cancer treated with CRT preoperatively (54 patients) or postoperatively (60 patients) from June 2003 to April 2011 was analyzed retrospectively. 5-Fluorouracil (5-FU) or a precursor of 5-FU-based concurrent CRT (median, 50.4 Gy) and total mesorectal excision were conducted for all patients. The median follow-up duration was 43 months (range, 16 to 118 months). The primary end point was disease-free survival (DFS). The secondary end points were overall survival (OS), locoregional control, toxicity, and sphincter preservation rate. Results: The 5-year DFS rate was 72.1% and 48.6% for the preoperative and postoperative CRT group, respectively (p = 0.05, the univariate analysis; p = 0.10, the multivariate analysis). The 5-year OS rate was not significantly different between the groups (76.2% vs. 69.0%, p = 0.23). The 5-year locoregional control rate was 85.2% and 84.7% for the preoperative and postoperative CRT groups (p = 0.98). The sphincter preservation rate of low-lying tumor showed significant difference between both groups (58.1% vs. 25.0%, p = 0.02). Pathologic tumor and nodal down-classification occurred after the preoperative CRT (53.7% and 77.8%, both p < 0.001). Acute and chronic toxicities were not significantly different between both groups (p=0.10 and p = 0.62, respectively). Conclusion: The results confirm that preoperative CRT can be advantageous for improving down-classification rate and the sphincter preservation rate of low-lying tumor in rectal cancer.

• 한국임상수의학회지
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• 제28권2호
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• pp.258-261
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• 2011

8연령의 암컷 요크셔 테리어견이 요실금을 주증으로 내원하였다. 환축은 요실금 증상이 나타나기 이전부터 다음다뇨 증상을 가지고 있었으며, 난소제거 8개월 이후 야뇨증이 나타났다. 신체검사 상에서 비만과 고혈압이 확인되었다. 실험실 검사에서 적혈구증가증, 지질혈증 및 간수치 증가가 관찰되었다. 다양한 검사를 통하여 난소제거 이후 발생한 요도 괄약근 기능부전증이 가장 의심되었다. 이와 더불어 본 환축은 부신피질기능 항진증을 가진 것으로 진단되었다. 합성 에스트로겐인 디에틸스틸베스테롤을 통한 치료적 접근에서 요실금 증상의 개선이 확인 되었으며, 이를 통하여 요도 괄약근 기능부전증이 요실금의 원인으로 확진 되었다. 결론적으로 본 증례는 부신피질기능 항진증과 더불어 암캐의 난소 제거 이후 발생한 요도 괄약근 기능부전의 임상증상과 실험실 검사 결과 그리고, 치료 반응에 대한 국내 첫 증례보고이다.

• 한국수정란이식학회지
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• 제15권1호
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• pp.9-14
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• 2000

This experiment was undertaken to investigate the effect of administration of Agyoju or Mokhyang on the maintenance of pregnancy, delivery and sex ratio in the mice in different gestation periods. Adult female mice were administered orally at three different periods, from ovulation to implantation (Exp.1), from post-implantation to organogenesis (Exp.2), and from fetal growth to parturition (Exp.3). In Experiment 1, number of fetus implanted and mean body weight were not significantly different. However, the delivery of male offspring was significantly increased in Agyoju and Mokhyang administrated groups than control group. In Experiment 2, the number of fetuses implanted, live offsprins and their body weight at delivery were significantly increased in the Agyoju administered group than Mokhyang and control groups. In Experiment 3, the number of live offspring and sex ratio were not different in both treatments and control group. However, mean body weight at delivery was significantly increased in both treatment groups than that of control group. These results suggest that 1) Agyoju and Mokhyang have beneficial effects in maintenance of pregnacy, and that 2) The action of unknown component(s) in Agyoju may be related to selection of male spermatozoa for fertilization in vivo, and that 3) the administration of Agyju of Mojhyang during mid-and late-pregnance periods were shown the increment of body weight of live offspring without decrease of litter size.

• Journal of Preventive Medicine and Public Health
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• 제40권6호
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• pp.487-494
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• 2007

Objectives : Little is known about the physician-related factors that are associated with the management of Hypertension. The purpose of this study was to determine the physician-related factors associated with blood pressure control in hypertensive patients. Methods : We surveyed 154 physicians at 117 public health (subhealth) centers in Gyeonggi-do, Forty-one physicians completed the survey (response rates : 26.6%) and 31 physicians were finally included as the study subjects. Using the information obtained from the self-reported survey, we measured the physician-related factors associated with hypertension control, including their perception of hypertension, prescription patterns (combination prescription rates, specific antihypertensives prescription rates among patients with diabetes mellitus), and sociodemographic factors. We then collected data on blood pressure and medication use in patients seen by these physicians from the health center#s information system. We compared the physicians# perceived hypertension control rates with the actual rates, and then evaluated the rate of high overestimation (overestimation by more than 25% of the median degree of hypertension control rate overestimation) among the physicians. The physicians# antihypertensive prescription patterns were also evaluated. Multiple logistic regression analysis was used to evaluate the independent association between hypertension control and physician-related factors. Results : The physicians tended to overestimate the proportion of their patients with controlled blood pressure (79.5% perceived vs. 57.8% actual). The percentage of physicians with high overestimation was 35.5% (11 physicians). The physicians with lower control rates were more likely to highly overestimate their patients# control rates. Physicians with below-median actual control rates tended to prescribe fewer combination treatments for patients with uncontrolled blood pressure and angiotensin-converting enzyme inhibitors or fewer angiotensin receptor blockers for patients with diabetes mellitus. The rate of high overestimation by physicians was 1.31 times higher in patients with uncontrolled blood pressure than in patients with other conditions (OR=1.31, 95% CI : 1.17-1.48). Conclusions : Physicians have a tendency to overestimate the rates of hypertension control in their patients. Because physicians have a direct role in treatment outcomes, physicians# overestimation about hypertension management contributes to inadequate blood pressure control. Thus, interventions for improving physician# awareness regarding the management of patients with hypertension are needed.

• Journal of Chest Surgery
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• 제39권11호
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• pp.822-827
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• 2006

배경: 폐 이식 수술은 호흡부전을 동반한 말기 폐질환 환자에서 유용한 치료방법 중의 하나로 본원에서는 1996년 국내에서 처음으로 일측 폐 이식 수술을 성공한 이래로 현재까지 재 이식 2예를 포함한 총 13예의 폐 이식 수술을 시행하였다. 저자 등은 그동안 환자들의 수술성적 및 합병증, 생존율 등을 분석하고자 하였다. 대상 및 방법: 1996년 7월부터 2005년 7월까지 영동세브란스병원 흉부외과에서 폐 이식을 시행받은 13예, 11명의 환자(2명은 재 이식환자)를 대상으로 후향적으로 임상기록지를 분석하였다. 결과: 남녀비는 9:4, 평균연령은 $45.2{\pm}10.7$세(범위 $25{\sim}59$세)였으며, 폐기종 및 만성폐쇄성 폐질환이 5예로 가장 많았고, 동맥관 개존증으로 인한 아이젠맹거 증후군 2예, 폐섬유증, 폐고혈압, 림프관 평활근종증, 기관지확장증이 각 1예였다. 조기 합병증으로는 출혈, 이식 폐 부전, 감염이며 후기 합병증으로는 감염 및 이식 후 림프증식증이었다. 조기사망 3예를 제외한 평균생존기간은 16.5개월($2{\sim}60$개월)이었다. 재 이식 2예는 이식 폐의 기능 부전에 의하여 각각 첫 이식 후에 2주, 13개월째 시행 받았다. 결론: 폐 이식 수술 후 장기성적을 향상시키기 위해서는 수술술기의 향상뿐만 아니라 수술 후 집중적인 환자관리를 통하여 합병증을 조기에 발견하고 필요한 내과적, 외과적 처치를 즉시 시행하는 것이 예후에 좋은 영향을 미칠 것으로 생각된다.

• 대한유전성대사질환학회지
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• 제18권1호
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• pp.23-29
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• 2018

Carbamoyl phosphate synthetase 1 (CPS1) 결핍은 고암모니아혈증을 특징으로 하는 요소 회로 이상 질환 중 하나로 상염색체 열성으로 유전되며 2q35 염색체에 존재하는 CPS1 유전자 변이로 인해 발생된다. CPS1 결핍은 발병 연령에 따라 신생아형과 신생아기 이후에 발생하는 지연형으로 나뉜다. CPS1 결핍의 임상 양상의 중증도는 주로 효소 활성 결핍의 정도에 따라 다를 수 있으며, 고암모니아혈증으로 신경 기능 이상 및 장애를 초래하게 된다. 본 증례는 생후 25일 즈음 구토, 의식 저하, 고암모니아혈증을 보여 시행한 생화학적, 분자유전학적 검사(targeted gene panel sequencing)를 통해 CPS1 결핍을 진단하였다. 수액 치료, 관장, 소듐 벤조에이트 치료로 고암모니아혈증 및 임상 양상 호전 보여 응급 투석을 시행하지 않았으며 생후 17개월까지 관찰한 결과 고암모니아혈증의 재발없이 성장과 발달 및 신경학적 예후가 좋음을 보고하는 바이다.

• 가정∙방문간호학회지
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• 제2권
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• pp.35-51
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• 1995

This study was done to define nursing diagnose and to test the validity of the characteristics for patients with cerebrovascular accidents being seen at home by home health care nurses. This study was a descriptive study. The sample consisted of 10 experts(professors and home health care nurses) who had had a variety of experience using nursing diagnoses in clinical practice, and 336 nurse progress notes for 18 patients with cerebrovascular accidents. First, 32 nursing diagnoses were defined by the analysis of 336 nurse progress notes, and ten nursing diagnoses were selected according to a criteria of frequency and four nursing diagnoses from home health care clinical practice. Second, content validity was examined by an expert group which considered the sign / symtoms of the fourteen nursing diagnoses. The instrument used for this was a checklist for sign / symtoms based on the nurse progress notes and literature : Carpenito(1993), Kim Cho Ja et al (1994), Lee Sun Ok et al.(1994), Kim Mae Ja et al. (1992), Seoul University Hospital (1993) , Kim Mi Ja et al. (1991). The data were collected from March 1995 to April 1995. Data were analyzed using Content Validity Incidence where if 80% or more of the expert group agreed, characteristics were defined as a major sign/symtoms, if between 50% and 79% of the expert group agreed with the characteristic it was defined as a minor sign / symtoms. The results of this study are summarized as follows : 1. Thirty-two nursing diagnoses related to patients with cerebrovascular accidents were defined. There was a high frequency for the following : 'Potential for disuse syndrome (61%)', 'Impaired physical mobility(50%)', 'Impaired skin integrity (44.4%)', Potential for aspiration(33.3%)', 'Potential for infection: respiration(33.3%)', 'Self-care deficit : bathing /hygine(27.8%)', 'Ineffective family coping(22.2%)', 'Potential for trauma(22.2%)', 'Alteration in nutrition: less than body requirements(22.2%)'. The following diagnoses were also used in home health care clinical practice : 'Anxiety in family (50%)', 'Caregiver fatigue(27.8%)', 'Ineffective treatment behavior (22.2%)', 'Ineffective Levin tube management and Levin tube feeding(22.2%)'. Fourteen nursing diagnoses were selected. 2. Ten of the nursing diagnoses for patients with cerebrovascular accident were listed as nursing diagnoses by NANDA but four nursing diagnoses were new nursing diagnoses used in home health care clinical practice. 3. Characteristics of the ten Nursing Diagnoses from NANDA were developed from the sign /symtoms in the literature and in the nurse progress notes. These characteristics was verified as major or minor sign / symtoms by the expert group. 4. Characteristics of the four nursing diagnoses used in home health care were not defined by the literature but only by the nurse progress notes and verified as major or minor signs /symtoms by the expert group. On the basis of the findings of this study, the following recommendations are made : 1. Continual study is necessary to identify other signs /symtoms not verified in this study. 2. It is necessary to use verified signs /symtoms in home health care clinical practice. 3. It is necessary to define related factors which define each diagnoses in this study. 4. It is necessary to develop of standardized nursing are plans which include defined signs and symtoms. 5. It is necessary to study the outcomes of the standardized nursing care plans.

• 한국콘텐츠학회논문지
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• 제12권2호
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• pp.483-496
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• 2012

학습자의 정보처리유형에 따른 e-Book 인터페이스의 설계 및 개발은 학습자 중심의 적성처지교수를 위해 중요한 이슈가 된다. 이에 본 연구에서는 하이퍼텍스트 정보구조가 제공된 e-Book 학습환경에서 학습자의 정보처리유형이 학습내용 이해 및 사용 편의성에 있어 어떠한 차이를 보이는지를 검증해 봄으로써 보다 처방적인 e-Book 인터페이스의 설계전략에 대한 시사점을 제공하고자 하였다. 본 연구를 위해 대학생 68명이 참여하였으며, 하이퍼텍스트 정보구조가 제공된 e-Book 콘텐츠를 통해 학습한 후 정보처리유형(시각 정보처리, 언어 정보처리)에 따른 학업성취도 (텍스트 구조 파악 및 학습내용이해)와 사용 편의성에 대한 효과성을 검증하였다. 연구결과, 학업성취도에 있어서는 정보처리 유형에 따라 텍스트 구조 파악에는 유의미한 차이가 나타났으나, 학습내용 이해에는 유의미한 차이가 나타나지 않았다. 사용 편의성에 있어서는 학습자의 정보처리유형에 따라 유의미한 차이가 나타났으며, 구체적으로는 텍스트 구조 파악의 용이성, 텍스트 분량 파악의 용이성, 네비게이션의 용이성, 그리고 내용기억의 편의성 등에 있어 유의미한 차이가 나타났다. 또한 학업성취도에 영향을 미친 사용 편의성의 주요요인은 학습위치 파악의 용이성이었으며, 정보처리유형의 집단간 분류의 정확도는 79.4%로 비교적 높은 것으로 나타났다. 이러한 결과를 바탕으로 e-Book 콘텐츠 설계 및 개발에 대한 전략적 시사점에 논의 되었다.