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Cantongqi and Its Relation to the System of Taegeuk (Taeil), Yin-yang, and the Five Movements (『참동계』와 태극(태일)-음양-오행 체계)

  • Lee, Bong-ho
    • Journal of the Daesoon Academy of Sciences
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    • v.37
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    • pp.263-295
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    • 2021
  • Until recently, academic consensus held that Zhou Dunyi's Taijitu (Taiji Diagram) originated from Cantongqi. However, a new debate has arisen wherein some scholars question that theory and related theories. They criticize these previous theories because the books and charts used as evidence in those theories were published after the lifetime of Zhou Dunyi, and this disqualifies their influence on his thought. However, identifying certain authors as being of a slightly later period than Zhou Dunyi does not definitively answer whether or not Zhou Dunyi's diagram was based on Cantongqi. I approached this problem from a different perspective. Zhou Dunyi's Taijitu is based on the system of taiji (Taiyi), yin-yang, and the five movements. Consequently, the formation of this system should be traced back historically. In the process of tracing it back, I intended to explain that the main character of Cantongqi is closely related to the formation of the system of taiji (Taiyi), yin-yang, and the five movements. The system of taiji (Taiyi), yin-yang, and the five movements was first established as a religious theological system in the Han Dynasty. In this process, yin-yang and the five movements were combined by Dong Zhongshu, and the five movements were introduced by Han Dynasty scholars as a method of interpreting the I-ching. However, Han Dynasty scholars did not form this system. In the late Han Dynasty, Cantongqi adopted the theological system of yin-yang and the five movements to theoretically form the system of taiji (Taiyi), yin-yang, and the five movements. Cantongqi was able to form this system because of the logic that yin-yang is the essence of the I-ching. Cantongqi does not have the same schematic as Taijitu. However, the system of taiji (Taiyi), yin-yang, and the five movements appears and extracts the components that make up Taijitu. Therefore, I do not think we should hastily agree with the recent claims made by scholars.

The risk factors for implant survival and marginal bone loss: a retrospective long-term study (임플란트 장기간 유지와 변연골 소실에 영향을 주는 요인들에 대한 후향적 연구)

  • Lee, Eun-Woo;Jung, Ha-Na;Jo, Yujin;Kim, Ok-Su
    • Journal of Dental Rehabilitation and Applied Science
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    • v.38 no.2
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    • pp.97-109
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    • 2022
  • Purpose: This study aims to investigate the risk indicators contributing to implant failure, and analyze the relationship between risk indicators and marginal bone loss (MBL) through long-term follow-up over 3 years. Materials and Methods: From 2003 to 2017, patients' medical charts with a history of dental implant surgery at Chonnam National University Dental Hospital were reviewed retrospectively. The patient's demographic variables, and clinical variables were recorded. Periapical radiographs were used to evaluated the changes in MBL around implants. And we analyzed implant survival rates. Multiple regression analysis with backward elimination was conducted to correlate the patient's clinical variables and implant failure and Pearson correlation analysis was performed to the correlated between implant long-term survival rates and MBL and initial stability. Results: In multiple regression analysis, there was a statistically significant negative correlation between abutment connection type (β = -.189, P < .05), with or without SPT (β = -.163, P < .05), diabetes (β = -.164, P < .05), osteoporosis (β = -.211, P < .05) and MBL. Anticoagulant medication influenced the long-term success rate of implants. PTV values at the second implant surgery showed a statistically significant negative correlation with long-term implant survival (P < .05). Conclusion: For the long-term success of the implant, the appropriate abutment connection type must be selected and the periodic SPT is recommended. Systemic diseases such as diabetes and osteoporosis and anticoagulant medication should be considered. Furthermore, since high PTV at the second implant surgery correlated with the long-term survival rates of the implant, initial stability should be carefully considered before undergoing the prosthetic procedure.

The Maritime Geography of Korea Strait: Suggested Nomenclature and Cartographic Boundaries Derived from a Review of Historical and Contemporary Maps (국제학술지, 지도, 문서에 나타난 대한해협 해양지명과 경계에 대한 인식 변화)

  • DO-SEONG BYUN;BYOUNG-JU CHOI
    • The Sea:JOURNAL OF THE KOREAN SOCIETY OF OCEANOGRAPHY
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    • v.28 no.2
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    • pp.63-93
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    • 2023
  • This study aims to examine the history of naming the strait between the Yellow and East China Seas and the East Sea to suggest a consistent nomenclature and to demarcate the geographic region of the strait. Although the strait is internationally known as 'Korea Strait', it is commonly referred to as the 'South Sea' in Korean common usage. This review ultimately recommends the use of 'Korea Strait' as an appropriate geographical name for this area. To support this recommendation, the historical boundaries typically assigned to the Korea Strait were investigated. We also analyzed the evolution of geographical labels assigned to Korea Strait and to the Western and Eastern Channels (labels given to the two maritime areas surrounding Tsushima). Resources for this analysis included historic maps and charts, International Hydrographic Organization Special Publications (S-23), and maps published in the Ocean Science Journal (OSJ) and Journal of Oceanography (JO), which are two international journals representing Korean and Japanese sources, respectively, from 2005 to 2021. In these two international journals, the most frequently used names assigned to the strait of interest were Korea Strait (appearing 42.9% of OSJ maps, and 7.5% of JO maps), and Tsushima Strait (appearing 60.4% of JO maps, and 0% of OSJ maps). Other names were South Sea and Korea Strait/Tsushima Strait. On maps in the two reviewed journals, the boundaries of Korea Strait were defined explicitly or implicitly in five different ways: a broad region between the Yellow and East China Seas and Ulleung Basin (Type 1), the region between Ulleung Basin and Tsushima (Type 2), the western channel of the strait (Type 3-1), the eastern channel of the strait (Type 3-2), and both the western and eastern channels of the strait (Type 4). Overall, Type 1 was the most frequently used boundary, taking up 71.4% of OSJ and 60.4% of JO maps. Lastly, we suggest in this paper that the current flowing through Korea Strait from the East China Sea to the East Sea should be labeled the 'Korea Strait Warm Current' to indicate its full path through the strait. Currently, this current is internationally referred to as the 'Tsushima Warm Current', which does not link well to the commonly used geographic name of the strait.

Implementing RPA for Digital to Intelligent(D2I) (디지털에서 인텔리전트(D2I)달성을 위한 RPA의 구현)

  • Dong-Jin Choi
    • Information Systems Review
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    • v.21 no.4
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    • pp.143-156
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    • 2019
  • Types of innovation can be categorized into simplification, information, automation, and intelligence. Intelligence is the highest level of innovation, and RPA can be seen as one of intelligence. Robotic Process Automation(RPA), a software robot with artificial intelligence, is an example of intelligence that is suited for simple, repetitive, large-scale transaction processing tasks. The RPA, which is already in operation in many companies in Korea, shows what needs to be done to naturally focus on the core tasks in a situation where the need for a strong organizational culture is increasing and the emphasis is on voluntary leadership, strong teamwork and execution, and a professional working culture. The introduction was considered naturally according to the need to find. Robotic Process Automation, or RPA, is a technology that replaces human tasks with the goal of quickly and efficiently handling structural tasks. RPA is implemented through software robots that mimic humans using software such as ERP systems or productivity tools. RPA robots are software installed on a computer and are called robots by the principle of operation. RPA is integrated throughout the IT system through the front end, unlike traditional software that communicates with other IT systems through the back end. In practice, this means that software robots use IT systems in the same way as humans, repeat the correct steps, and respond to events on the computer screen instead of communicating with the system's application programming interface(API). Designing software that mimics humans to communicate with other software can be less intuitive, but there are many advantages to this approach. First, you can integrate RPA with virtually any software you use, regardless of your openness to third-party applications. Many enterprise IT systems are proprietary because they do not have many common APIs, and their ability to communicate with other systems is severely limited, but RPA solves this problem. Second, RPA can be implemented in a very short time. Traditional software development methods, such as enterprise software integration, are relatively time consuming, but RPAs can be implemented in a relatively short period of two to four weeks. Third, automated processes through software robots can be easily modified by system users. While traditional approaches require advanced coding techniques to drastically modify how they work, RPA can be instructed by modifying relatively simple logical statements, or by modifying screen captures or graphical process charts of human-run processes. This makes RPA very versatile and flexible. This RPA is a good example of the application of digital to intelligence(D2I).

Development of smart education-based teaching and learning plans and a smart textbook for 'healthy diet and meal plans' unit in 「Technology·Home Economics」 (중학교 「기술·가정」의 '건강한 식생활과 식사 구성' 단원에 적용한 스마트 교수·학습 과정안과 교재 개발)

  • Choi, Song Eun;Chae, Jung-Hyun
    • Journal of Korean Home Economics Education Association
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    • v.26 no.4
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    • pp.85-114
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    • 2014
  • The main purpose of this study was to develop teaching and learning plans and a smart textbook for food and nutrition education in Home Economics focusing on 'healthy diet and meal plans' unit in "Technology home Economics" textbooks for 7th graders to evaluate the effectiveness of the instruction conducted with the smart textbook. The content of the study to achieve the purpose is as follows: First, design a smart education-based teaching and learning curriculum for food and nutrition education in Home Economics, focusing on 'healthy diet and meal plans' unit. Second, develop a smart textbook for food and nutrition education based on the teaching and learning curriculum, using a smart content authoring tool. Third, evaluate the effectiveness of the instruction after applying the curriculum in real classroom situations. The results of this study were as follows: First, teaching and learning plans and materials were developed for two units, 'issues regarding teenagers' diet' and 'implementation of a healthy and balanced diet', under 'teenagers' life'. The first unit, 'issues regarding teenagers' diet', dealt with topics such as teenagers' dietary behaviors, nutrition, and health. Learning objectives for this unit were to help students identify and evaluate their own dietary behaviors. The second unit, 'implementation of a healthy and balanced diet', encouraged students to diagnose problems with their diet and plan nutrient rich meals. The objectives for this unit were to help students implement a healthy and balanced diet by providing them with nutrition and dietary guidelines for Koreans, sample meal plans, and guidelines for developing healthy eating habits for teenagers. In order to develop a teaching and learning plans to achieve these objectives, teaching and learning materials including inquiry tasks, materials for group activities, multimedia, applications and various pop-up learning materials were developed. Second, a smart textbook using DocZoom, which was a smart content authoring tool was developed. The textbook dealt with issues regarding teenagers' diet and implementation of a healthy and balanced diet. Multimedia material used in the textbook come from the Ministry of Food and Drug Safety's food and nutrition education web sites and other sources. To develop student-oriented material, relevant video clips were added to the smart textbook to motivate students and enhance their interest in the course. Third, the outcome of this study indicated that the instruction using teaching and learning plans and learning materials with the smart textbook was effective for enhancing students' interest in Home Economics classes (t-value=-3.99, p<.001), creating enthusiasm for learning(t-value = -2.61, p<.05), encouraging self-directed and independent learning(t-value = -4.77, p<.001), and improving students' interest in food and nutrition courses(t-value = -3.83, p<.001). The students' evaluation of the instruction were as follows: the instruction using teaching and learning plans and learning materials with smart textbooks, instead of paper textbooks, helped them save time looking for learning materials; students evaluated that it was easier for them to see and understand video clips and charts. In addition, most students answered that instruction with smart textbooks were more fun and convenient, and they agreed that the courses enhanced their learning experience.

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Study of nosocomial rotavirus infection in neonates admitted to a postpartum-care center (서울시내 1개 산후 조리원에서 시행한 로타바이러스 선별검사에 대한 분석)

  • Park, Ji Young;Kim, Dong Hwan;Bae, Seung Young;Choi, Chang Hee;Cho, Eun Young;Choi, Jeong Hoon;Kim, Sun Mi
    • Pediatric Infection and Vaccine
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    • v.14 no.2
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    • pp.145-154
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    • 2007
  • Purpose : Rotavirus is one of the most important etiologic agents of nosocomial infections among the neonates. This study was designed to investigate nosocomial rotavirus infection in neonates who were admitted to a postpartum-care center after birth. Methods : From March 2005 to September 2006, 957 healthy neonates were examined for rotavirus antigen in stool by immunochromatographic method and 216 neonates were rotavirus antigen positive within 24 hours after admitted to a postpartum-care center. We reviewed the nursing charts retrospectively such as characteristics, monthly distribution, birth hospitals, delivery methods, feeding types and clinical manifestations. Results : Among 957 neonates, 216 neonates (22.6%) were rotavirus antigen positive and there were no differences in sex, birth weight, gestational age. Monthly positive rate of rotavirus antigen showed diversity from 10% to 36%. According to birth hospitals, positive rate showed diversity from 3.5% to 53.6%. Out of 957 neonates, 655 cases (68.4%) were born of vaginal delivery and mean hospitalized duration was 2.4 days, 302 cases (31.6%) were born of cesarean section and mean hospitalized duration was 5.7 days. 17.6% of vaginal delivery and 33.4% of cesarean section were rotavirus antigen positive. The positive rate was higher in neonates by cesarean section than vaginal delivery (P<0.001). According to feeding types, positive rate of rotavirus antigen was lower in breast-fed group than formula-fed group (P<0.001). Proportion of symptomatic case among rotavirus antigen positive was 34.7%. Most common clinical manifestation was diarrhea (61.3%), following poor feeding (45.3%), fever (40.0%), vomiting (25.3%), delayed weight gain (12.0%), and decreased urine amount (5.3%). Conclusion : Some neonates were already infected before admission to a postpartum-care center. Without meticulous management, nosocomial rotavirus infection would transmit rapidly in a postpartum-care center spreading to the community. Recommendation of breast-feeding, routine rotavirus screeing test with or without symptom, and isolation of all rotavirus antigen positive neonates in a postpartum-care center seem to be necessary. Also attentive hygiene education and further investigations of rotavirus infection in a postpartum-care center would be needed.

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Study of Patient Teaching in The Clinical Area (간호원의 환자교육 활동에 관한 연구)

  • 강규숙
    • Journal of Korean Academy of Nursing
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    • v.2 no.1
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    • pp.3-33
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    • 1971
  • Nursing of today has as one of its objectives the solving of problems related to human needs arising from the demands of a rapidly changing society. This nursing objective, I believe, can he attained by the appropriate application of scientific principles in the giving of comprehensive nursing care. Comprehensive nursing care may be defined as nursing care which meets all of the patient's needs. the needs of patients are said to fall into five broad categories: physical needs, psychological needs, environmental needs, socio-economic needs, and teaching needs. Most people who become ill have adjustment problems related to their new situation. Because patient teaching is one of the most important functions of professional nursing, the success of this teaching may be used as a gauge for evaluating comprehensive nursing care. This represents a challenge foe the future. A questionnaire consisting of 67 items was distributed to 200 professional nurses working ill direct patient care at Yonsei University Medical Center in Seoul, Korea. 160 (80,0%) nurses of the total sample returned completed questionnaires 81 (50.6%) nurses were graduates of 3 fear diploma courser 79 (49.4%) nurses were graduates of 4 year collegiate nursing schools in Korea 141 (88,1%) nurses had under 5 years of clinical experience in a medical center, while 19 (11.9%) nurses had more than 5years of clinical experience. Three hypotheses were tested: 1. “Nurses had high levels of concept and knowledge toward patient teaching”-This was demonstrated by the use of a statistical method, the mean average. 2. “Nurses graduating from collegiate programs and diploma school programs of nursing show differences in concepts and knowledge toward patient teaching”-This was demonstrated by a statistical method, the mean average, although the results showed little difference between the two groups. 3. “Nurses having different amounts of clinical experience showed differences in concepts and knowledge toward patient teaching”-This was demonstrated by the use of a statistical method, the mean average. 2. “Nurses graduating from collegiate programs and diploma school programs of nursing show differences in concepts and knowledge toward patient teaching”-This was demonstrated by a statistical method, the mean average, although the results showed little difference between the two groups. 3. “Nurses having different amounts of clinical experience showed differences in concepts and knowledge toward patient teaching”-This was demonstrated by the use of the T-test. Conclusions of this study are as follow: Before attempting the explanation, of the results, the questionnaire will he explained. The questionnaire contained 67 questions divided into 9 sections. These sections were: concept, content, time, prior preparation, method, purpose, condition, evaluation, and recommendations for patient teaching. 1. The nurse's concept of patient teaching: Most of the nurses had high levels of concepts and knowledge toward patient teaching. Though nursing service was task-centered at the turn of the century, the emphasis today is put on patient-centered nursing. But we find some of the nurses (39.4%) still are task-centered. After, patient teaching, only a few of the nurses (14.4%) checked this as “normal teaching.”It seems therefore that patient teaching is often done unconsciously. Accordingly it would he desirable to have correct concepts and knowledge of teaching taught in schools of nursing. 2. Contents of patient teaching: Most nurses (97.5%) had good information about content of patient teaching. They teach their patients during admission about their diseases, tests, treatments, and before discharge give nurses instruction about simple nursing care, personal hygiene, special diets, rest and sleep, elimination etc. 3. Time of patient teaching: Teaching can be accomplished even if there is no time set aside specifically for it. -a large part of the nurse's teaching can be done while she is giving nursing care. If she believes she has to wait for time free from other activities, she may miss many teaching opportunities. But generally proper time for patient teaching is in the midmorning or midafternoon since one and a half or two hours required. Nurses meet their patients in all stages of health: often tile patient is in a condition in which learning is impossible-pain, mental confusion, debilitation, loss of sensory perception, fear and anxiety-any of these conditions may preclude the possibility of successful teaching. 4. Prior preparation for patient teaching: The teaching aids, nurses use are charts (53.1%), periodicals (23.8%), and books (7.0%) Some of the respondents (28.1%) reported that they had had good preparation for the teaching which they were doing, others (27.5%) reported adequate preparation, and others (43.8%) reported that their preparation for teaching was inadequate. If nurses have advance preparation for normal teaching and are aware of their objectives in teaching patients, they can do effective teaching. 5. Method of patient teaching: The methods of individual patient teaching, the nurses in this study used, were conversation (55.6%) and individual discussion (19.2%) . And the methods of group patient teaching they used were demonstration (42.3%) and lecture (26.2%) They should also he prepared to use pamphlet and simple audio-visual aids for their teaching. 6. Purposes of patient teaching: The purposes of patient teaching is to help the patient recover completely, but the majority of the respondents (40.6%) don't know this. So it is necessary for them to understand correctly the purpose of patient teaching and nursing care. 7. Condition of patient teaching: The majority of respondents (75.0%) reported there were some troubles in teaching uncooperative patients. It would seem that the nurse's leaching would be improved if, in her preparation, she was given a better understanding of the patient and communication skills. The majority of respondents in the total group, felt teaching is their responsibility and they should teach their patient's family as well as the patient. The place for teaching is most often at the patient's bedside (95.6%) but the conference room (3.1%) is also used. It is important that privacy be provided in learning situations with involve personal matters. 8. Evaluation of patient teaching: The majority of respondents (76.3%,) felt leaching is a highly systematic and organized function requiring special preparation in a college or university, they have the idea that teaching is a continuous and ever-present activity of all people throughout their lives. The suggestion mentioned the most frequently for improving preparation was a course in patient teaching included in the basic nursing program. 9. Recommendations: 1) It is recommended, that in clinical nursing, patient teaching be emphasized. 2) It is recommended, that insertive education the concepts and purposes of patient teaching he renewed for all nurses. In addition to this new knowledge, methods and materials which can be applied to patient teaching should be given also. 3) It is recommended, in group patient teaching, we try to embark on team teaching.

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Efficacy of Self-manipulation Technique in the Treatment of Patients with Anterior Disc Displacement without Reduction (비정복성 관절원판 전방변위 환자의 치료에 있어서 자가 수조작술의 효과에 대한 연구)

  • Kim, Ju-Sik;Lee, Chae-Hoon;Kim, Young-Ku
    • Journal of Oral Medicine and Pain
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    • v.32 no.4
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    • pp.441-447
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    • 2007
  • Internal derangement of the temporomandibular joint(TMJ) is defined as an abnormal relationship of the articular disc to the condyle. Mandibular manipulation is one of the conservative treatments to be considered first to manage the patients with anterior disc displacement without reduction. Mandibular manipulation is used to increase articular mobility and to restore the displaced disc into an anatomically normal position. While Farrar's technique has been popularly used, Minagi et al., Mongini and Suarez introduced the manipulation technique conducted by the patients themselves. But there is no study on the efficacy of self-manipulation technique, comparing with conventional one. The aim of this study was to investigate the efficacy of the conventional and self-manipulation technique, which was modified to complement the previously described technique by Minagi et al., in the treatment of patients with anterior disc displacement without reduction. TMD patients, who visited Department of Oral Medicine of Seoul National University Dental Hospital from December, 2002 to November, 2004 and were diagnosed as anterior disc displacement without reduction by TMJ magnetic resonance imaging (MRI) were enrolled. Conservative treatments including physical therapy, exercise, behavioral therapy, stabilization splint therapy, and manipulation therapy were done to every single patient until the symptomsimproved enough to discharge the patient. The charts were reviewed retrospectively according to the type of manipulation. In the results, patients whose maximum mouth opening was more than 40 mm was higher in the self-manipulation group(69.9%) than in the conventional manipulation group(42.9%). But difference between two groups was not significant. According to the fact that we decided to discharge the patients whentheir mouth opening increased to more than 40 mm and subjective symptoms such as pain and discomfort were improved as well, treatment period of discharged patients was significantly shorter in the self-manipulation group($29.2{\pm}12.3$ weeks) than in the conventional manipulation group ($61.0{\pm}38.0$ weeks) (p<0.01). In conclusion, in the treatment of TMD patients with anterior disc displacement without reduction, the self-manipulation technique which is performed by patients themselves is an effective treatment modality for increasing the range of mouth opening and shortening the total treatment period.

Deep Neck Abscesses in Korean Children (소아 심부 경부 농양에 대한 임상적 고찰)

  • Lee, Dae Hyoung;Kim, Sun Mi;Lee, Jung Hyun;Kim, Jong Hyun;Hur, Jae Kyun;Kang, Jin Han
    • Pediatric Infection and Vaccine
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    • v.11 no.1
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    • pp.81-89
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    • 2004
  • Purpose : Retropharyngeal and parapharyngeal abscesses are often distinguishable from other head and neck abscesses on clinical grounds, but these infections can combine and the presentations are similar to one another. Because of the advances of antibiotic therapy, the frequency of the diseases decreased considerably, but recently the incidence of neck abscesses has increased. We sought to describe the clinical presentation of patients with deep neck abscess, and implications on management. Methods : For 10 year periods, 94 cases of charts were reviewed retrospectively, who were diagnosed as neck abscesses aged below 16 years old(between January 1993 to August 2003) in 4 hospitals. Deep neck abscesses were diagnosed by surgical pus drainage, neck CT (homogenous, hypodense area with ring enhancement) and neck sono findings. Results : The annual incidence of deep neck abscess has been increased since 2000. The median age of the patients was 4 years(range, 26 days~15 years); 63% of the patients were younger than 5 years. Abscesses in the submandibular space(34%) were most common, followed by peritonsillar space(29.7%), retropharyngeal space(11.7%), combined(10.8%), parotid space(7.4%) and parapharyngeal space(6.4%). Fever(73.4%), sore throat(37.2%), decreased oral intake(34%) and neck pain(27.7%) were the most common symptoms. In 6 children(6.4%), there was refusal to move neck, in 6(6.4%) headache, and in 4(4.3%) torticollis. Respiratory distress was observed in only 1 patient(2.1%) and stridor in 1 other(2.1%). The most common physical examinations were neck swelling/mass(67%), pharyngitis(46.8%), tonsillitis(36.2 %), and cervical lymphadenopathy(28.7%). Neck stiffness was observed in 4 patients(4.3%). Total 35 organisms were isolated in 33 patients. The most common organisms cultured by patients' blood or pus were S. aureus(34%) and S. pyogenes(28.6%). Most organisms were gram positive, and had sensitivities in vancomycin(96.4%), cefotaxime(88.9%), cephalothin (86.4%), trimethoprime-sulfamethoxazole(83.3%), and clindamycin(77.8%). 77 patients(81.9%) underwent surgery plus antibiotics; 17 patients(18.1%) were treated with antibiotics only. There is no significant differences between two groups. In duration of admission, fever after admission, and antibiotic treatment. Conclusion : The incidence of deep neck abscess has increased recently and the major symptoms have been changed. The incidence of respiratory distress or stridor is decreasing, while the incidence of abnormal head and neck symptoms and signs like headache, neck stiffness, refusal to move neck, or torticollis are increasing. Gram positive organisms are predominant, S. aureus is the most common followed by S. pyogenes. 1st generation cephalosporin has high sensitivity on gram positive organisms. Treatment with surgery plus antibiotics dose not significantly decrease total duration of antibiotic treatment or admission compared to treatment with antibiotics alone.

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Analysis of the Causes of Subfrontal Recurrence in Medulloblastoma and Its Salvage Treatment (수모세포종의 방사선치료 후 전두엽하방 재발된 환자에서 원인 분석 및 구제 치료)

  • Cho Jae Ho;Koom Woong Sub;Lee Chang Geol;Kim Kyoung Ju;Shim Su Jung;Bak Jino;Jeong Kyoungkeun;Kim Tae_Gon;Kim Dong Seok;Choi oong-Uhn;Suh Chang Ok
    • Radiation Oncology Journal
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    • v.22 no.3
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    • pp.165-176
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    • 2004
  • Purpose: Firstly, to analyze facto in terms of radiation treatment that might potentially cause subfrontal relapse in two patients who had been treated by craniospinal irradiation (CSI) for medulloblastoma, Secondly, to explore an effective salvage treatment for these relapses. Materials and Methods: Two patients who had high-risk disease (T3bMl, T3bM3) were treated with combined chemoradiotherapy CT-simulation based radiation-treatment planning (RTP) was peformed. One patient who experienced relapse at 16 months after CSI was treated with salvage surgery followed by a 30.6 Gy IMRT (intensity modulated radiotherapy). The other patient whose tumor relapsed at 12 months after CSI was treated by surgery alone for the recurrence. To investigate factors that might potentially cause subfrontal relapse, we evaluated thoroughly the charts and treatment planning process including portal films, and tried to find out a method to give help for placing blocks appropriately between subfrotal-cribrifrom plate region and both eyes. To salvage subfrontal relapse in a patient, re-irradiation was planned after subtotal tumor removal. We have decided to treat this patient with IMRT because of the proximity of critical normal tissues and large burden of re-irradiation. With seven beam directions, the prescribed mean dose to PTV was 30.6 Gy (1.8 Gy fraction) and the doses to the optic nerves and eyes were limited to 25 Gy and 10 Gy, respectively. Results: Review of radiotherapy Portals clearly indicated that the subfrontal-cribriform plate region was excluded from the therapy beam by eye blocks in both cases, resulting in cold spot within the target volume, When the whole brain was rendered in 3-D after organ drawing in each slice, it was easier to judge appropriateness of the blocks in port film. IMRT planning showed excellent dose distributions (Mean doses to PTV, right and left optic nerves, right and left eyes: 31.1 Gy, 14.7 Gy, 13.9 Gy, 6.9 Gy, and 5.5 Gy, respectively. Maximum dose to PTV: 36 Gy). The patient who received IMRT is still alive with no evidence of recurrence and any neurologic complications for 1 year. Conclusion: To prevent recurrence of medulloblastoma in subfrontal-cribriform plate region, we need to pay close attention to the placement of eye blocks during the treatment. Once subfrontal recurrence has happened, IMRT may be a good choice for re-irradiation as a salvage treatment to maximize the differences of dose distributions between the normal tissues and target volume.