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Esophageal Atresia and Tracheoesophageal Fistula in Korea - A National Survey of Its Members by the Korean Association of Pediatric Surgeons - (선천성 식도 무공증 및 기관식도 누공 - 대한 소아외과학회 회원을 대상으로 한 전국 조사 -)

  • Park, W.H.;Kwon, S.I.;Kim, S.C.;Kim, S.K.;Kim, W.K.;Kim, I.K.;Kim, J.E.;Kim, H.H.;Park, K.W.;Park, Y.S.;Song, Y.T.;Yang, J.W.;Oh, S.M.;Yoo, S.Y.;Lee, D.S.;Lee, M.D.;Lee, S.C.;Lee, S.K.;Lee, T.S.;Chang, S.I.
    • Advances in pediatric surgery
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    • v.1 no.2
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    • pp.149-161
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    • 1995
  • The first national survey on esophageal atresia and tracheoesophageal fistula was conducted to access the current status of its incidence, clinical manifestation, preoperative diagnosis and management, type of its anomaly, associated anomalies, and surgical results and course. The 43 members of the Korea Association of Pediatric Surgeons received questionnaires and registration forms to be filled out on each patient who were born during the three years from January 1, 1992 through December 31, 1994. Questionnaires composed of six broad areas which include 1) preoperative diagnosis and management, 2) surgical technic, 3) long gap, 4) postoperative management, and 5) complications and courses. A total of 148 cases was returned by 28 members working at 23 institutions and 27 members returned questionnaires. We obtained the following results by analysis of the 148 cases of tracheoesophageal anomalies. The incidence of tracheoesophageal anomaly was about 1/10,000-11,000 in 1994, which is one third of that of anorectal malformations in Korea and the distribution of the patients was almost proportionate to the size of each province. Both sexes are about equally affected. Majority of the members make diagnosis of tracheoesophageal anomaly by taking a simple infantogram with a radiopaque tube in upper pouch and a little under half(46%) prefers to perform echocardiography as a part of preoperative management to identify congenital heart disease and lateralize the aorta. Esophageal atresia with distal TEF(87.5%) was by far the most common and there were pure esophageal atresia(5.6%), H-type TEF(2.1%), and so on. About half(49%) of the patients had one or more associated anomalies in addition to tracheoesophageal anomalies. Congenital heart disease was associated in 46 cases(31%), anorectral malfomations in 19 cases(13%), musculoskeletal anomalies in 15 cases(10%), genitourinary anomalies in 10 cases(7%) and gastrointestinal anomalies in 7 cases(5%). Postoperatively, parenteral nutrition and assisted ventilation were given in 66% and 52% of patients respectively. Ninety three(74%) of 126 cases who underwent sugical procedure, experienced one or more complications such as respiratory complication(65%), leak(22%), stricture(21%) and so on. The survival rates related to the Waterston risk categories were 90.2% in group A, 71.4-75% in $B_1$, $B_2$, and $C_1$, groups, and 28% in group $C_2$, and the overall survival rate was 71.4%. Thirty six(28.6%) of 126 cases died of pneumonia/sepsis(12 cases), respiratory failure(12 cases), and congenital heart disease(4 cases). With short term follow-up, 69% of patients have been excellent whereas remainders of the cases have suffered from some sort of morbidity related to gastroesophageal reflux, recurrent respiratory infection, and esophageal stricture.

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Inter-fractional Target Displacement in the Prostate Image-Guided Radiotherapy using Cone Beam Computed Tomography (전립선암 영상유도 방사선 치료시 골반내장기의 체적변화에 따른 표적장기의 변화)

  • Dong, Kap Sang;Back, Chang Wook;Jeong, Yun Jeong;Bae, Jae Beom;Choi, Young Eun;Sung, Ki Hoon
    • The Journal of Korean Society for Radiation Therapy
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    • v.28 no.2
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    • pp.161-169
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    • 2016
  • Purpose : To quantify the inter-fractional variation in prostate displacement and their dosimetric effects for prostate cancer treatment. Materials and Methods : A total of 176 daily cone-beam CT (CBCT) sets acquired for 6 prostate cancer patients treated with volumetric-modulated arc therapy (VMAT) were retrospectively reviewed. For each patient, the planning CT (pCT) was registered to each daily CBCT by aligning the bony anatomy. The prostate, rectum, and bladder were delineated on daily CBCT, and the contours of these organs in the pCT were copied to the daily CBCT. The concordance of prostate displacement, deformation, and size variation between pCT and daily CBCT was evaluated using the Dice similarity coefficient (DSC). Results : The mean volume of prostate was 37.2 cm3 in the initial pCT, and the variation was around ${\pm}5%$ during the entire course of treatment for all patients. The mean DSC was 89.9%, ranging from 70% to 100% for prostate displacement. Although the volume change of bladder and rectum per treatment fraction did not show any correlation with the value of DSC (r=-0.084, p=0.268 and r=-0.162, p=0.032, respectively), a decrease in the DSC value was observed with increasing volume change of the bladder and rectum (r=-0.230,p=0.049 and r=-0.240,p=0.020, respectively). Conclusion : Consistency of the volume of the bladder and rectum cannot guarantee the accuracy of the treatment. Our results suggest that patient setup with the registration between the pCT and daily CBCT should be considered aligning soft tissue.

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The Fate of Intractable Tuberculosis Cases Under National Tuberculosis Programme (국가결핵관리 체계내의 난치성 결핵환자(만성 배균자)의 운명)

  • Lew, Woo-Jin;Lee, Eun-Gyu;Kwon, Dong-Won;Kim, Sang-Jae;Hong, Yong-Pyo;Kim, Jeong-Bae
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.1
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    • pp.11-18
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    • 1995
  • Background: The natural history of bacillary tuberculosis was studied in India and results showed that at the end of the 5-year period, 49% of the patients were dead, 33% were cured and 18% remained sputum-positive. The aim of this survey is to observe the natural course of the patients with intractable tuberculosis disease who were incurable with all drug regimens of the national tuberculosis programme(NTP). Method: Of the patients who have been found as intractable cases in Kang-Weon Province by the supervisory medical officer during the period from January 1,1987 to December 31,1992, 179 were eligible for this study. Sputum examination was done for those who were survived until October in 1993 at the Kang-Weon provincial laboratory of KNTA. 49 out of 179 patients were transferred to the private sectors and retreated with the combination of prothionamide, cycloserine, ofloxacin, enviomycin, etc. They seemed to have been bacteriologically cured, and so they were excluded from the study. Finally 130 patients were analyzed by modified life table method to calculate the fatality rate and the survival rate during the period of 7 years. Results: 1) 80.8% of intractable cases were male and 19.2%, female. 2) More than 94% of intractable cases showed moderately or far advanced Tb findings on their X-rays at the time of registration at health centres. 3) The cumulative case-fatality rate was 19.74% at the end of 1-year period and has risen to 34.55% by the end of 4-year period(increasing by 4.9% a year on an average). The case-fatality rate has shown no appreciable rise since then until the end of 7-year period. 4) The case-survival rate was 80.26% at the end of 1-year period and has decreased to 65.45% by the end of 4-year period. And then there was no appreciable change in the survival rate until the end of 7-year observation. Conclusion: The case-survival rate of intractable cases was higher than that of untreated pulmonary tuberculosis patients and they may have risk of spreading multidrug resistant organisms. It is time we made an effort to improve case-management qualitatively.

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Development of Video Image-Guided Setup (VIGS) System for Tomotherapy: Preliminary Study (단층치료용 비디오 영상기반 셋업 장치의 개발: 예비연구)

  • Kim, Jin Sung;Ju, Sang Gyu;Hong, Chae Seon;Jeong, Jaewon;Son, Kihong;Shin, Jung Suk;Shin, Eunheak;Ahn, Sung Hwan;Han, Youngyih;Choi, Doo Ho
    • Progress in Medical Physics
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    • v.24 no.2
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    • pp.85-91
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    • 2013
  • At present, megavoltage computed tomography (MVCT) is the only method used to correct the position of tomotherapy patients. MVCT produces extra radiation, in addition to the radiation used for treatment, and repositioning also takes up much of the total treatment time. To address these issues, we suggest the use of a video image-guided setup (VIGS) system for correcting the position of tomotherapy patients. We developed an in-house program to correct the exact position of patients using two orthogonal images obtained from two video cameras installed at $90^{\circ}$ and fastened inside the tomotherapy gantry. The system is programmed to make automatic registration possible with the use of edge detection of the user-defined region of interest (ROI). A head-and-neck patient is then simulated using a humanoid phantom. After taking the computed tomography (CT) image, tomotherapy planning is performed. To mimic a clinical treatment course, we used an immobilization device to position the phantom on the tomotherapy couch and, using MVCT, corrected its position to match the one captured when the treatment was planned. Video images of the corrected position were used as reference images for the VIGS system. First, the position was repeatedly corrected 10 times using MVCT, and based on the saved reference video image, the patient position was then corrected 10 times using the VIGS method. Thereafter, the results of the two correction methods were compared. The results demonstrated that patient positioning using a video-imaging method ($41.7{\pm}11.2$ seconds) significantly reduces the overall time of the MVCT method ($420{\pm}6$ seconds) (p<0.05). However, there was no meaningful difference in accuracy between the two methods (x=0.11 mm, y=0.27 mm, z=0.58 mm, p>0.05). Because VIGS provides a more accurate result and reduces the required time, compared with the MVCT method, it is expected to manage the overall tomotherapy treatment process more efficiently.

Current Development of Company Law in the European Union (유럽주식회사법의 최근 동향에 관한 연구)

  • Choi, Yo-Sop
    • Journal of Legislation Research
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    • no.41
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    • pp.229-260
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    • 2011
  • European Union (EU) law has been a complex but at the same time fascinating subject of study due to its dynamic evolution. In particular, the Lisbon Treaty which entered into force in December 2009 represents the culmination of a decade of attempts at Treaty reform and harmonisation in diverse sectors. Amongst the EU private law fields, company law harmonisation has been one of the hotly debated issues with regards to the freedom of establishment in the internal market. Due to the significant differences between national provisions on company law, it seemed somewhat difficult to harmonise company law. However, Council Regulation 2157/2001 was legislated in 2001 and now provides the basis for the Statute for a European Company (or Societas Europaea: SE). The Statute is also supplemented by the Council Directive 2001/86 on the involvement of employees. The SE Statute is a legal measure in order to contribute to the internal market, and provides a choice for companies that wish to merge, create a joint subsidiary or convert a subsidiary into an SE. Through this option, the SE became a corporate form which is only available to existing companies incorporated in different Member States in the EU. The important question on the meaning of the SE Statute is whether the distinctive characteristics of the SE make it an attractive option to ensure significant numbers of SE registration. In fact, the outcome that has been made through the SE Statute is an example of regulatory competition. The traditional regulatory competition in the freedom of establishment has been the one between national statutes between Member States. However, this time is not a competition between Member States, which means that the Union has joined the area in competition between legal orders and is now in competition with the systems of company law of the Member States.Key Words : European Union, EU Company Law, Societas Europaea, SE Statute, One-tier System, Two-tier System, Race to the Bottom A quite number of scholars expect that the number of SE will increase significantly. Of course, there is no evidence of regulatory competition that Korea faces currently. However, because of the increasing volume of international trade and expansion of regional economic bloc, it is necessary to consider the example of development of EU company law. Addition to the existing SE Statute, the EU Commission has also proposed a new corporate form, Societas Private Europaea (private limited liable company). All of this development in European company law will help firms make their best choice for company establishment. The Delaware-style development in the EU will foster the race to the bottom, thereby improving the contents of company law. To conclude, the study on the development of European company law becomes important to understand the evolution of company law and harmonisation efforts in the EU.

Management and Use of Oral History Archives on Forced Mobilization -Centering on oral history archives collected by the Truth Commission on Forced Mobilization under the Japanese Imperialism Republic of Korea- (강제동원 구술자료의 관리와 활용 -일제강점하강제동원피해진상규명위원회 소장 구술자료를 중심으로-)

  • Kwon, Mi-Hyun
    • The Korean Journal of Archival Studies
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    • no.16
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    • pp.303-339
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    • 2007
  • "The damage incurred from forced mobilization under the Japanese Imperialism" means the life, physical, and property damage suffered by those who were forced to lead a life as soldiers, civilians attached to the military, laborers, and comfort women forcibly mobilized by the Japanese Imperialists during the period between the Manchurian Incident and the Pacific War. Up to the present time, every effort to restore the history on such a compulsory mobilization-borne damage has been made by the damaged parties, bereaved families, civil organizations, and academic circles concerned; as a result, on March 5, 2004, Disclosure act of Forced Mobilization under the Japanese Imperialism[part of it was partially revised on May 17, 2007]was officially established and proclaimed. On the basis of this law, the Truth Commission on Forced Mobilization under the Japanese Imperialism Republic of Korea[Compulsory Mobilization Commission hence after] was launched under the jurisdiction of the Prime Minister on November 10, 2004. Since February 1, 2005, this organ has begun its work with the aim of looking into the real aspects of damage incurred from compulsory mobilization under the Japanese Imperialism, by which making the historical truth open to the world. The major business of this organ is to receive the damage report and investigation of the reported damage[examination of the alleged victims and bereaved families, and decision-making], receipt of the application for the fact-finding & fact finding; fact finding and matters impossible to make judgment; correction of a family register subsequent to the damage judgement; collection & analysis of data concerning compulsory mobilization at home and from abroad and writing up of a report; exhumation of the remains, remains saving, their repatriation, and building project for historical records hall and museum & memorial place, etc. The Truth Commission on Compulsory Mobilization has dug out and collected a variety of records to meet the examination of the damage and fact finding business. As is often the case with other history of damage, the records which had already been made open to the public or have been newly dug out usually have their limits to ascertaining of the diverse historical context involved in compulsory mobilization in their quantity or quality. Of course, there may happen a case where the interested parties' story can fill the vacancy of records or has its foundational value more than its related record itself. The Truth Commission on Compulsory mobilization generated a variety of oral history records through oral interviews with the alleged damage-suffered survivors and puts those data to use for examination business, attempting to make use of those data for public use while managing those on a systematic method. The Truth Commission on compulsory mobilization-possessed oral history archives were generated based on a drastic planning from the beginning of their generation, and induced digital medium-based production of those data while bearing the conveniences of their management and usage in mind from the stage of production. In addition, in order to surpass the limits of the oral history archives produced in the process of the investigating process, this organ conducted several special training sessions for the interviewees and let the interviewees leave their real context in time of their oral testimony in an interview journal. The Truth Commission on compulsory mobilization isn't equipped with an extra records management system for the management of the collected archives. The digital archives are generated through the management system of the real aspects of damage and electronic approval system, and they plays a role in registering and searching the produced, collected, and contributed records. The oral history archives are registered at the digital archive and preserved together with real records. The collected oral history archives are technically classified at the same time of their registration and given a proper number for registration, classification, and keeping. The Truth Commission on compulsory mobilization has continued its publication of oral history archives collection for the positive use of them and is also planning on producing an image-based matters. The oral history archives collected by this organ are produced, managed and used in as positive a way as possible surpassing the limits produced in the process of investigation business and budgetary deficits as well as the absence of records management system, etc. as the form of time-limit structure. The accumulated oral history archives, if a historical records hall and museum should be built as regulated in Disclosure act of forced mobilization, would be more systematically managed and used for the public users.

Problems in the field of maternal and child health care and its improvement in rural Korea (우리나라 농촌(農村)의 모자보건(母子保健)의 문제점(問題點)과 개선방안(改善方案))

  • Lee, Sung-Kwan
    • Journal of agricultural medicine and community health
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    • v.1 no.1
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    • pp.29-36
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    • 1976
  • Introduction Recently, changes in the patterns and concepts of maternity care, in both developing and developed countries have been accelerating. An outstanding development in this field is the number of deliveries taking place in hospitals or maternity centers. In Korea, however, more than 90% of deliveries are carried out at home with the help of untrained relatives or even without helpers. It is estimated that less than 10% of deliveries are assisted by professional persons such as a physician or a midwife. Taking into account the shortage of professional person i11 rural Korea, it is difficult to expect widespread prenatal, postnatal, and delivery care by professional persons in the near future, It is unrealistic, therefore, to expect rapid development of MCH care by professional persons in rural Korea due to economic and sociological reasons. Given these conditions. it is reasonable that an educated village women could used as a "maternity aid", serving simple and technically easy roles in the MCH field, if we could give such a women incentive to do so. The midwife and physician are assigned difficult problems in the MCH field which could not be solved by the village worker. However, with the application of the village worker system, we could expect to improve maternal and child hoalth through the replacement of untrained relatives as birth attendants with educated and trained maternity aides. We hope that this system will be a way of improving MCH care, which is only one part of the general health services offered at the local health centre level. Problems of MCH in rural Korea The field of MCH is not only the weakest point in the medical field in our country hut it has also dropped behind other developing countries. Regarding the knowledge about pregnancy and delivery, a large proportion of our respondents reported having only a little knowledge, while 29% reported that they had "sufficient" knowledge. The average number of pregnancies among women residing in rural areas was 4.3 while the rate of women with 5 or more pregnancies among general women and women who terminated childbearing were 43 and 80% respectively. The rate of unwanted pregnancy among general women was 19.7%. The total rate for complications during pregnancy was 15.4%, toxemia being the major complication. The rate of pregnant women with chronic disease was 7%. Regarding the interval of pregnancy, the rates of pregnancy within 12 months and within 36 months after last delivery were 9 and 49% respectively. Induced abortion has been increasing in rural areas, being as high as 30-50% in some locations. The maternal death rate was shown 10 times higher than in developed countries (35/10,000 live births). Prenatal care Most women had no consultation with a physician during the prenatal period. Of those women who did have prenatal care, the majority (63%) received such care only 1 or 2 times throughout the entire period of pregnancy. Also, in 80% of these women the first visit Game after 4 months of gestation. Delivery conditions This field is lagging behind other public health problems in our country. Namely, more than 95% of the women deliveried their baby at home, and delivery attendance by a professional person occurred only 11% of the time. Attendance rate by laymen was 78% while those receiving no care at all was 16%. For instruments used to cut the umbilical corn, sterilized scissors were used by 19%, non-sterilized scissors by 63% and 16% used sickles. Regarding delivery sheets, the rate of use of clean sheets was only 10%, unclean sheets, vinyl and papers 72%, and without sheets, 18%. The main reason for not using a hospital as a place of delivery was that the women felt they did not need it as they had previously experience easy deliveries outside hospitals. Difficult delivery composed about 5% of the total. Child health The main food for infants (95%) was breast milk. Regarding weaning time, the rates within one year, up to one and half, two, three and more than three years were 28,43,60,81 and 91% respectively, and even after the next pregnancy still continued lactation. The vaccination of children is the only service for child health in rural Korea. As shown in the Table, the rates of all kinds of vaccination were very low and insufficient. Infant death rate was 42 per 1,000 live births. Most of the deaths were caused by preventable diseases. Death of infants within the neonatal period was 83% meaning that deaths from communicable diseases decreased remarkably after that time. Infant deaths which occurred without medical care was 52%. Methods of improvement in the MCH field 1. Through the activities of village health workers (VHW) to detect pregnant women by home visiting and. after registration. visiting once a month to observe any abnormalities in pregnant women. If they find warning signs of abnormalities. they refer them to the public health nurse or midwife. Sterilized delivery kits were distributed to the expected mother 2 weeks prior to expected date of delivery by the VHW. If a delivery was expected to be difficult, then the VHW took the mother to a physician or call a physician to help after birth, the VHW visits the mother and baby to confirm health and to recommend the baby be given proper vaccination. 2. Through the midwife or public health nurse (aid nurse) Examination of pregnant women who are referred by the VHW to confirm abnormalities and to treat them. If the midwife or aid nurse could not solve the problems, they refer the pregnant women to the OB-GY specialist. The midwife and PHN will attend in the cases of normal deliveries and they help in the birth. The PHN will conduct vaccination for all infants and children under 5, years old. 3. The Physician will help only in those cases referred to him by the PHN or VHW. However, the physician should examine all pregnant women at least three times during their pregnancy. First, the physician will identify the pregnancy and conduct general physical examination to confirm any chronic disease that might disturb the continuity of the pregnancy. Second, if the pregnant woman shows any abnormalities the physician must examine and treat. Third, at 9 or 10 months of gestation (after sitting of the baby) the physician should examine the position of the fetus and measure the pelvis to recommend institutional delivery of those who are expected to have a difficult delivery. And of course. the medical care of both the mother and the infants are responsible of the physician. Overall, large areas of the field of MCH would be served by the VHW, PHN, or midwife so the physician is needed only as a parttime worker.

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