• Title/Summary/Keyword: general clinical view

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HORIZONTAL AUGMENTATION WITH AUTOGENOUS BLOCK BONE AND IMPLANT PLACEMENT (자가 블록골을 이용한 치조골수평증강술과 임프란트 식립)

  • Ahn, Ji-Yeon;Kim, Young-Kyun;Yun, Pil-Young;Hwang, Jung-Won
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.29 no.5
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    • pp.444-450
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    • 2007
  • In general, labiolingual or buccolingual widths of residual alveolar bone are insufficient in edentulous area, because of alveolar resorption. Horizontal augmentation is bone graft procedure with a view to reinforcing horizontally insufficient bone quantity for installation of implants. The standard method is taking appropriate amount of block bone from intraoral or extraoral autogenous bone, and solid fixation with screws or mini-plate on labial or buccal side of residual alveolar bone. The purpose of this study is to discuss clinical usefulness of horizontal augmentation with autogenous block bone by observation and analysis of course of 41 implants installed to 12 patients by horizontal augmentation in Seoul National University Bundang Hospital from July, 2002 to December, 2005. The mean age of patients is 52.7, from 19 to 70, and the number of men and women is each 2 and 10. Block bone was taken from symphysis, body, ramus of mandible or iliac bone. And 6 types of implants were installed simultaneously or not, the diameters of implants are from 3.3 to 5.5mm, the lengths are from 8 to 15mm. The operator added artificial bone grafting material and optionally covered with membrane. The mean periods of observation after operation and final prosthetics were 28.6 and 17.0 months. As a result, 40 among 41 implants survived, the survival rate was 97.6%. Average 0.9mm crestal resorption was observed at final point of time by periapical view of each patients. Major complication related to the procedure was numbness in 7 patients.

A Method for Estimating the Lung Clinical Target Volume DVH from IMRT with and without Respiratory Gating

  • J. H. Kung;P. Zygmanski;Park, N.;G. T. Y. Chen
    • Proceedings of the Korean Society of Medical Physics Conference
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    • 2002.09a
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    • pp.53-60
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    • 2002
  • Motion of lung tumors from respiration has been reported in the literature to be as large as of 1-2 cm. This motion requires an additional margin between the Clinical Target Volume (CTV) and the Planning Target Volume (PTV). While such a margin is necessary, it may not be sufficient to ensure proper delivery of Intensity Modulated Radiotherapy (IMRT) to the CTV during the simultaneous movement of the DMLC. Gated treatment has been proposed to improve normal tissues sparing as well as to ensure accurate dose coverage of the tumor volume. The following questions have not been addressed in the literature: a) what is the dose error to a target volume without gated IMRT treatment\ulcorner b) what is an acceptable gating window for such treatment. In this study, we address these questions by proposing a novel technique for calculating the 3D dose error that would result if a lung IMRT plan were delivered without gating. The method is also generalized for gated treatment with an arbitrary triggering window. IMRT plans for three patients with lung tumor were studied. The treatment plans were generated with HELIOS for delivery with 6 MV on a CL2100 Varian linear accelerator with a 26 pair MLC. A CTV to PTV margin of 1 cm was used. An IMRT planning system searches for an optimized fluence map ${\Phi}$ (x,y) for each port, which is then converted into a dynamic MLC file (DMLC). The DMLC file contains information about MLC subfield shapes and the fractional Monitor Units (MUs) to be delivered for each subfield. With a lung tumor, a CTV that executes a quasi periodic motion z(t) does not receive ${\Phi}$ (x,y), but rather an Effective Incident Fluence EIF(x,y). We numerically evaluate the EIF(x,y) from a given DMLC file by a coordinate transformation to the Target's Eye View (TEV). In the TEV coordinate system, the CTV itself is stationary, and the MLC is seen to execute a motion -z(t) that is superimposed on the DMLC motion. The resulting EIF(x,y)is inputted back into the dose calculation engine to estimate the 3D dose to a moving CTV. In this study, we model respiratory motion as a sinusoidal function with an amplitude of 10 mm in the superior-inferior direction, a period of 5 seconds, and an initial phase of zero.

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Polyostotic Fibrous Dysplasia of Cranio-Maxillofacial Area (두개 악안면 부위에 발생한 다골성 섬유성이형성증)

  • Han Jin-Woo;Kwon Hyuk-Rok;Lee Jin-Ho;Park In-Woo
    • Imaging Science in Dentistry
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    • v.30 no.2
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    • pp.149-154
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    • 2000
  • Fibrous dysplasia is believed to be a hamartomatous developmental lesion of unknown origin. This disease is divided into monostotic and polyostotic fibrous dysplasia. Polyostotic type can be divided into craniofacial type, Lichtenstein-Jaffe type, and McCune-Albright syndrome. In this case, a 31-year-old female presented spontaneous loss of right mandibular teeth before 5 years and has shown continuous expansion of right mandibular alveolus. Through the radiographic view, the coarse pattern of the mixed radiopaque-lucent lesion was seen on the right mandibular body, and there was diffuse pattern of the mixed radiopaque-lucent lesion with ill-defined margin in the left mandibular body. In the right calvarium, the lesion had cotton-wool appearance. Partial excision for contouring, multiple extraction, and alveoloplasty were accomplished under general anesthesia for supportive treatment. Finally we could conclude this case was polyostotic fibrous dysplasia of cranio-maxillofacial area based on the clinical, radiologic finding, and histopathologic examination.

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Overseas Residency Training Systems and Implications for Korea (외국 전공의 수련교육의 제도 및 시사점)

  • Lee, Sun Woo
    • Korean Medical Education Review
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    • v.20 no.3
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    • pp.128-134
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    • 2018
  • Medical education, competency, and outcome-based medical education started as part of the basic medical education curriculum in advanced countries 20 years ago, and such an approach was adopted in residency training. General competency training is at the core of residency training in advanced countries, and it goes beyond competency and outcome-based training to the extent that in a milestone training system, competency development is expected and measured with set competency achievements at each level. Recently, for the purpose of ensuring that doctors uphold patient safety and fulfill their obligations, entrustable professional activities (EPA) were applied at the beginning of residency when doctors move away from clinical trials and start actual care. The adoption of EPA in all residency training curriculum has spread very rapidly in the United States, United Kingdom, and Canada. Presently, Korea lags behind other countries significantly as the adoption of competency and outcome-based medical education in residency training has just begun. It is time to identify the current state of the Korean residency training system, and then design and practice a well-established system with a long-term view based on cooperation across the whole medical industry.

Acute Postoperative Pulmonary Edema without Reasonable Causes -A Case Report- (수술 후 발생한 원인을 알 수 없는 폐부종 - 1예 보고 -)

  • Jeong, Ji-Hoon;Lim, Hyung-Jun;Lee, Sung-Min;Jee, Dae-Lim
    • Journal of Yeungnam Medical Science
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    • v.21 no.1
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    • pp.114-119
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    • 2004
  • This report concerns an unusual case of acute postoperative pulmonary edema without any apparent causes in a 45-year-old man. The patient was subjected to the removal of a previously placed device on the left tibia, and the excision of a benign mass on the right forearm. Unexpected acute bilateral pulmonary edema occurred immediately after the completion of the procedures. The etiologies were reviewed in relation to the patient's condition and clinical manifestations. Fluid overloading was excluded as a cause in view of the patient's perioperative state and postoperative chest X-ray results. We could not find any symptoms of upper airway obstruction during emergence from general anesthesia. We had doubts about tourniquet or fentanyl-induced pulmonary edema, but these factors were not sufficient to bring about pulmonary edema in this case. To our knowledge, the cause of acute pulmonary edema in this case is indeterminate.

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Prehospital Treatments of the Patient with Hypoglycemia by 119 Emergency Medical Technicians - Analysis of the Current Data and Survey - (119구급대원의 저혈당 환자에 대한 병원 전 응급처치현황과 개선방안)

  • Ahn, Hee-Jeong
    • The Korean Journal of Emergency Medical Services
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    • v.14 no.1
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    • pp.31-46
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    • 2010
  • This study was intended to analyze the clinical characteristic of the patient with hypoglycemia and the status of prehospital treatments by 119 emergency medical technicians well as the cause of inappropriate emergency treatment by 119 emergency medical technicians in a bid to seek the measures for improvement, thereby enhancing the emergency medical services before medical treatment at hospital. Examination of the daily work log on 430 patients suffering with hypoglycemia who were sent to the university hospital in Gyunggi-Province by 119 emergency medical technicians, beginning on Jan 1, 2004 till Dec 31. 2008 was carried out and the survey of 206 119 emergency medical technicians working at the region of Gyunggid-Province was conducted from Sep 19 through Oct 6, 2009. Evaluation of the frequency and percentage and ANOVA analysis using SPSS WIN 14.0 program was carried out. In view of the examination of daily emergency work log and questionnaire, prehospital treatment for the patients with hypoglycemia needs to be further improved in general, and to provide the emergency treatment in accurate and timely manner, improvement of the system such as assignment of licensed rescue members and development of protocol that will replace the medical consultant system, mandatory emergency treatment, constant and efficient training and maintenance of emergency rescue records shall be implemented, and furthermore, social recognition to 119 emergency medical technicians shall be improved to encourage them to perform more positive way and manner.

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Knowledge Structure of the Korean Journal of Occupational Health Nursing through Network Analysis (네트워크분석을 통한 직업건강간호학회지 논문의 지식구조 분석)

  • Kwon, Sun Young;Park, Eun Jung
    • Korean Journal of Occupational Health Nursing
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    • v.24 no.2
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    • pp.76-85
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    • 2015
  • Purpose: The purpose of this study was to identify knowledge structure of the Korean Journal of Occupational Health Nursing from 1991 to 2014. Methods: 400 articles between 1991 and 2014 were collected. 1,369 keywords as noun phrases were extracted from articles and standardized for analysis. Co-occurrence matrix was generated via a cosine similarity measure, then the network was analyzed and visualized using PFNet. Also NodeXL was applied to visualize intellectual interchanges among keywords. Results: According to the results of the content analysis and the cluster analysis of author keywords from the Korean Journal of Occupational Health Nursing articles, 7 most important research topics of the journal were 'Workers & Work-related Health Problem', 'Recognition & Preventive Health Behaviors', 'Health Promotion & Quality of Life', 'Occupational Health Nursing & Management', 'Clinical Nursing Environment', 'Caregivers and Social Support', and 'Job Satisfaction, Stress & Performance'. Newly emerging topics for 4-year period units were observed as research trends. Conclusion: Through this study, the knowledge structure of the Korean Journal of Occupational Health Nursing was identified. The network analysis of this study will be useful for identifying the knowledge structure as well as finding general view and current research trends. Furthermore, The results of this study could be utilized to seek the research direction in the Korean Journal of Occupational Health Nursing.

Influence of Death Perception, Attitude Toward Terminal Care, Mental Health on the Terminal Care Stress of Intensive Care Unit Nurses (중환자실 간호사의 죽음 인식, 임종간호 태도, 정신건강이 임종간호 스트레스에 미치는 영향)

  • Hwang, Jung Ok;Kim, Sang Hee
    • Journal of Korean Clinical Nursing Research
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    • v.25 no.3
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    • pp.323-332
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    • 2019
  • Purpose: This study aimed to identify the factors affecting the terminal care stress of nurses in intensive care units in terms of their death perception, attitude toward terminal care, and mental health. Methods: This descriptive study collected data from 118 nurses in intensive care units in one tertiary referral hospital and three general hospitals. The instruments used in the study were the Terminal Care Stress Assessment Tool, the View of Life and Death Scale, the Frommelt Attitudes toward Nursing Care of the Dying Scale (FATCOD), and the Mental Health Assessment Tool. The data were analyzed by t-test, ANOVA, Pearson's correlation coefficient, and multiple regression. Results: There was a significant positive correlation between terminal care stress and death perception (r=.31, p<.001). The factors significantly influencing the terminal care stress of the participants included gender (β=.33, p<.001), religion (β=.24, p=.004), and death perception (β=.35, p<.001), and the overall explanatory power was 23.1% (F=12.73, p<.001). Conclusion: To decrease terminal care stress among nurses, establishing the death perception of nurses based on value clarification about death may be necessary. Furthermore, this study suggests an intervention study examining the effect of an education program on terminal care stress among ICU nurses.

A case of a bronchial foreign body (기관이물 1례)

  • 장인원;김종영;김성곤;권령춘;양한모
    • Proceedings of the KOR-BRONCHOESO Conference
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    • 1976.06a
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    • pp.89.3-89
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    • 1976
  • This is a case of a left lower bronchial foreign body in a 11 years old boy. This boy was admitted to E.N.T. clinic, Chonnam University Hospital with the complaints of paroxysmal attack of cough and dyspnea for 45 days. He had been treated at a local clinic under the diagnosis of active pulmonary tuberculosis, however, no significant response was achieved by the treatment. The chest X-ray film showed atelectatic shadow, however, no density of suspicious foreign body was observed. On the clinical points of view and the patient's history, bronchoscopy was carried out under the general anesthesia and a plastic gun bullet was removed from the left main bronchus. The boy was discharged from the hospital with good aeration of the left entire lung field and good recovery.

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A CLINICAL CASE OF ALLOPLASTIC CONDYLE REPLACEMENT WITH CONDYLAR PROSTHESIS IN SEVERE DEGENERATIVE JOINT DISEASE (심한 퇴행성 악관절 질환 환자에서 보철성 과두를 이용한 하악과두 재건술의 치험례)

  • Jeon, Yong-Min;Kim, Chang-Hyun;Cha, Jeong-Seop;Min, Kyung-Gi;Kwon, Jong-Jin
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.32 no.2
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    • pp.162-167
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    • 2010
  • This is a case report about patient who had suffered from degenerative joint disease and treated by TMJ reconstruction with condylar prosthesis. The patient visited Korea University An-am hospital on 2007 complaining symptom about both TMJ pain, mouth opening limitation and open bite. From CT view there was severe resorption of both condylar head, therefore condylar prosthesis reconstruction was planned. After 3D RP model analysis for preparation, the patient was operated under general anesthesia for condylar prosthesis reconstruction and the symptom was alleviated. (increased mouth opening, reduced anterior open bite, full mouth occlusal contact achieved) Follow up was carried out monthly, but after this, patient refused follow up. After 26 months from the operation, the patient revisited for anterior open bite. In clinical evaluation, occlusal contact was remained, but anterior open bite was relapsed. From cephalometry analysis, severe resorption of glenoid fossa was found. Therefore, Autogenous disc reconstruction with alloplastic material was planned on August 2009. After another surgery, condylar prosthesis was regained its normal position in glenoid fossa, and occlusion was recovered properly.