• 대한예방한의학회지
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• 제26권1호
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• pp.11-23
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• 2022

Objectives : The aim of this study was to develop a clinical pathway (CP) model for the integrative treatment of non-invasive breast cancer, with western medicine and Korean traditional medicine. Methods : The checklist model was composed in four types according to the target patients: DCIS inpatients, DCIS outpatients, LCIS inpatients, LCIS outpatients. The vertical axis of the pathway consists of 11 categories of actions applied to the patient. The horizontal axis was in accordance with the flow of time, comprising three periods during inpatient care and seven periods during outpatient care. In addition, CP was also composed in flow chart form. The pathway model was developed through a literature review of clinical practice guidelines, conference publications, papers, books, and websites. Results : The integrative CP model for non-invasive breast cancer was developed. Conclusions : The goal of the CP suggested in this study was to improve non-invasive breast cancer patients' quality of life and to supplement conventional treatment, by alleviating the side effects. The model developed through this study could serve as the basis when developing CPs in a real-world integrative medical environment. This could lead to a reduction in cost and time for CP development, thus bringing about efficiency in the clinical setting.

• Archives of Plastic Surgery
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• 제49권4호
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• pp.494-500
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• 2022

Background Seroma formation is the most common donor site complication following autologous breast reconstruction, along with hematoma. Seroma may lead to patient discomfort and may prolong hospital stay or delay adjuvant treatment. The aim of this study was to compare seroma rates between the deep inferior epigastric perforator (DIEP), transverse musculocutaneous gracilis (TMG), and superior gluteal artery perforator (SGAP) donor sites. Methods The authors conducted a retrospective single-center cohort study consisting of chart review of all patients who underwent microsurgical breast reconstruction from April 2018 to June 2020. The primary outcome studied was frequency of seroma formation at the different donor sites. The secondary outcome evaluated potential prognostic properties associated with seroma formation. Third, the number of donor site seroma evacuations was compared between the three donor sites. Results Overall, 242 breast reconstructions were performed in 189 patients. Demographic data were found statistically comparable between the three flap cohorts, except for body mass index (BMI). Frequency of seroma formation was highest at the SGAP donor site (75.0%), followed by the TMG (65.0%), and DIEP (28.6%) donor sites. No association was found between seroma formation and BMI, age at surgery, smoking status, diabetes mellitus, neoadjuvant chemotherapy, or DIEP laterality. The mean number of seroma evacuations was significantly higher in the SGAP and the TMG group compared with the DIEP group. Conclusion This study provides a single center's experience regarding seroma formation at the donor site after microsurgical breast reconstruction. The observed rate of donor site seroma formation was comparably high, especially in the TMG and SGAP group, necessitating an adaption of the surgical protocol.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제42권
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• pp.17.1-17.11
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• 2020

Background: To evaluate the facial asymmetry, three-dimensional computed tomography (3D-CT) has been used widely. This study proposed a method to quantify facial asymmetry based on 3D-CT. Methods: The normal standard group consisted of twenty-five male subjects who had a balanced face and normal occlusion. Five anatomical landmarks were selected as reference points and ten anatomical landmarks were selected as measurement points to evaluate facial asymmetry. The formula of facial asymmetry index was designed by using the distances between the landmarks. The index value on a specific landmark indicated zero when the landmarks were located on the three-dimensional symmetric position. As the asymmetry of landmarks increased, the value of facial asymmetry index increased. For ten anatomical landmarks, the mean value of facial asymmetry index on each landmark was obtained in the normal standard group. Facial asymmetry index was applied to the patients who had undergone orthognathic surgery. Preoperative facial asymmetry and postoperative improvement were evaluated. Results: The reference facial asymmetry index on each landmark in the normal standard group was from 1.77 to 3.38. A polygonal chart was drawn to visualize the degree of asymmetry. In three patients who had undergone orthognathic surgery, it was checked that the method of facial asymmetry index showed the preoperative facial asymmetry and the postoperative improvement well. Conclusions: The current new facial asymmetry index could efficiently quantify the degree of facial asymmetry from 3D-CT. This method could be used as an evaluation standard for facial asymmetry analysis.

• 보건행정학회지
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• 제2권2호
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• pp.131-151
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• 1992

The contents of prescription service were comparatively analysed between health centers(HC) and private clinics(PC). Medical chart review was done for 330 otu-patients diagnosed with upper respiratory tract infection(UR) of 120 adults and 90 children, and gastritis or duodenitis of 120 adults. Emphasis on comparison was the prime cost of medication which used in prescription service. The results were as follows; 1. The prime costs fro the medication per visit of HC group were significantly higher than PC group in all three diseases, and the out of pocket payments of patients per visit were significantly lower in the HC group than PC group. 2. The reason for high prime costs of medication per visit of HC in adult case of URI were due to the idverse use of medication and long prescription period per visit. And high medication costs in children cases of URI in HC group were due to the longer prescription day. In cases of gastritis, the prime cost of medication was also higher because of longer prescription period and the higher prime cost of medication. The proportions of medications for injection in the HC and PC groups showed similar features. 3. In depth analysis of the prescription services showed the differences of the contents of medication. In adults cases of URI, the averaged cost of oral medication was significantly lower in HC group, but that of medication for injection was higher in HC group. In children cases of URI, the averaged cost of oral medication and medication for injection was lower in HC group than in PC group. But in the cases of gastritis it was was higher in HC group than in PC group. The prescription periods were longer in HC group than in PC group in all three diseases. As a conclusion prime medication cost and quality of prescription services of HC group were higher than PC group. In terms of health care the cost containment and quality assurance in physician visit for common disease, public sector utilization is good option for those perspectives. But it should not be generalized unless future study about structure and outcome research for quality assurance.

• Archives of Plastic Surgery
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• 제50권3호
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• pp.315-324
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• 2023

Hemoglobinopathies such as sickle cell disease (SCD) are traditionally considered a relative contraindication to free tissue transfer, due to concerns that erythrocyte sickling will increase the risk of microvascular thrombosis and flap failure. This article describes a case report with the successful use of free tissue transfer in a patient with SCD and provides a systematic literature review on free tissue transfer in SCD. A retrospective chart review was performed of a patient with SCD who underwent free tissue transfer at the authors' institution. A systematic literature review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed using the keywords "free tissue transfer," "free flap," or "microsurgery" and "sickle cell" on PubMed, Ovid/Medline, and Scopus. A 29-year-old male with delayed presentation of an electrical burn to the face and scalp underwent wound closure with a free anterolateral thigh flap. Key management principles included red blood cell transfusion to keep hemoglobin S under 30% and hemoglobin greater than 10 g/dL, maintenance of hydration, normothermia, adequate analgesia, and postoperative anticoagulation. Systematic literature review identified 7 articles describing 13 cases of free tissue transfer in 10 patients with SCD, with combined complete free flap success in 10 of the 13 flaps. Free tissue transfer can be successfully performed in patients with SCD. However, evidence on the optimal management of this unique patient population in the perioperative period after free tissue transfer is limited to case reports in the literature.

• 대한두개안면성형외과학회지
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• 제24권1호
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• pp.18-23
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• 2023

Background: When performing reduction of zygomatic arch fractures, locating the inward portion of the fracture can be difficult. Therefore, this study investigated the discrepancy between the locations of the depression on the soft tissue and bone and sought to identify how to determine the inward portion of the fracture on the patient's face. Methods: We conducted a retrospective review of chart with isolated zygomatic arch fractures of type V in the Nam and Jung classification from March 2013 to February 2022. For consistent measurements, a reference point (RP), at the intersection between a vertical line passing through the end point of the root of the ear helix in the patient's side-view photograph and a transverse line passing through the longest horizontal axis of the external meatus opening, was established. We then measured the distance between the RP and the soft tissue depression in a portrait and the bone depression on a computed tomography (CT) scan. The discrepancy between these distances was quantified. Results: Among the patients with isolated zygomatic arch fractures, only those with a fully visible ear on a side-view photograph were included. Twenty-four patients met the inclusion criteria. There were four types of discrepancies in the location of the soft tissue depression compared to the bone depression: type I, forward and upward discrepancy (7.45 and 3.28 mm), type II, backward and upward (4.29 and 4.21 mm), type III, forward and downward (10.06 and 5.15 mm), and type IV, backward and downward (2.61 and 3.27 mm). Conclusion: This study showed that discrepancy between the locations of the depressions on the soft tissue and bone exists in various directions. Therefore, applying the transverse and vertical distances measured from a bone image of the CT scan onto the patient's face at the indicated RP will be helpful for predicting the reduction location.

• Archives of Plastic Surgery
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• 제51권1호
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• pp.94-101
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• 2024

Background For the small glabrous skin defect, Thenar and Hypothenar skin are useful donors and they have been used as a free flap. Because of similar skin characteristics, both flaps have same indications. We will conduct comparative study for the donor morbidity of the Free thenar flap and Hypothenar free flap. Methods From January 2011 to December 2021, demographic data, characteristics of each flap, and complications using retrospective chart review were obtained. Donor outcomes of the patient, who had been followed up for more than 6 months, were measured using photographic analysis and physical examination. General pain was assessed by Numeric Rating Scale (NRS) score, neuropathic pain was assessed by Douleur Neuropathique 4 Questions (DN4) score, scar appearance was assessed by modified Vancouver Scar Scale (mVSS), and patient satisfaction was assessed on a 3-point scale. Statistical analysis was performed on the outcomes. Results Out of the 39 survey respondents, 17 patients received Free thenar flaps, and 22 patients received Hypothenar free flaps. Thenar group had higher NRS, DN4, and mVSS (p < 0.05). The average scores for the Thenar and Hypothenar groups were 1.35 and 0.27 for NRS, 2.41 and 0.55 for DN4, and 3.12 and 1.59 for mVSS, respectively. Despite the Hypothenar group showing greater satisfaction on the 3-point scale (1.82) compared with the Thenar group (1.47), the difference was not significant (p = 0.085). Linear regression analysis indicated that flap width did not have a notable impact on the outcome measures, and multiple linear regression analysis revealed no significant interaction between flap width and each of the outcome measures. Conclusion Despite the limited number of participants, higher donor morbidity in general pain, neuropathic pain, and scar formation was noted in the Thenar free flap compared with the Hypothenar free flap. However, no difference in overall patient satisfaction was found between the two groups.

• Childhood Kidney Diseases
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• 제13권2호
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• pp.161-169
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• 2009

저자들은 1세 이하에 발병한 신증후군 환아 7명의 진단 및 치료를 경험하였기에 보고하는 바이다. 1996년부터 2007년까지 본원에서 1세 이전에 신증후군으로 진단 받은 환아 7명을 대상으로 병록 고찰을 통해 후향적으로 조사하였다. 선천성 신증후군은 3명, 영아형 신증후군은 4명 이었고, 남아가 1명, 여아가 6명으로 여아가 많았다. 6명에서 신생검을 시행하였고, 2명에서 미만성 메산지움 경화증, 2명에서 국소분절사구체경화증, 1명에서 Finnish형 신증후군 그리고 나머지 1명에서는 미세 변화형으로 확인되었다. 4명의 환아에서 NPHS2, PLCE1, 그리고 WT1의 유전자 분석을 시행하였고 2예에서 WT1 변이가 확인되었다. 선천성 신증후군으로 진단받은 3명 중 1명은 Finnish형 신증후군, 2명은 DDS로 진단받았고, 3명 모두 패혈증으로 사망하였다. 영아형 신증후군으로 진단받은 4명 중 2명은 사망하였고, 다른 1명은 관해가 되어 치료되었고, 나머지 1명은 치료 4개월 경 말기 신부전으로 진행하여 복막투석을 하고 있다. 1세 이전에 발병하는 선천성 신증후군은 소아 신증후군에 비하여 예후가 나쁘지만, 병력의 세밀한 검토, 임상소견 및 조직검사, 유전자 분석을 통한 정확한 진단이 빠르게 이루어져 조기 투석 및 신이식 등 적극적인 치료를 한다면 생존률의 향상을 기대할 수 있을 것이다. 대부분의 1세 이전 진단받는 신증후군은 유전적 신질환으로 추후 이들 환아들에 대한 유전형-표현형의 상관관계에 대한 추가 연구가 필요하다.

• 수면정신생리
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• 제25권2호
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• pp.68-73
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• 2018

목 적 : 본 연구의 목적은 입원 환자들 중 불면증으로 정신건강의학과로 자문을 요청하게 되는 환자들의 인구학적 특성과 협진을 의뢰하는 형태를 알아보고, 또한 비 재협진군과 재협진군의 인구학적 특성과 협진 유형의 차이를 살펴봄으로써, 종합병원 입원 환자의 불면증의 특징을 조사하는 것이다. 방 법 : 2005년 8월 1일부터 2011년 12월 31일까지 약 6년 6개월 간 입원한 환자들 중 정신건강의학과로 자문 의뢰된 4,966명의 환자를 대상으로 하였고 이중 불면증으로 의뢰된 236명의 환자들의 협진 결과를 이용하여 후향적으로 인구학적 특성 및 협진 유형에 대해 분석하였다. 또한, 전체 대상자를 재협진군과 비 재협진군으로 구분하여 두 군의 인구학적 특성과 협진 유형의 차이에 대해 분석하고자 하였다. 결 과 : 6년 6개월 간, 병원에 입원한 전체 환자 중 정신건강의학과에 불면증으로 의뢰된 환자는 총 236명으로 전체 정신건강의학과 협진 중 4.8%에 해당하였다. 불면증으로 의뢰된 환자의 평균 연령은 $62.0{\pm}14.3$세로 전체 정신건강의학과에 협진 의뢰된 환자 군의 평균 $56.7{\pm}18.7$세 보다 높았다. 이중 재협진 의뢰 되었던 환자는 65명으로 전체의 27.5%를 차지 하였고 이는 전체 정신건강의학과 협진 의뢰 환자 중 평균 재협진 환자 비율(41.5%)에 비해 낮았다. 불면증으로 의뢰된 환자 군의 협진 의뢰 형태는 3형 의뢰 형태가(입원 후 생긴 정신건강의학과적 합병증 치료를 위한 협진 의뢰) 가장 많았고(51.3%) 2형 의뢰(입원 상의 문제와 정신건강의학과적 증상과의 직접적인 관계가 없는 경우)가 2번째로 많았다(36.0%). 결 론 : 대학 병원에서 불면증으로 의뢰된 환자 군은 전체 정신건강의학과 협진 의뢰 환자 군에 비해 고령, 남성의 비율이 높았고, 재협진률이 낮으며 2차적으로 발생한 경우가 많았다. 각 과 주치의들은 입원 환자들의 불면증에 발생 가능성에 유의하고, 필요시 적극적인 평가와 자문 의뢰를 시행하여야 하며, 자문 의뢰를 받은 정신건강의학과 의사들은 초진 시 진단과 치료와 함께 재협진 시기 권고와 같은 적극적인 개입을 할 필요가 있다.

• Imaging Science in Dentistry
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• 제34권1호
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• pp.25-30
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• 2004

Purpose: Several panoramic indices have been suggested to assess bone quality from the morphology and width of mandibular cortex on panoramic radiography. The purpose of this study was to compare dental implant failure group with control group in panoramic mandibular index (PMI), mandibular cortical index (MCI), and gonion index (GI) and to determine the effect of these panoramic indices on dental implant failure. Materials and Methods: A case-control study was designed. Test group (n=42) consisted of the patients who had their implants extracted because of peri-implantitis. Control group (n=139) consisted of the patients who retained their implants over one year without any pathologic changes and had been followed up periodically. They had dental implants installed in their mandibles without bone augmentation surgery from 1991 to 2001. The following measures were collected for each patients: 1) PMI, MCI, and GI were measured twice at one-week interval on preoperative panoramic views; and 2) age, sex, implant length, implant type, installed location, occluding dentition state, and complication were investigated from the chart record. Results: The PMI showed moderate level of repeatability. The intra-observer agreement of MCI and GI were good. There was statistically significant difference in PMI between two groups. There were significant different patterns of distribution of MCI and GI between two groups. Among the panoramic indices, PMI and MCI showed significant correlation with dental implant failure. Conclusion: Panoramic indices can be used as reference data in estimating bone quality of edentulous patients who are to have implants installed in their mandibles.