• Title/Summary/Keyword: 외래 환자경험

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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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Clinical Characteristics and Heart Rate Variability in Patients with Comorbid Panic Disorder and Major Depressive Disorder (주요우울장애가 동반된 공황장애 환자의 임상 특징과 심박변이도)

  • Choi, Young-Hee;Kim, Won;Kim, Min-Sook;Yoon, Hye-Young;Choi, Seung-Mi;Woo, Jong-Min
    • Sleep Medicine and Psychophysiology
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    • v.12 no.1
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    • pp.50-57
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    • 2005
  • Objectives: This study was designed to evaluate the differences in clinical characteristics and severity of symptoms between panic patients with and without comorbid major depressive disorder, and to ascertain the differences in the function of the autonomic nerve system measured by heart rate variability (HRV). Methods: The subjects were 60 patients who have panic disorder without major depressive disorder and 19 patients who met DSMIV criteria for both panic disorder and major depressive disorder. First, they drew up symptom checklists and self-rating scales, and were measured by Anxiety Disorder Inventory Schedule-Panic Attack & Agoraphobia (ADIS-P&A), Clinical Global Impression (CGI), Hamilton Rating Scale for Depression (HAM-D), Panic Disorder Severity Scale (PDSS) and Heart Rate Variability (HRV). For statistical analysis, we performed t-test to compare the scores of self reported scales and clinician’s rating scales in panic patients with comorbid major depressive disorder and those without major depressive disorder. ANCOVA was used to compare the variables of HRV, considering age as a covariate. Results: The subjective severities of depression and anxiety that comorbid patients complained of were higher than those of patients with only panic disorder. Futhermore, comorbid patients were more sensitive to anxiety and physical sensations, and they tend to be more negative in their thinking. The scores of clinician-rating scales such as CGI and PDSS were also higher in the comorbid patients. However, there were no significant differences in HRV variables between both groups, despite a tendency to low heart rate variability in the comorbid group. Conclusion: This study suggests that patients with panic disorder and comorbid major depressive disorder tend to complain of more symptoms and to be more sensitive to various symptoms than those with panic disorder without comorbid depression. However, in this study comorbid major depressive disorder did not have a significant impact on the HRV variables of patients with panic disorder.

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Case of Acute Hemolytic Transfusion Reaction due to Anti-Fya Alloantibody in a Patient with Autoimmune Hemolytic Anemia (자가면역용혈환자에서 항-Fya 동종항체에 의한 급성용혈성수혈반응 1예)

  • Choi, Seung Jun;Nah, Hyunjin;Kim, Yundeok;Kim, Sinyoung;Kim, Hyun Ok
    • The Korean Journal of Blood Transfusion
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    • v.29 no.3
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    • pp.320-327
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    • 2018
  • A 72-year-old man with general weakness visited the outpatient clinic of the hematology department. The patient had been treated under the diagnosis of autoimmune hemolytic anemia for 2 years. His hemoglobin level at the time of the visit was 6.3 g/dL, and a blood transfusion was requested to treat his anemia. The patient's blood type was A, RhD positive. Antibody screening and identification test showed agglutination in all reagent cells with a positive reaction to autologous red blood cells (RBCs). He had a prior transfusion history with three least incompatible RBCs. The patient returned home after receiving one unit of leukoreduced filtered RBC, which was the least incompatible blood in the crossmatching test. After approximately five hours, however, fever, chills, dyspnea, abdominal pain, and hematuria appeared and the patient returned to the emergency room next day after the transfusion. The $anti-Fy^a$ antibody, which was masked by the autoantibody, was identified after autoadsorption using polyethylene glycol. He was diagnosed with an acute hemolytic transfusion reaction due to $anti-Fy^a$ that had not been detected before the transfusion. In this setting, it is necessary to consider the identification of coexisting alloantibodies in patients with autoantibodies and to become more familiar with the method of autoantibody adsorption.

Psychophysiologic Responses to Event Imagery in Traffic Accident Related Patients (교통사고관련 환자에서 사건상상에 대한 정신생리반응)

  • Chung, Sang-Keun;Choi, Myong-Su;Hwang, Ik-Keun
    • Sleep Medicine and Psychophysiology
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    • v.8 no.1
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    • pp.45-51
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    • 2001
  • Objectives: The experience of traffic accident is a kind of the psychosocial stressors to person. The traffic accident-related patients may show the psychophysiologic hyperarousal. So we examined the differences of psychophysiologic response between patients with and without the memory of experienceing a traffic accident. Methods: Twenty-four traffic accident-related patients were divided into two groups according to ther memory of a traffic accident. In psychological assessment, levels of anxiety and depression were evaluated by State-Trait Anxiety Inventory, Beck's Depression Inventory, and Hamilton Rating Scales For Anxiety and Depression. Heart rate, electrodermal response (EDR), and electromyographic activity (EMG) were measured by biofeedback system, and systolic and diastolic blood pressure by automated vital sign monitor during baseline, task, and rest periods. We utilized script-driven imagery technique as a stressful task. The patients listened to the script describing their own traffic accident experience and were instructed to imagine the event during the task period. Statistically analytic data were obtained from the differences of psychological and psychophysiologic data between two groups. Results: The memory group did not show significantly higher EDR than the none memory group, but showed higher tendency during baseline, imagery, and rest periods. The memory group showed significantly lower EMG than the none memory group during rest period. However, there were no differences in other psychophysiologic reponses between the two groups. Conclusion: Our results showed that the memory group had higher tendency in autonomic arousal level such as electrodermal response than the none memory group. We suggest that physicians need to minimize repetitive imagery of traffic accident (reexperience), and decrease the autonomic hyperarousal in the treatment of traffic accident-related patients.

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A Case of Locally Recurrent Gastric Cancer at Kim's Tie Site of the Jejunum after a Total Gastrectomy (위전절제술 후 Kim 's Tie 부근 공장에 국소 재발한 위암환자 1예)

  • Bae Byung-Gu;Suh Byoung-Jo;Yu Hang-Jong;Kang Yun-Kyung;Kim Jin-Pok
    • Journal of Gastric Cancer
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    • v.5 no.1
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    • pp.52-56
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    • 2005
  • Despite improvements in the surgical treatment of gastric adenocarcinomas, the recurrence rates remain high in patients with advanced-stage disease. Most of the recurrence occurs within 3 years of the surgical resection, and nearly $90\%$ of the patients with recurrence die within 2 years of the diagnosis of recurrence. A recent study analyzed recurrence patterns for patients who had undergone a potentially curative gastrectomy. For those patients, $33\%$ of the recurrences involved locoregional sites, $44\%$ the peritoneum, and $38\%$ distant sites. A 51-year-old female patient was diagnosed with stomach cancer and underwent a total gastrectomy with D2 lymph node dissection during Oct. 1999. The pathologic report indicated a T3N1M0 tumor. We performed immunochemotherapy for 2 years with regular follow up. A gastrofiberscopic examination done during sep. 2004, cancer recurrence was found at the Kim's tie site of the jejunual loop. We did an abdominal exploration and a segmental resection of cancer site with pathologically negative resection margins. After the operation, we started secondary chemotherapy with TS-1.

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Experiences with Emergency Percutaneous Cardiopulmonary Support in In-hospital Cardiac Arrest or Cardiogenic Shock due to the Ischemic Heart Disease (허혈성 심질환으로 인해 병원 내에서 발생한 심정지 혹은 심정지 혹은 심인성 쇼크에 있어서의 경피적 심폐 보조장치의 치료 경험)

  • Rhee Il;Kwon Sung-Uk;Cho Sung Woo;Gwon Hyeon-Cheol;Lee Young Tak;Park Pyo Won;Park Kay-Hyun;Lee Sang Hoon;Sung Kiick
    • Journal of Chest Surgery
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    • v.39 no.3 s.260
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    • pp.201-207
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    • 2006
  • Background: Percutaneous cardiopulmonary support (PCPS) provides passive support of gas exchange and perfusion, allowing the use of other methods of care for organ recovery, and saves lives of patients with severe cardiopulmonary failure in a wide variety of clinical settings with a minimal risk of bleeding and need for chest re~ exploration. We summarized a single center's experiences with PCPS in patients with cardiogenic shock or cardiac arrest due to the ischemic heart disease. Material and Method: Among the 20 consecutive patients with cardiogenic shock or cardiac arrest from May 1999 to June 2005, Biopump (Medtronic, Inc, Minneapolis, MN) was used in 7 patients and the self-priming, heparin-coated circuit of EBS (Terumo, Japan) was applied to remaining 13 patients. Most of cannulations were performed percutaneously via femoral arteries and veins. The long venous cannulas of DLP (Medtronic inc. Minneapolis, MN) or the RMI (Edwards's lifescience LLC, Irvine, CA) were used with the arterial cannulae from 17 Fr to 21 Fr and the venous cannula from 21 Fr to 28 Fr. Result: The 20 consecutive patients who were severely compromised and received PCPS for the purpose of resuscitation were comprised of 13 cardiac arrests and 7 cardiogenic shocks in which by-pass surgery was performed in 11 patients and 9 ongoing PCls under the cardiopulmonary support. The mean support time on the PCPS was 38$\pm$42 hours. Of the 20 patients implanted with PCPS, 11 patients ($55\%$) have had the PCPS removed successfully; overall, 8 of these patients ($40\%$) were discharged from the hospital in an average surviving time for 27$\pm$17 days after removing the PCPS and survived well with 31$\pm$30 months of follow-up after the procedure. Conclusion: The use of PCPS appears to provide the hemodynamic restoration, allowing the survival of patients in cardiac arrest or cardiogenic shock who would otherwise not survive, and patients receiving PCPS had a relatively long-term survival.

Influence of Non-compliance of Treatment and Family Support on Depression in Diabetic Patients with Hypoglycemia (저혈당을 경험한 당뇨병 환자의 치료지시 불이행, 가족지지가 우울에 미치는 영향)

  • Son, Hye Gyeong;Jeong, Kyeong-Sook
    • The Journal of the Korea Contents Association
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    • v.18 no.6
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    • pp.518-528
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    • 2018
  • This study was to identify the effective factors on the Depression in Diabetic patients with hypoglycemia. This study used 119 questionnaires from Diabetic patients with hypoglycemia in B city to collect data from October 1, 2015 to March 15, 2016. Data were analyzed by SPSS 20.0 program using descriptive statistics, t-test, ANOVA, Scheffe's test. Pearson's correlation coefficient and Stepwise Multiple Regression. The Depression in Diabetic patients with hypoglycemia showed a positive correlation with Non-Compliance of Treatment(r=42, p<.001), a negative correlation with Family support(r=-.38, p<.001). According to the result of multiple regression analysis, the significant factors influencing depression were Family support(${\beta}=-.29$, p<.001), Drug therapy(${\beta}=.21$, p=.020), Dietetic therapy(${\beta}=.23$, p=.014), Monthly average income over 3,000,000won (${\beta}=-.20$, p=.014), Monthly average income 2,000-3,000 thousand(${\beta}=-.17$, p=.033), it was explained by 30.0%. Based on these findings, it is suggested to develop and apply a family support program to reduce the depression of diabetic patients with hypoglycemia.

Inferior Vena Cava Thrombectomy in a Patient with Antiphospholipid Syndrome - A case report - (하대정맥의 혈전증을 동반한 인지질항체 증후군의 수술적 치료 - 1예 보고 -)

  • Jang, Jae-Seok;Kwon, Oh-Choon;Lee, Sub;Kim, Seok
    • Journal of Chest Surgery
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    • v.42 no.3
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    • pp.371-374
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    • 2009
  • A 36-year-old woman with a history of spontaneous abortion and photosensitivity was admitted to our hospital with periumbilical pain and lower extremity edema. The preoperative CT scan revealed massive inferior vena cava thrombus, which extended from the suprarenal portion of the vena cava to the hepatic vein. The laboratory data showed an elevated level of anticardiolipin antibody, which suggested the diagnosis of antiphospholipid syndrome. After medical management, she underwent an operation for removal of an vena cava thrombus by performing cavectomy and thrombectomy. After the operation, she has been taking oral anticoagulation and she is doing quite well at 9 months after her operation.

The Study of Life Event Stress, Coping Strategy, and Type A Behavior Pattern of Alopecia Areata Patients - Comparison with Fungal Infection Patients - (원형탈모증 환자의 생활 사건 스트레스, 대처방식, A형 행동 패턴에 관한 연구)

  • Hyun, Sang-Bae;Song, Su-Kil;Lee, Dong-Soo;Lee, Eil-Soo;Park, Kyung-Ho
    • Korean Journal of Psychosomatic Medicine
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    • v.8 no.2
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    • pp.165-171
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    • 2000
  • Objectives : Alopecia areata has been known to be closely related to stress. The purpose of this study is to examine the relationship between stress and alopecia areata investigating how life events(which alopecia areata patients experience), amount of stress, coping strategy, and their personality type affect the oneset and aggravation of the disease. Methods : The subjects were 43 alopecia areata patients who visited the department of dermatology outpatients clinic, and 36 fungal infection diseases patients as the control group. They all completed Scale of Life Events, Coping Style Cheklist, Eysenck A-type Personality Inventory. The analysis of covariance with the age as covariate was carried out. Results : Compared to the control group, alopecia areata patients had significantly more stressful life events, and higher amount of stress, but there was no significant difference in coping strategy. Type A Personality is also resulted to have no significant relationship to alopecia areata. Conclusions : Alopecia areata patients had significantly higher amount of stress than the control group, and this result is consistent with the previous studies which suggest that stress contributes to the oneset of alopecia areata. The causual relationship between stress and alopecia areata should be further examined in order to be applied in clinical setting.

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Survey on Preferences Regarding Rubber Dams in Children, Adolescents and Parents (러버댐에 대한 소아, 청소년 및 보호자에 대한 선호도 조사)

  • Jeong, Hankeul;Lee, Nanyoung;Lee, Sangho
    • Journal of the korean academy of Pediatric Dentistry
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    • v.43 no.1
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    • pp.17-26
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    • 2016
  • The use of a rubber dam is a useful technique for protecting patients and operators, producing good results when treating children and adolescent patients. Despite its many advantages, some children and adolescent patients have negative feelings and sometimes express its discomfort. The purpose of this study was to evaluate the patients' preferences for rubber dam use and the associated factors that may affect it. A survey was conducted targeting patients aged 4-18 years old who visited the pediatric dental clinic, the restorative dental clinic, or the student treatment dental clinic of ${\bigcirc}{\bigcirc}$ University Dental Hospital, and were treated using a rubber dam without sedation. We collected questionnaires through electronic medical records. Most children and adolescent patients showed positive attitudes towards using rubber dams. The group with a short treatment time and the group with past knowledge or experience of rubber dam use showed more positive attitudes towards rubber dams (p < 0.05), while no significant difference was found among factors such as gender, age, procedure, anesthetics, treatment site, and operator (p > 0.05).