• Journal of Oriental Neuropsychiatry
• /
• v.2 no.1
• /
• pp.19-28
• /
• 1991

내의원(內醫院)은 병원과 약국을 겸비한 일종의 궁중의료기관으로 의사를 비롯하여 여러의원들이 임금과 왕비 및 왕자들의 약을 조제하여 달이던 곳으로, 일명 내국(內局) 또는 약원(藥院)이라고 내의원 앞에 예시되어 있다. 그러나 내의원은 현재 그 내용이 전해지지 않고, 단지 관광지의 유물로만 여겨지고 있다. 현재의 내의원은 창덕궁(昌德宮)에 위치하고 있다. 내의원은 창덕궁의 돈화문(敦化門)을 지나, 인정전(仁政殿)을 거쳐 희정당(熙政當) 좌측에 있으며, 왕비의 거처인 대조전에 가장 가까이 자리잡고 있다. 내의원은 조선왕조 세종25년(1443)에 개원하게 되었으니, 이때는 정치, 문화적으로 안정이 이루어져 가는 상황이었다. 또한 당시 왕이나 왕비 기타 왕족들의 여러 가지 정신적인 갈등으로 인한 질병이 많았으며, 이로인해 전문적이고 독립적인 왕실의료기관의 필요성에 의해 내의원이 독립적인 개원이 이루어졌으리라 사료된다. 이로인하여 저자가 내의원에 관한 자료조사와 실제답사를 통하여 다음과 같은 사실을 알수 있었다. 1) 내의원의 개원은 조선왕조 초기 중앙의료질서 성립을 통한 봉건왕조의 절대왕권확립을 의미함으로 사료된다. 2) 내의원의 위치가 창덕궁의 중심부에 위치하고, 특히 어전(御殿)과 내전(內殿) 가까이에 위치함은 왕실의 질병을 신속하고도 중요하게 다루기 위함으로 사료된다. 3) 특히 의인을 내전에서도 대조전(大造殿) 가까히 둔것은 왕실의 질병중 왕비의 정신신체질환의 치료를 위함으로 사료된다. 4) 내의원의 진료형태는 왕진(往診)이었으며, 이는 당시 의원신분이 중인층이었음으로 사료된다. 5) 내의원의 이용중에서 평민에게는 왕명에 의해서만 이루어졌음으로 사료된다.

• Journal of Chest Surgery
• /
• v.39 no.2 s.259
• /
• pp.117-126
• /
• 2006

Background: The purpose of this study is to describe the characteristics of malpractice claims related to hemopneumothorax and to identify the causes and potential preventability of such claims. Material and Method: A retrospective study was performed by reviewing the records in the Lawnb website and Lx CD-rom: the records on closed malpractice claims involving hemopneumothorax were abstracted from the files available for analysis. The records were reviewed and were analysed to determine the etiology of hemopneumothorax, patient age, results of lawsuit and indemnity payment, underlying diseases, cause of death or complications, and the factors associated with a successful defense. Result: Seven closed claim involving hemopneumothorax were founded in the data for malpractice. Three claims were supreme court decision, one was a high court decision and three claims were district court decision. The most common cause of death was tension pneumothorax. Four of which resulted in indemnity payments. Conclusion: While malpractice claims involving hemopneumothorax were uncommon, they resulted in a high rate and amount of indemnity payments. Claims are more common in pediatric patients. In case of iatrogenic hemopneumothorax, post-procedural X-ray can improve patient outcome and is also associated with decreased indemnity risks. Informed consent is also important.

• Tuberculosis and Respiratory Diseases
• /
• v.43 no.3
• /
• pp.410-419
• /
• 1996

Background : Spontaneous pneumothorax have been managed with a variety of methods. The technique most frequently used is chest tube drainage. Small caliber catheters were first used in the management of pneumothorax complicating the percutaneous needle aspiration lung biopsy, and the try to treat spontaneous pneumothorax also has been reported. However, the value of small caliber catheters in spontaneous pneumothorax has not been fully evaluated. So, we tried to elucidate the efficacy of 8 French catheter in the management of spontaneous pneumothorax. Method : From January, 1990, to April, 1994, 44 patients with spontaneous pneumothorax treated at Chung-Ang university hospital were reviewed. The patients were sub-divide into 8 French catheter insertion group (n=21) and chest tube insertion group (n=23). We compared the presence of underlying lung disease, the extent of the collapse, the duration of indwelling catheter and complication between two groups. Results : 1) The duration of indwelling showed no significant difference between 8 French catheter group and chest tube. But, complication after insertion as subcutaneous emphysema was developed in only chest tube group. (p<0.05) 2) In the primary spontaneous pneumothorax, all case of the pneumothorax of which size was less than 50% showed complete healing with 8 French catheter insertion. Whereas the success rate in patients with large pneumothorax (more than 50%) was tended to be dependent on the age. 3) In the patients with secondary spontaneous pneumothorax who were managed with 8 French catheter, the success rate was trended to be high if the underlying disease of pneumothorax was not COPD and if the patient was young. Conclusion : These results show that 8 French catheter insertion probably was effective in the pneumothorax less than 50%, the primary spontaneous pneumothorax, young age or secondary pneumothorax not associated with COPD.

• Tuberculosis and Respiratory Diseases
• /
• v.44 no.5
• /
• pp.1094-1104
• /
• 1997

Background : Spontaneous pneumothoraces(SP) are divided into primary spontaneous pneumothoraces (PSP) which develop in healthy individuals without underlying pulmonary disorders and secondary spontaneous pneumothoraces(SSP) which occur in those who have underlying disorders such as tuberculosis or chronic obstructive lung diseases. Yet there is no established standard therapeutic approach to this disorder, i.e., from the spectrum of noninvasive treatment such as clinical observation with or without oxygen therapy, to aggressively invasive thoracoscopic bullectomy or open thoracotomy. Although chest tube thoracostomy has been most widely used, the patients should overcome pain in the initiation of tube insertion or during indwelling it potential infection and subcutaneous emphysema. Thus smaller-caliber tube has been challenged for the treatment of pneumothorax. Previously, we studied the therapeutic efficacy of 8 French catheter for spontaneous pneumothorax. But there has been few data for effectiveness of small-caliber catheterization in comparison with that of chest tube. In this study, we intended to observe the long-term effectiveness of 8 French catheter for the treatment of spontaneous pneumothoraces in comparison with that of chest tube thoracostomy. Method : From January, 1990 to January, 1996, sixty two patients with spontaneous pneumothoraces treated at Chung-Ang University Hospital were reviewed retrospectively. The patients were sub-divided into a group treated with 8 French catheter(n=23) and the other one with chest tube insertion(n=39). The clinical data were reviewed(age, sex, underlying pulmonary disorders, past history of pneumothorax, size of pneumothorax, follow-up period). And therapeutic effect of two groups was compared by treatment duration(duration of indwelling catheter or tube), treatment-associated complications and recurrence rate. Results : The follow-up period(median) of 8 French catheter group and chest tube group was 28 and 22 months, which had no statistical significance. Ther was no statistically significant difference of clinical characteristics between two groups with SP, PSP, SSP. The indwelling time of 8 French catheter group was $6.2{\pm}3.8$ days, which was significantly shorter than that of chest tube group in SP, $9.1{\pm}7.5$ days(p=0.047). In comparison of treatment-related complication in PSP, 8 French catheter group as 6.25% of complication showed lower tendency than the other group as 23.8% (p=0.041 ; one-tailed, p=0.053; two-tailed). The recurrence rate in each group of SP was 17.4%, 10.3%, which did not show any statistically significant difference. Conclusion : Treatment with 8 French catheter resulted in shorter indwelling time in sponteous pneumothorax, and lower incidence of treatment-related complication in primary spontaneous pneumothorax. And the recurrence rate in each of treatment group showed no statistically significant difference. So, we can recommend the 8 French small-caliber catheter for the initial therapy for spontaneous pneumothorax for the replacement of conventional chest tube thoracostomy. But further prospective study with more subjects of spontaneous pneumothorax will be needed for the evaluation of effectiveness of 8 French cateter.

• The Journal of Korean Institute of Communications and Information Sciences
• /
• v.30 no.9B
• /
• pp.610-618
• /
• 2005

As developed Internet and Computer Capability, Many Users take the many information through the network. So requirement of User that use to network was rapidly increased and become various. But it spend much time to accept user requirement on current network, so studied such as Active network for solved it. This Active node on Active network have the capability that stored and processed execution code aside from capability of forwarding packet on current network. So required execution code for executed packet arrived in active node, if execution code should not be in active node, have to take by request previous Action node and Code Server to it. But if this execution code take from previous active node and Code Server, bring to time delay by transport execution code and increased traffic of network and execution time. So, As used execution code stored in cache on active node, it need to increase execution time and decreased number of request. So, our paper suggest ANC caching technique that able to decrease number of execution code request and time of execution code by efficiently store execution code to active node. ANC caching technique may decrease the network traffic and execution time of code, to decrease request of execution code from previous active node.