• 대한응급의학회지
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• 제29권5호
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• pp.423-429
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• 2018

Objective: Falling is a common cause of head injury in preschool aged children. We investigated the characteristics of mild head injuries caused by falling and the association between body weight and occurrence of traumatic brain injuries (TBI). Methods: This retrospective observational study was conducted on head-injured preschool-aged children that visited the emergency department from January 2012 to December 2015. Characteristics such as age, sex, weight, free fall height, floor type, and presence of TBI, as defined as cerebral hemorrhage or skull fracture, were investigated. We calculated body weight percentiles by calibrating age and weight and categorized them into four quartile ranges. We grouped all included cases into two groups according to the presence of TBI. The characteristics of the two groups were compared by using chi-square test, and the association with TBI was investigated by using binomial logistic regression. Results: A total of 701 children were included, and TBI was observed in 95 children. Children with TBI were younger. The proportion of children with TBI was higher in the third and fourth quartiles of the body weight group as well as according to soft floor and fall from high height (${\geq}1m$). The odds of soft floor being associated with TBI was higher than the odds for hard floor (odds ratio, 2.734; 95% confidence interval [CI], 1.597-4.680). The odds of high height (${\geq}1m$) being associated with TBI was higher than that for low height (odds ratio, 2.306; 95% CI, 1.155-4.601), and the odds ratio for the weight percentile group was 1.228 (95% CI, 1.005-1.499). Conclusion: Prevalence of TBI after falling in preschool-aged children might be associated with high fall-height and body weight quartiles.

• The Korean Journal of Medicine
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• 제99권3호
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• pp.123-126
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• 2024

The amendment to the Higher Education Act enforced on February 20, 2024, abolishing the traditional 2-year pre-med and 4-year medical school programs, marks a significant shift in medical education in Korea. The academic system reform is expected to be a driving force for large-scale curriculum revision, presenting an opportunity to introduce new educational innovations not only in curriculum but also in student assessment and support systems. Addressing these challenges requires collaborative efforts among educators, students, and communities to navigate the evolving landscape of medical education effectively. In this regard, I will illustrate the recruitment and development of educators to implement the reform and the collaboration between communities and medical schools to innovate medical education.

• 한국방사선학회논문지
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• 제13권3호
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• pp.333-338
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• 2019

방사선치료 분야에서는 치료의 안전성을 검증하기 위한 Quality Assurance(QA) 절차가 매우 중요하게 여겨진다. 그러나 일반적으로 이에 사용되는 선량계들의 다양한 문제점 때문에, 이를 대체하기 위한 선량계 연구가 활발히 진행되고 있다. 본 연구에서는 형광체로부터 방출된 visible light(VL)에 의한 Sensitivity 극대화를 위해, 뛰어난 형광 효율을 가지는 형광체인 $Gd_2O_2S:Tb$를 요오드화납(Lead(II) Iodide; $PbI_2$)에 다양한 weight percent(wt%)로 혼합한 Blended hybrid sensor를 제작하였다. 이후 Blended sensor 및 Pure $PbI_2$ sensor의 고에너지 방사선에 대한 반응특성을 비교 및 평가하였다. 민감도 평가결과, 3wt%는 sensor에서 타 sensor들과 40% 이상 차이나는 최댓값이 나타났으며, 이를 제외한 센서에서 wt%의 증가에 따른 점차적 민감도 감소추세를 확인하였다. 또한, 재현성 평가에서는 Pure $PbI_2$ sensor가 coefficient of variation(CV)>0.015의 큰 편차를 보인 반면, blended sensor는 모두 CV<0.015 이하의 결과를 보였다.

• 대한족부족관절학회지
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• 제25권2호
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• pp.89-94
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• 2021

The surgical repair of an Achilles tendon acute rupture is a proven, traditional treatment for optimal functional recovery. However, concerns regarding complications such as re-rupture, wound problems and infections are driving new techniques, including minimally invasive approaches and nonoperative treatments. If we understand the characteristics and contemplate treatment strategies for possible complications, the surgical repair of the Achilles tendon is an attractive option and can be expected to yield satisfactory functional recovery.

• 대한방사선기술학회지:방사선기술과학
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• 제46권6호
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• pp.527-533
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• 2023

The purpose of this study is to evaluate the clinical risk of spinal radiosurgery by calculating the dose difference due to dose calculation algorithm and multi-leaf collimator positioning error. The images acquired by the CT simulator were recalculated by correcting the multi-leaf collimator position in the dose verification program created using MATLAB and applying stoichiometric calibration and Monte Carlo algorithm. With multi-leaf collimator positioning error, the clinical target volume (CTV) showed a dose difference of up to 13% in the dose delivered to the 95% volume, while the gross tumor volume (GTV) showed a dose difference of 9%. The average dose delivered to the total volume showed dose variation from -8.9% to 9% and -10.1% to 10.2% for GTV and CTV, respectively. The maximum dose delivered to the total volume of the spinal cord showed a dose difference from -14.2% to 19.6%, and the dose delivered to the 0.35 ㎤ volume showed a dose difference from -15.5% to 19.4%. In future research, automating the linkage between treatment planning systems and dose verification programs would be useful for spinal radiosurgery.

• 대한불안의학회지
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• 제15권2호
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• pp.61-67
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• 2019

Objective : This study aimed to investigate the general process from the symptom onset to the psychiatric treatment in Korean panic patients and the effect of improved public awareness on it. Methods : This study has a retrospective design. The subjects were the new patients with panic disorder who visited the psychiatric outpatient clinic in twelve university-affiliated hospitals all across Korea. The medical chart was reviewed retrospectively and the data were collected including chief complaints of symptoms, recent stressors, the time to visit the psychiatric outpatient clinic, and visit of other departments and diagnostic approaches for their symptoms. Results : A total of 814 participants were included in the study. The most common department other than psychiatry the panic patients visited were cardiology (28.3%), general internal medicine (16.0%) and neurology (11.4%). The most frequently used diagnostic tests were a echocardiography (17.9%), 24-hour Holter monitoring (11.2%), and brain MRI (8.2%). Only 37.3% of participants visited psychiatric clinic directly. About 80% of participants visited psychiatric department within 1 year after their first panic symptoms and it took $13.8{\pm}13.7weeks$ on average. Comparing before and after 2012, the number of participants increased who visit directly the psychiatric clinic without visiting other departments (p=0.002) and without visiting emergency room (p<0.001). Conclusions : Our results suggest that a substantial number of patients visit departments other than psychiatry when they experience first panic symptoms. However, most patients begin psychiatric treatment within 1 year after their first symptoms and the number of patient are increasing who visit psychiatric department directly without visiting other departments.

• 대한소화기학회지
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• 제72권6호
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• pp.318-321
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• 2018

Primary neuroendocrine tumors originating from the extrahepatic bile duct are rare. Among these tumors, large cell neuroendocrine carcinomas (NECs) are extremely rare. A 59-year-old man was admitted to Sanggye Paik Hospital with jaundice that started 10 days previously. He had a history of laparoscopic cholecystectomy, which he had undergone 12 years previously due to chronic calculous cholecystitis. Laboratory data showed abnormally elevated levels of total bilirubin 15.3 mg/dL (normal 0.2-1.2 mg/dL), AST 200 IU (normal 0-40 IU), ALT 390 IU (normal 0-40 IU), and gamma-glutamyl transferase 1,288 U/L (normal 0-60 U/L). Serum CEA was normal, but CA 19-9 was elevated 5,863 U/mL (normal 0-37 U/mL). Abdominal CT revealed a 4.5 cm sized mass involving the common bile duct and liver hilum and dilatation of both intrahepatic ducts. Percutaneous transhepatic drainage in the left hepatic duct was performed for preoperative biliary drainage. The patient underwent radical common bile duct and Roux-en-Y hepaticojejunostomy for histopathological diagnosis and surgical excision. On histopathological examination, the tumor exhibited large cell NEC (mitotic index >20/10 high-power field, Ki-67 index >20%, CD56 [+], synaptophysin [+], chromogranin [+]). Adjuvant concurrent chemotherapy and radiotherapy were started because the tumor had invaded the proximal resection margin. No recurrence was detected at 10 months by follow-up CT.

• 대한정형외과학회지
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• 제56권4호
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• pp.361-365
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• 2021

골반골 골절은 고에너지 손상이며 주변 조직 및 장기의 손상이 동반되는 경우가 흔하다. 골반 외상 환자에서 적절한 치료가 제공되지 않으면 사망률이 높아지므로 수상 초기에 적극적인 치료를 요하게 된다. 하지만 광범위한 수술을 시행하기에는 환자의 상태가 허락되지 않는 경우가 많아서 최소 침습적인 수술을 고려하게 된다. 치골의 경피적 고정은 피부 절개를 크게 하지 않고도 골반의 전방부 안정성을 획득할 수 있는 방법으로 비교적 쉽게 적용할 수 있어 여러 문헌에서 소개되고 있다. 그러나 대부분의 문헌에서는 비전위성 골절에 대한 나사 고정을 기술하고 있으며 전위성 골절을 경피적 나사 고정으로 치료할 때 비구의 관절면을 침범하지 않는 위치로 나사를 삽입하는 것이 어려운 점은 간과되고 있다. 저자는 치골의 전위성 골절의 경피적 나사 고정 시 구부러진 유도핀을 이용하여 관절면의 침범을 피하면서 유관나사를 쉽게 삽입할 수 있었기에 본 술식을 소개하고자 한다.

• Journal of Chest Surgery
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• 제23권6호
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• pp.1256-1262
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• 1990

Percutaneous pulmonary valvuloplasty was performed in 19 patients of congenital pulmonary valve stenosis. Pulmonary annulus diameter was estimated by cross sectional echocardiography and right ventricular cineangiography. The size of balloon dilatation catheter was chosen by the same size of the estimated pulmonary annulus in the first 3 patients and 20 \ulcorner30% greater than the annulus in the last 17 patients. After valvuloplasty a satisfactory results was obtained in most patients. Before dilatation, the right ventricular systolic pressure was 91.7 mmHg[range 58-150 mmHg] and it fell to 49.2mmHg[25-85 mmHg] after dilatation. The transvalvular gradient was 67.7 mmHg[33 \ulcorner120 mmHg] before dilatation and it fell to 23.7mmHg [5 \ulcorner62] after dilatation. Repeat cardiac catheterization has been scheduled in all patients 3 months after the initial valvuloplasty but follow up recatheterization was performed in only two patients; in one of them residual gradient of 50 mmHg was reduced to 30 mmHg by repeat valvuloplasty. The other patient showed no evidence of restenosis with transvalvular gradient of 20 mmHg The balloon used for valvuloplasty was single balloon for the first 10 cases and for the later 10 cases it was replaced by Trefoil balloon which was easier for inflation and deflation. There were no significant complications during and after the procedure. From our results, we conclude that balloon valvuloplasty for congenital pulmonary valve stenosis is the treatment of choice in most patients.

• 대한영상의학회지
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• 제82권2호
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• pp.487-492
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• 2021

Immunoglobulin G4 (이하 IgG4)연관 질환은 풍부한 IgG4 형질세포 형태의 림프형질 세포 침윤과 현저한 섬유아세포 증식을 특징으로 하는 전신 질환이다. 일반적으로 IgG4 연관 질환의 후복막강 발현은 복부 대동맥을 둘러싸거나, 요관을 압박하여 수신증을 일으키는 연조직의 형태로 나타난다. 우리는 75세 여성 환자에서 발생한 비전형적인 IgG4 연관 질환의 후복막강 발현에 대해 보고하고자 한다. 수술 전 전산화단층촬영에서 정상 해부학적 경계를 넘어서는 침윤성 성질을 가진 불규칙한 형태의 후복막강의 종괴가 관찰되었으며, 이는 악성 혹은 염증성 상태가 의심되었다. 조영증강 촬영에서 종괴는 균일한 점진적인 조영증강을 보였다.