• Title/Summary/Keyword: 진단 지연

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Clinical Study of Vascular Injuries (혈관 손상의 임상적 고찰)

  • Chung, Sung-Woon;Kim, Young-Kyu
    • Journal of Chest Surgery
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    • v.40 no.7 s.276
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    • pp.480-484
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    • 2007
  • Background: Major vascular injuries can jeopardize a patient's life or imperil limb survival. We performed this study to establish an optimal management plan for vascular injuries. Material and Method: We retrospectively reviewed 26 cases of vascular injury that were treated at Pusan National University Hospital from May, 1999 to September, 2004. The age and sex distribution, the locations and causes of vascular injury, the diagnostic tools, the degree of injuries, clinical manifestations, the treatment modality and complications were reviewed. Result: The mean age was 39.5 years (range: $12{\sim}86$) and the male to female ratio was 22 : 4. The injuries were in 6 descending thoracic aortas, 4 femoral arteries, 4 popliteal veins and so on. The causes of injury were iatrogenic in 8 cases, traffic accident in 7, stab injury in 6 and industrial accident in 5. The most commonly used diagnostic tools were CT and angiography. The degrees of arterial injury were pseudoaneurysm in 10 cases, partial severance in 5, complete severance in 3 and thrombosis in 3. The degrees of venous injury were partial severance in 6 cases, complete severance in 2 and arteriovenous fistula in 2. The clinical manifestations were absence of pulse in 8 cases, coldness in 7, chest pain in 6, swelling in 5, bleeding in 5 and so on. The most frequently used type of revascularization was graft interposition in 11 cases. Two arteriovenous fistulae were repaired by endovascular procedure. There was one case of mortality due to multi-organ failure after hemorrhagic shock, There were three major amputations, and two of them were due to delayed diagnosis and treatment. Conclusion: A system for the early diagnosis and treatment is essential for improving limb salvage and patient mortality. As a consequence of the widespread application of endovascular procedures, the incidence of iatrogenic injuries has recently increased. Educating physicians is important for the prevention of iatrogenic injury. Easy communication and cooperation for earlier involvement of a vascular surgeon is also an important factor.

Nitroglycerin-Challenged Tc-99m MIBI Quantitative Gated SPECT to Predict Functional Recovery After Coronary Artery Bypass Surgery (니트로글리세린 투여 Tc-99m-MIBI 정량 게이트 심근SPECT를 이용한 관상동맥우회로술 후 심근 기능 회복 예측)

  • Lee, Dong-Soo;Kim, Yu-Kyeong;Cheon, Gi-Jeong;Paeng, Jin-Chul;Lee, Myoung-Mook;Kim, Ki-Bong;Chung, June-Key;Lee, Myung-Chul
    • The Korean Journal of Nuclear Medicine
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    • v.37 no.5
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    • pp.278-287
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    • 2003
  • Purpose: The performance of nitroglycerin-challenged Tc-99m-MIBI quantitative gated SPECT for the detection of viable myocardium was compared with rest/24-hour redistribution Tl-201 SPECT Materials and Methods: In 22 patients with coronary artery disease, rest Tl-20l/ dipyridamole stress Tc-99m-MIBI gated/24-hour redistribution Tl-201 SPECT were peformed, and gated SPECT was repeated on-site after sublingual administration of nitroglycerin (0.6 mg). Follow-up gated SPECT was done 3 months after coronary artery bypass graft surgery. For 20 segments per patient, perfusion at rest and 24-hour redistribution, and wall motion and thickening at baseline and nitroglycerin-challenged state were quantified. Quantitative viability markers were evaluated and compared;(1) rest thallium uptake, (2) thallium uptake on 24-hour redistribution SPECT, (3) systolic wall thickening at baseline, and (4) systolic wall thickening with nitroglycerin-challenge. Results: Among 100 revascularized dysfunctional segments, wall motion improved in 66 segments (66%) on follow-up gated myocardial SPECT after bypass surgery. On receiver operating characteristic (ROC) curve analysis, the sensitivity and specificity of rest and 24-hour delayed redistribution Tl-201 SPECT were 79%, 44% and 82%, 44%, respectively, at the optimal cutoff value of 50% of Tl-201 uptake. The sensitivity and specificity of systolic wall thickening at baseline and nitroglycerin-challenge were 49%, 50% and 64%, 65% at the optimal cutoff value of 15% of systolic wall thickening. Area under the ROC curve of nitroglycerin-challenged systolic wall thickening was significantly larger than that of baseline systolic wall thickening (p=0.004). Conclusion: Nitroglycerin-challenged quantitative gated Tc-99m-MIBI SPECT was a useful method for predicting functional recovery of dysfunctional myocardium.

Psychosocial Factors Predicting Delayed Diagnosis of Breast Cancer : The Role of Marital Relationship Functioning (지연된 유방암 진단을 예측하는 정신사회적 요인 : 부부관계기능의 역할)

  • Kim, Ji Young;Woo, Jungmin;Lee, Sang Shin;Kim, Hea Won;Khang, Dongwoo;Rim, Hyo-Deog
    • Korean Journal of Psychosomatic Medicine
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    • v.22 no.1
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    • pp.13-22
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    • 2014
  • Objectives : Breast cancer has been the most prevalent female cancer in South Korea since 2001. Early detection of this disease is the most effective strategy for reducing mortality. The objective of this study was to identify factors which could predict advanced stage at diagnosis of breast cancer. Methods : Participants who were initially diagnosed with breast cancer and referred to the Stress Clinic of the Breast Cancer Center at Kyungpook National University Hospital were included. Through a semi-structured interview, the authors investigated psychosocial variables such as the extent of marital and family functioning and emotional-economic family burden as well as sociodemographic and health behavior-, health characteristic- and cancer-related variables. Results : Data were collected from 219 participants. One hundred and twenty(54.8%) subjects were diagnosed with advanced-stage breast cancer. Variables that were significantly different between the advanced-stage and early-stage groups included : monthly breast self examination(p<0.000), annual mammographic screening(p<0.000), mode of tumor detection(p<0.000), nature of the first symptoms(p<0.000), time to treatment after diagnosis(p<0.000), overloaded economic and family burden(p=0.018), marital functioning(p<0.000) and family functioning(p<0.00). Logistic regression analysis indicated that irregular annual mammography screening(OR=7.431 ; 95% CI 2.407-22.944) or a lack of screening(OR=25.299 ; 95% CI 7.855-81.482) and a dysfunctional marital relationship(OR=4.772 ; 95% CI 2.244-10.145) were significantly associated with advanced stage at diagnosis of breast cancer. Conclusions : We reconfirmed screening behavior to be a risk factor for delayed diagnosis of breast cancer. Our findings also emphasized the importance of psychosocial factors such as marital functioning in early detection of breast cancer. Psychiatric consultation in the area of martial functioning could be beneficial for increasing early detection in breast cancer.

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Randomized Trial of Early Versus Late Alternating Radiotherapy/ Chemotherapy in Limited-Disease Patients with Small Cell Lung Cancer (국한성병기 소세포폐암 환자에서 조기 혹은 지연 교대 방사선-항암제치료의 전향적 비교연구)

  • Lee Chang Geol;Kim Joo Hang;Kim Sung Kyu;Kim Sei Kyu;Kim Gwi Eon;Suh Chang Ok
    • Radiation Oncology Journal
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    • v.20 no.2
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    • pp.116-122
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    • 2002
  • Purpose : A randomized prospective study was conducted to compare the efficacy of early or late alternating schedules of radiotherapy, and carboplatin and ifosfamide chemotherapy in patients with limited-disease small cell lung cancer. Materials and Methods: From August 1993 to August 1996, a total of 44 patients with newly diagnosed, limited-disease small cell lung cancer, PS $H0\~2$, wt $loss<10\%$ were enrolled in a randomized trial which compared early alternating radiotherapy (RT)/chemotherapy (CT) and late alternating RT/CT. The CT regimen included ifosfamide $1.5\;g/m^2$ IV, d1-5 and carboplatin AUC 5/d IV, d2 peformed at 4 week intervals for a total of 6 cycles. RT (54 Gy/30 fr) was started after the first cycle of CT (early arm, N=22) or after the third cycle of CT (late arm, N=22) with a split course of treatment. Results : The pretreatment characteristics between the two arms were well balanced. The response rates in the early $(86\%)$ and late $(85\%)$ arm were similar. The median survival durations and 2-year survival rates were 15 months and $22.7\%$ in the early arm, and 17 months and $14.9\%$ in the late arm (p=0.47 by the log-rank test). The two-year progression free survival rates were $19.1\%$ in the early arm and $19.6\%$ in the late arm (p=0.52 by the log-rank test). Acute grade 3 or 4 hematologic and nonhematologic toxicities were similar between the two arms. Eighteen patients $(82\%)$ completed 6 cycles of CT in the early arm and 17 $(77\%)$ in the late arm. Four patients received less than 45 Gy of RT in the early arm and two in the late arm. There was no significant difference in the failure patterns. The local failure rate was $43\%$ in the early arm and $45\%$ in the late arm. The first site of failure was the brain in $24\%$ of the early arm patients compared to $35\%$ in the late arm (p=0.51). Conclusion : There were no statistical differences in the overall survival rate and the pattern of failure between the early and late alternating RT/CT in patients with limited-disease small cell lung cancer.

Maturation of the First Molars in Primary Dentition with Class III Malocclusion (유치열기 골격성과 비골격성 3급 부정교합 환아의 제1대구치 성숙도 비교)

  • Jung, Boram;Kim, Shin;Jeong, Taesung;Kim, Jiyeon
    • Journal of the korean academy of Pediatric Dentistry
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    • v.42 no.2
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    • pp.144-150
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    • 2015
  • Early treatment is recommended for class III malocclusion in the primary dentition, though it is difficult to diagnose correctly. It was recommended dental maturation can possibly be used to make a differential diagnosis of skeletal class III malocclusion. This study aimed to compare dental maturation of first molars in children with skeletal or non-skeletal class III malocclusion in the primary dentition and to determine if dental maturation could be used to make a differential diagnosis of class III malocclusion. Among the children visiting the department of pediatric dentistry in Pusan National University Dental Hospital for anterior crossbite in the primary dentition, 18 were categorized into the non-skeletal class III malocclusion and 34 into the skeletal class III malocclusion. Panoramic radiographs were used to make comparative analysis of dental age and the eruption rate of the first molars. The following results were obtained. No difference was found between chronologic and dental age by the skeletal features or gender, with the latter being older than the former (p < 0.05). The discrepancies in eruption rate of first molars were significantly different between skeletal (18.91%) and non-skeletal groups (16.53%) (p < 0.05). This result implies that maturation of the first molars might be used to make a differential diagnosis of class III malocclusion.

Primary Pulmonary Angiosarcoma Presenting as Enbodronchial Stenosis -One Case Report (기관지 협착을 동반한 원발성 폐동맥 육종 -1예 보고-)

  • 김경화;서연호;김민호
    • Journal of Chest Surgery
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    • v.36 no.10
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    • pp.789-793
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    • 2003
  • Primary pulmonary angiosarcomas are extremely rare tumors. The diagnosis is often delayed due to nonspecific symptoms, mimicking pulmonary embolism and require careful clinical evaluation to exclude metastasis from the heart, pericardium, and distant extrathoracic sites. Most diagnosis are made postmortem. We report a case of primary pulmonary angiosarcoma histopathologically confirmed postoperatively, which was clinically suspected endobronchial carcinoma with endobronchial obstruction with relavant literature review.

전신질환과 치과질환

  • Lee, Seung-U
    • The Journal of the Korean dental association
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    • v.29 no.6 s.265
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    • pp.467-474
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    • 1991
  • 구강질병의 합리적인 관리는 질병의 원인규명을 바탕으로 예방과 치료가 이루어 져야 한다. 구강의 발생학적, 생리학적인 복합성 때문에, 구강질병에 대한 정확한 이해가 어려우므로 치과진료실에서의 진료행위는 상당한 제한된 것이었고 불완전한 것이었다. 치아의 지지경조직, 연조직, 기타 구강에 영향을 주는 제반질병의 합리적인 관리가 구강내과학적으로 우선되야 할 것이다. 치과의사는 백혈구나 적혈구에 이상이 있는 환자는 치료하는 경우에 주의하여야 할 점이 많으므로 환자의 병력, 임상검사 및 예비검사등에 의하여 이러한 질병을 발견할 수 있어야 한다. 이러한 환자에서는 비정상 출혈, 치유지연, 감염 혹은 점막 궤양이 나타나기 쉽다. 더구나 이들 중 어떤 질환은 치명적으로 이런 환자를 찾아내어 치과처치를 하기전에 내과의사에 보내어 진단, 치료를 받게 해야 한다. 환자자신이 질환에 대해 알고 있고 내과적 처치를 받고 있는 경우라도 의사와 협의가 없이는 어떠한 치과적 처치라도 피하도록 하는 것이 좋겠다. 이에 이러한 혈액질환들의 원인과 증상, 치료법등을 간단히 소개하여 수차에 걸쳐 연재하도록 하겠다. 여기에 연재된 내용들은 어떤부분에서는 너무 자세하게 기술된 내용도 없지 않으나 조금이나마 환자 치료에 도움이 되었으면 하는 바램이다.

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Ultrasonic Tomography Using Cylindrical Array (원통형 배열 음원을 이용한 초음파 토모그래피)

  • Kim Jung-Soon;Kim Moo-Joon;Kim Jung-Ho;Ha Kang-Lyeol
    • Proceedings of the Acoustical Society of Korea Conference
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    • autumn
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    • pp.363-364
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    • 2004
  • 본 연구에서는, 초음파 단층 화상 장치의 구현을 목적으로, 횡 진동모드의 초음파 트랜스듀서를 원통 내부 벽면에 배열하고 송신부와 수신부를 선택적으로 구동하는 방식의 진단용 초음파 토모그래피의 데이터 송수신부를 제작하였다. 제작된 원통형 트랜스듀서 어레이의 평가를 위해, 각 소자의 주파수특성을 확인하였다. 또한, 원통형 트랜스듀서 어레이의 구동부의 각 진동소자에 적절한 지연시간을 부여하여 음장을 측정한 결과, 양호한 합성평면파가 방사됨을 확인할 수 있었다.

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Malfunction diagnosis device by measuring active power in SC Bank (SC뱅크에서의 유효전력측정을 통한 고장진단)

  • Lee, In-Sung;Hong, Jeong-Jo;Song, Young-Cheol;Park, Myoung-Keun;Hong, Young-Min
    • Proceedings of the KIEE Conference
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    • 2009.07a
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    • pp.1631_1632
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    • 2009
  • 일반적으로 3상 유도전동기 회로에서는 회전자계를 얻기 위하여 델타회로가 이용되고 권선의 리액턴스(xL) 성분에 의한 역률지연에 따라 컨덕턴스(xC)회로를 통하여 보상을 하는 회로를 채용하며 관련 회로는 중성선에 흐르는 전류나 전압을 통하여 제어를 한다. 이러한 제어 회로는 몇 가지 문제점이 있는데 델타회로에서는 중성선이 없어 제어가 불가능하고, 실제로 사고 시 현존하는 고속도 계전기의 동작시간인 3사이클 이전에 사고가 진행되는 경우 실제 동작이 불가능한 문제점이 제기된다. 본 논문에서는 이러한 단점을 개선하기 위해 무효전력계통에서 유효전력을 측정하여 고장 및 사고를 사전에 예방하는 방법을 제안하고 시뮬레이션을 통해 타당성을 검증한다.

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사용 중인 피니언 축의 미세 균열 측정 방법에 관한 연구

  • Jang, Hyung-Rok;Choi, Rin;Kim, Yong-Soo
    • Proceedings of the Korean Institute of Industrial Safety Conference
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    • 2002.11a
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    • pp.19-27
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    • 2002
  • 최근 경제구조가 고도화되고 생활수준이 향상됨에 따라 사회간접자본시설 및 각종 용도의 건축물에 대한 요구가 높으며, 특히 고층건물 건축시에 사용되는 리프트카의 수요 또한 증가되고 있다. 일반적으로 기계구조물은 사용기간동안 절대적 안전성을 확보하기 위하여 설계되고 있으나 실제 건설 현장에서 사용중인 피니언축에 균열이 발견되고 있으며 이로 인하여 피니언축 수리보수 기간동안의 공사중지로 공기지연 뿐만 아니라 리프트카 추락으로 인한 인명사고가 발생하는 등 그 위험성이 매우 높다. 이에 따라 각종 구조물, 설비 및 기기의 안전진단을 통한 유지보수가 중요시되고, 결함 검출의 정량화에 대한 연구, 기술 개발이 강력히 요구되고 있다.(중략)

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