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The Effect of Midazolam As Sedative Agent in Bronchoscopy (기관지내시경 검사시 전처치로서 Midazolam의 효과)

  • Lee, Sang-Haak;Hyun, Dae-Sing;Lee, Sook-Young;Kim, Seok-Chan;Kim, Young-Kyoon;Kim, Kwan-Hyoung;Moon, Hwa-Sik;Song, Jeong-Sup;Park, Sung-Hak
    • Tuberculosis and Respiratory Diseases
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    • v.53 no.6
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    • pp.612-618
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    • 2002
  • Background : Bronchoscopy is an important diagnostic and a therapeutic tool in chest medicine. However, most patients feel that a bronchoscopy is an unpleasant procedure, and it is important to sedate the patients appropriately, particularly where repetitive examinations are required. Midazolam is a sedative drug with amnestic qualities and a rapid 2 hour half-life. This study have attempted to determine the safety, appropriate dosage, and the effect of midazolam premedication in patients who underwent a bronchoscopy. Methods : One hundred and eighty consecutive patients undergoing bronchoscopy were enrolled in this study. The patients received a midzolam doses of 0.03 mg/kg, 0.06 mg/kg, or a placebo. An additional dose of lidocaine, the total number of coughs, and the duration of the procedures were recorded with monitoring the the blood pressure, heart rate, and oxygen saturation. The level of satisfaction was assessed by the patient, bronchoscopist, and the nurse. Results : The blood pressure, pulse rates, oxygen saturation, number of coughs, lidocaine dose, and procedure time in the 3 groups were similar. There was a trend for the midazolam 0.03 mg/kg group to satisfy bronchoscopists more than the other two groups. The nurses' acceptability was lower in the midazolam 0.06 mg/kg group than the other groups. The patients' acceptablity was greater in both the midazolam 0.03 mg/kg and 0.06 mg/kg groups than in the control group. Conclusion : Sedation with low doses of intravenous midazolam is a safe technique for fiberoptic bronchoscopy with a low morbidity and high acceptable to patients and bronchoscopists.

Clinical Benefits and Complications of Cryotherapy in Advanced Lung Cancer with Central Airway Obstruction (중심성 기도 폐쇄를 동반한 폐암에서 냉동치료의 임상적 유용성 및 부작용)

  • Jung, Jin Yong;Lee, Sung Yong;Kim, Dae Hyun;Lee, Kyung Joo;Lee, Eun Joo;Kang, Eun Hae;Jung, Ki Hwan;Kim, Je Hyeong;Shin, Chol;Shim, Jae Jeong;In, Kwang Ho;Kang, Kyung Ho;Yoo, Se Hwa
    • Tuberculosis and Respiratory Diseases
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    • v.64 no.4
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    • pp.272-277
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    • 2008
  • Background: The efficacy of the use of the interventional bronchoscope for palliation of patients with central airway obstruction has been established. In the palliative setting to alleviate central airway obstruction, the use of laser resection, electrocautery, argon plasma coagulation, photodynamic therapy and cryotherapy can provide relief of an airway obstruction. Cryotherapy is the therapeutic application of extreme cold for the local destruction of living tissue. Recently, this technique has been used for endoscopic management of central airway obstructions in Korea. We report the role and complications of the use of cryotherapy for airway obstructions in patients with advanced lung cancer. Methods: We used a flexible cryoprobe for cryotherapy using nitrous oxide as a cryogen. The cryoprobe was applied through the working channel of a flexible fiberoptic bronchoscope. The temperature of the tip was approximately $-89^{\circ}C$, and the icing time was 5~20 seconds. Results: Four patients with a central airway obstruction from advanced lung cancer were treated with cryotherapy. Three of the four patients were treated successfully and the airway obstruction was improved after the cryotherapy procedure. Dyspnea, hypoxia and atelectais were improved in three cases. Two patients experienced complications- one patient experienced pneumomediastinum and the other patient experienced massive hemoptysis during the cryotherapy procedure. However, these complications resolved and did not influence mortality. Conclusion: This technique is effective and relatively safe for palliation of inoperable advanced lung cancer with a central airway obstruction.

Morphology of Larvae, Egg Development and Spawning Behavior of the Blenniid Fish, Pictiblennius yatabei (Jordan et Snyder) (청베도라치, Pictiblennius yatabei의 산란습성(産卵習性), 난발생과정(卵發生過程)및 부화자어(孵化仔魚)의 형태(形態))

  • Kim, Yong-Uk;Myoung, Jung-Goo;Han, Kyeong-Ho;Kang, Chung-Bae
    • Korean Journal of Ichthyology
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    • v.4 no.2
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    • pp.44-54
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    • 1992
  • The blenniid fish, Pictiblennius yatabei(Jordan et Snyder) is ditributed in the central and southern Japan and southern Korea. The fish grows to a maximum size of 9cm in total length, and it seems to be matured in two years. Sex dimorphisms of the fish appear in the crest and the anal fin. Five egg masses of the fish were collected in Tongyoung Bay near Kyeong Nam on June 16 and 20, 1991. The eggs were laid on inner surface of empty shells of the oyster, Crassotrea gigas and blue mussel, Mytilus edulis. Each egg mass was guarded by the male parent. Numbers of eggs in each of masses were as about 450~1000.The eggs were spherical but somewhat oval in shape and ranged from 0.72 to 0.80mm in longer axis and from 0.55 to 0.65mm in shorter axis. Each egg was provided with an adhesive pedestal. Hatching took place in 105 hours after formation of embyo at the water temperature varying from 20.0 to $21.4^{\circ}C$. Melanophores appearing on the yolk remarkably changed in form during the embryonic development.The newly hatched larvae, having 32~34 somites, were from 2.71 to 3.35mm in total length. The larvae absorbed the yolk material and oil globule completely in 7 days after hatching and became postlarvae. Nine days after hatching, the larvae averaged 5.35mm in TL and the caudal notochord flex at $45^{\circ}$ Total lengths of the larvae reached 6.00 and 6.58mm in 11 and 13 days after the hatching, respectively.

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An Analysis of the Operational Time and Productivity in Whole-tree and Cut-to-Length Logging Operation System (전목 및 단목 집재작업시스템에서 작업시간 및 공정 분석)

  • Kim, Min-Kyu;Park, Sang-Jun
    • Journal of Korean Society of Forest Science
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    • v.101 no.3
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    • pp.344-355
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    • 2012
  • This study was conducted to analyze on the operational time and productivities of logging operations in whole-tree logging operation system by tower-yarder and swing-yarder, and in cut-to-length logging operation system by excavator with grapple in order to establish the efficient logging operation system and to spread logging operation technique. In the analysis of operational time, in case of whole-tree logging operation system, the felling time was 46.6 sec/cycle by chain saw, the yarding time was 480.6 sec/cycle by tower-yarder, the yarding time was 287.4 sec/cycle by swing-yarder and the bucking time was 155.14 sec/cycle by chain saw. In case of the cut-to-length logging operation system, the felling and bucking time was 225.65 sec/cycle by chain saw, the cut-to-length extraction time was 4,972 sec/cycle by excavator with grapple, the branches and leaves extraction time was 3,143 sec/cycle by excavator with grapple. The forwarding time was 4,688 sec/cycle by wheel type mini-forwarder, the forwarding time was 2,118 sec/cycle by excavator with grapple and small forwarding vehicle. In the analysis of operational productivities, in case of whole-tree logging operation system, the average felling performance was $57.89m^3/day$ by chain saw, the average yarding performance was $20.3m^3/day$ by tower-yarder, $31.55m^3/day$ by swing-yarder respectively, the average bucking performance was $20.3m^3/day$ by chain saw. In case of the cut-to-length logging operation system, the average felling and bucking performance was $11.96m^3/day$ by chain saw, the average cut-to-length extraction performance was $34.75m^3/day$ by excavator with grapple, the average branches and leaves extraction performance was $37.66m^3/day$ by excavator with grapple, the average length of operation road construction was 73.8 m/day by excavator with grapple. The average forwarding performance by wheel type mini-forwarder and the average forwarding performance by excavator with grapple and small forwarding vehicle was $15.73m^3/day$ and $65.03m^3/day$, respectively.

Quantitative Evaluation of Regional Cerebral Blood Flow by Visual Stimulation in $^{99m}Tc-HMPAO$ Brain SPECT ($^{99m}Tc-HMPAO$ 뇌 SPECT에서 시각자극에 의한 국소 뇌 혈류변화의 정량적 검증)

  • Juh, Ra-Hyeong;Suh, Tae-Suk;Kwark, Chul-Eun;Choe, Bo-Young;Lee, Hyoung-Koo;Chung, Yong-An;Kim, Sung-Hoon;Chung, Soo-Kyo
    • The Korean Journal of Nuclear Medicine
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    • v.36 no.3
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    • pp.166-176
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    • 2002
  • Purpose: The purpose of this study is to investigate the effects of visual activation and quantitative analysis of regional cerebral blood flow. Visual activation was known to increase regional cerebral blood flow in the visual cortex in occipital lobe. We evaluated that change in the distribution of $^{99m}Tc-HMPAO$ (Hexamethyl propylene amine oxime) to reflect in regional cerebral blood flow. Materials and Methods: The six volunteers were injected with 925 MBq (mean ages: 26.75 years, n=6, 3men, 3women) underwent MRI and $^{99m}Tc-HMPAO$ SPECT during a rest state with closed eyes and visual stimulated with 8 Hz LED. We delineate the legion of interest and calculated the mean count per voxel in each of the fifteen slices to quantitative analysis. The ROI to whole brain ratio and regional index was calculated pixel to pixel subtraction visual non-activation image from visual activation image and constructed brain map using a statistical parameter map (SPM99). Results: The mean regional cerebral blood flow was increased due to visual stimulation. The increase rate of the mean regional cerebral blood flow which of the activation region in primary visual cortex of occipital lobe was $32.50{\pm}5.67%$. The significant activation sites using a statistical parameter of brain constructed a rendering image and image fusion with SPECT and MRI. Conclusion: Visual activation was revealed significant increase through quantitative analysis in visual cortex. Activation region was certified in Talairach coordinate and primary visual cortex (Ba17),visual association area (Ba18,19) of Brodmann.

The Effect of Jakamchotang(炙甘草湯) on Isolated rat herts under langendorff apparatus (자감초탕(炙甘草湯)이 재관류장치하에서 흰쥐의 적출심장(摘出心臟)에 미치는 영향(影響))

  • Moon, Hyung-Kun;Moon, Sang-Kwan;Ko, Chang-Nam;Cho, Ki-Ho;Kim, Young-Suk;Bae, Hyung-Sup;Lee, Kyung-Sup
    • The Journal of Korean Medicine
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    • v.18 no.2
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    • pp.340-354
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    • 1997
  • Background : The stenosis of the coronary artery results in a decrease in the myocardial oxygen supply, ischemia and infarction. Jakamchotang as a drug of liquid is generally regarded to have the effect of arrythmia, palpitation from Heart disease and promoting the flow of Ki and Blood. Methods : The purpose of this experimental study is to find whether Jakamchotang is effective or not in curing ischemia in isolated perfused rat hearts and to measure the degree of its curing effect. In this study, under the Langendorff apparatus, ischemia was induced in isolated Sprague-Dawley rat hearts by ceasing the perfusion for 20 minites. Subjects were divided into a normal saline orally administered group(control group), an Jakamchotang orally 100mg administered group (sample A), an Jakamchotang orally 300mg administered group (sample B), and an Jakamchotang injection perfused group(sample C). The heart rates, left ventricular pressure, myocardial dilatation/contraction, cardiac perfusion flow and cardiac ezyme(LDH, CPK) of the four group were measured and compared in order to assess the influence of Jakamchotang on isolated perfused rat hearts recovering abillity from ischemia and infarction. results : 1. Heart rates were increased significantly in Jakamchotang orally 100mg administered group, Jakamchotang orally 300mg administered group and Jakamchotang injection perfused group on perfusion and reperfusion(p<0.01). 2. Left ventricular pressure were increased significantly in Jakamchotang orally 100mg administered group and 300mg administered and Jakamchotang injection perfused group(p<0.01) in comparison with control group on perfusion, but every group did not significant on reperfusion. 3. While there were no differances in each group's abillities of myocardial dilatation, the ability of myocardial constriction of Jakamchotang 100mg administered group only on perfusion was significantly greater than that of control group(p<0.05). 4. CBF was no significant on perfusion and reperfusion in comparison with control group(N.S.) 5. LDH was not significantly decreased on perfusion, but significactly decreased in Jakamchotang orally 100mg administered group, Jakamchotang orally 300mg administered group on reperfusion. 6. CPK was significantly decreased in Jakamchotang orally 100mg administered group, 300mg administered and Jakamchotang injection perfused group on perfusion(p<0.01), but was not significantly in Jakamchotang 300mg administered group only on reperfusion(P<0.05) Conclusion : According to the result above, Jakamchotang have an effect to recover in the isolated perfused rat hearts. Especially, the effect of Jakamchotang in orally adminstered group is greater than that of Jakamchotang injection perfused group on preischemia. The followings are the two important results of this study: First, the effect of Jakamchotang used traditionally on heart disease was proved statistcally under the Langendorff apparatus. Second, on the basis of this study, the effect of other type medications on myocardial ischemia can be evaluted in further studies.

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The Role Behaviors of Oncology Nurse Specialist (종양전문간호사의 역할규명을 위한 연구)

  • Kim, Min-Young;Park, Sung-Ae
    • Asian Oncology Nursing
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    • v.3 no.1
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    • pp.24-44
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    • 2003
  • The purposes of this study was to identify and propose the expected role of the oncology nurse specialist by embodying role theory to oncology nurse specialist. The subjects of this study were 149 persons in 14 hospitals, who were classified to 4 groups, oncology nurse specialists(ONS) group, head nurses and charge nurses(HN & CN) group in hemato-oncology ward, registered nurses(RN) group in hemato-oncology ward, and hematologists & oncologists(H&O) group. The questionnaire which was consisted of 89 items for role of oncology nurse specialist, was made by researcher with a field study and literature review about role of oncology nurse specialist and verified by matrix delphi technique about content validity and construct validity. The data were collected from October 22, 2002 to November 5, 2002. All 4 groups proposed that ONS should perform an expert practitioner role first of all. But ONS group, RN group and H&O group proposed orderly expert practitioner, educator, researcher, consultant, and administrator & change agent, but HN & CN group did expert practitioner, educator, consultant, researcher, administrator & change agent. Expert practitioner had the most highest necessary degree in all groups and most highest performance degree in ONS group. That was consistent with results that all groups proposed role of expert practitioner at first. 4 items out of 20 items showed the meaningful differences between groups. For role of educator, oncology nurse specialist group proposed necessary degrees over 4.0 point out of 5.0 in all items. 4 items out of 18 items showed the meaningful differences between groups. For role of researcher, 3 nurses groups proposed a high necessary degree, but performance of ONS group was most lowest among 5 roles. 6 items out of 14 items showed the meaningful differences between groups. The role of consultant had high necessary degree in some items related to hematopoietic stem cell transplantation. 2 items out of 17 items showed the meaningful differences between groups. In nursing behaviors of administrator & change agent, those items about enacting principle, cost development and participation of professional academy had a high necessary degree. 4 items out of 18 items showed the meaningful differences between groups. Oncology nurse specialists group performed 5 roles orderly, expert practitioner, consultant, educator, administrator & change agent, researcher. This result was different from expected role of themselves as well as the other groups. There was a different necessary degree between role and embodied nursing behaviors of role. ONS group and RN group proposed orderly educator, researcher, administrator & change agent, expert practitioner, consultant, but the other groups did educator, expert practitioner, researcher, consultant, administrator & change agent. The expected standards of oncology nurse specialist in this study were usually master's degree, total career of 5-7 years, oncology career of 3-5 years and certification. But for the post, qualification and qualification institution, various opinions were suggested. In the conclusion, there was a different necessary degree between role and embodied nursing behaviors of role. All groups proposed expert practitioner at first in abstract role, but educator at first in embodied nursing behaviors of role. So we have to consider this difference carefully in the future research. ONS acted the role of expert practitioner first of all, but we should develope and expand the roles of researcher, and administrator & change agent. We should enact roles by role behaviors induced from mutual agreements in necessary degree and performance degree, and bargain the role behaviors that showed the meaningful differences between groups But, we should consider carefully which group's opinion we have to select. I suggested 36 items out of 89 items, in which ONS proposed necessary degree over 4.0 out of 5.0 and half of them performed as the nursing behaviors of oncology nurse specialist that did not induce role stress. For the future, We should role bargain the role with other groups based on these items.

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THE THREE DIMENSIONAL FINITE ELEMENT ANALYSIS OF STRESS DISTRIBUTION AND DEFORMATION IN MANDIBLE ACCORDING TO THE POSITION OF PONTIC IN TWO IMPLANTS SUPPORTED THREE-UNIT FIXED PARTIAL DENTURE (두 개의 임플란트를 이용한 3본 고정성 국소의치에서 가공치 위치에 따른 하악골에서의 응력 분포 및 변형에 관한 삼차원 유한요소법적 연구)

  • Kim, Dong-Su;Kim, Il-Kyu;Jang, Keum-Soo;Park, Tae-Hwan;Kim, Kyu-Nam;Son, Choong-Yul
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.34 no.2
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    • pp.166-179
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    • 2008
  • Excessive concentration of stress which is occurred in occlusion around the implant in case of the implant supported fixed partial denture has been known to be the main cause of the crestal bone destruction. Therefore, it is essential to evaluate the stress analysis on supporting tissue to get higher success rates of implant. The purpose of this study was to evaluate the effects of stress distribution and deformation in 3 different types of three-unit fixed partial denture sup-ported by two implants, using a three dimensional finite element analysis in a three dimensional model of a whole mandible. A mechanical model of an edentulous mandible was generated from 3D scan, assuming two implants were placed in the left premolars area. According to the position of pontic, the experiments groups were divided into three types. Type I had a pontic in the middle position between two implants, type II in the anterior posi-tion, and type III in the posterior position. A 100-N axial load was applied to sites such as the central fossa of anterior and posterior implant abutment, central fossa of pontic, the connector of pontic or the connector between two implants, the mandibular boundary conditions were modeled considering the real geometry of its four-masticatory muscular supporting system. The results obtained from this study were as follows; 1. The mandible deformed in a way that the condyles converged medially in all types under muscular actions. In comparison with types, the deformations in the type II and type III were greater by 2-2.5 times than in the type I regardless of the loading location. 2. The values of von Mises stresses in cortical and cancellous bone were relatively stable in all types, but slightly increased as the loading position was changed more posteriorly. 3. In comparison with type I, the values of von Mises stress in the implant increased by 73% in Type II and by 77% in Type III when the load was applied anterior and posterior respectively, but when the load was applied to the middle, the values were similar in all types. 4. When the load was applied to the centric fossa of pontic, the values of von Mises stress were nearly $30{\sim}35%$ higher in the type III than type I or II in the cortical and cancellous bone. Also, in the implant, the values of von Mises stress of the type II or III were $160{\sim}170%$ higher than in the type I. 5. When the load was applied to the centric fossa of implant abutment, the values of von Mises stress in the cortical and cancellous bone were relatively $20{\sim}25%$ higher in the type III than in the other types, but in the implant they were 40-45% higher in the type I or II than in the type III. According to the results of this study, musculature modeling is important to the finite element analysis for stress distribution and deformation as the muscular action causes stress concentration. And the type I model is the most stable from a view of biomechanics. Type II is also a clinically accept-able design when the implant is stiff sufficiently and mandibular deformation is considered. Considering the high values of von Mises stress in the cortical bone, type III is not thought as an useful design.

A Study to Determine the Effectsiveness of Severance Hospice Home Care Program (호스피스케어에 대한 평가 연구 - 세브란스호스피스 중심으로)

  • Kingsley, Marian R.N.;Cho, Won-Jung;Kim, Cho-Ja;Lee, Won-Hee;Yoo, Ji-Soo
    • The Korean Nurse
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    • v.29 no.4
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    • pp.51-72
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    • 1990
  • The purpose of this study was to determine whether Severance Hospice Home Care Pro gram was able to meet its objectives. This was done in order to show in detail the effects of hospice home care on the quality of life of terminally ill patients and to provide rationale for setting up more hospice home care programs in korea. The results of the study were as follows: The subjects of the study were 100 terminally ill patients who hnd died 'while in the hospice program and 64 family members who were registered with Severance Hospice Home Care Program between march 1988 and Feb. 1990. The nursing needs of these terminally ill patients were assessed by the nursing records of these patients. The need for pain control(82%) was the highest nursing need so far as the physical aspects were concerned. This was followed by poor appetite(37%), 8 dyspnea(34%), nausea and vomiting(30%) in that order of frequency. In reqard to spiritual needs, the need for religious' support was also high at 72%. Their main psychological symptoms were anxiety and fear(34% ). Burn-out was a major problem for 44% of the family members. The psychological process experiencel by the terminal ill patients was compared to the dying process, described by Kiibler Ross. In comparison of the five stages outlined by kubler Ross with the dying process of the subjects it was found that the subjects not only experienced the five stages but also experienced denial and doubt-fulness or denial with acceptance or acceptance with the expectation of a miracle. But rather than acceptance of the dying process, giving up was a frequent end point of the psychological process, of the subjects. However, when the combination of states was observed, most of the patients reached the state of acceptance in the dying process. It was difficult to identify a definite pattern of change in the psychological process of the subjects. Also it was difficult to identify the factors that influenced the psychological process. The symptoms of the terminally j]] subjects just before dying, that is, 3-4 days before dying included apparent signs of dying. These were a reduction of intake(77%), reduction of the amount of urination(63%), increase in sleeping time (64%) and acceptance of dying by patients and their families who had been unaccepting be before that time(66%). The primary care givers(family member's) degree of satisfaction with the care given to the patient by the hospice was 88.7%. The results of this study show that Severance Hospice Home Care Program had a positie effeet on the quality of life of the terminally ill patients and their family members as they faced the death of the patient. It can be seen from this study that there is an urgent need to extend hospice programs - in order to provide quality of care for terminally ill patient and their families. Based upon the reesults of this study several suggestions are presente as follows: 1) A follow up study should be carried out to identify the dying process as it is unique to Korea. 2) A comparison should be made of other hospice care programs. 3) A comparison study should- be made with subjects who do not receive any hospice care as compared to those who do by use of an experimental and control group methodology. 4) There is a need to determine a scientific method to adequeto measure the interventions carried out to meet the hospice patients nursing care needs. 5) A study should be made using quality research methodology to evaluate effects of hospiec care from the patients, their family members and the nurrse's perspective.

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1910's Tap-gol Park Construction Process through Design Document Interpretation (설계도서를 중심으로 본 1910년대 탑골공원의 성립과정)

  • Kim, Hai-Gyoung;Kim, Young-Soo;Yun, Hye-Jin
    • Journal of the Korean Institute of Traditional Landscape Architecture
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    • v.31 no.2
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    • pp.103-117
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    • 2013
  • This research analyzed the spatial components and establishment of the Tap-gol Park according to the plans between 1897 to 1916 when the discussions on the construction of the park began and it was accomplished as an urban park. The results are as follows. The establishment of Tap-gol Park can be divided by three period. Firstly, Tap-gol Park was owned by the royal family from 1987 to 1904. The discussions on construction of Tap-gol Park as a first urban park of Gyeongseong(京城) in 1897, and the private houses were tear down in order to secure land for the park in 1899. Gates and fences surrounding of Tap-gol Park were organized and it was opened in 1902 based on park plane of turtle - shaped. The octagonal pavilion for 'Lee-Wang-Jik musical band(李王職音樂隊)' was relocated in the southwestern part of the park in 1903. Secondly, Tap-gol Park was used actively by the public between 1910 to 1913, because it was opened for individuals. Also The boundary of Park were changed by surrounding facilities and recreational facilities and benefits was complemented for users. Tap-gol park was opened at nighttime in August 1913. Tap-gol Park was used as a place of amusement park. Thirdly, commercial facilities were made as the park facility between 1914 to 1916. The purpose of 'Kkikdajeom(喫茶店)' was similar to the one of modern cafes. It was built as a typical Japanese tea-house with a small pond having an island and a bridge constructed inside. With the increase of usage of Tap-gol Park as a recreational area by the citizens in 1916, the pavilion as a rest area and toilet as amenities were supplemented. Superintendent's office was equipped too. Simple chairs made from the wooden logs were installed around greenhouse, concert hall, the Wongaksa Buddhist temple(圓覺寺址十層石塔), and the flower garden was fenced round. After the relocation of Yongsan music band to Tap-gol Park, the existing concert hall was demolished. The shape of the park which was seen from the pictures of the magazines of 1920s were achieved as early as 1916. The importance of this research includes the basis to revise the errors of the preexistence researches and value of historical material of the design plan reference of the park which was accomplished during the Japanese colonial era. Also this research is to study on the spatial components of the modern landscape architecture and parks.