• 대한두경부종양학회지
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• 제23권2호
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• pp.178-180
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• 2007

Tortuosity of the internal carotid artery is not a rare condition. A 68-year-old woman presented with a 3 years' history of a pulsatile tinnitus and throat abnormal sensation. On physical examination, a soft pulsatile mass on the left posterior oropharyngeal wall was noted. By neck CT and neck MRI the tortuous internal carotd artery was visualized. Otolaryngologists should recognize this anomaly and the patient should be made aware of their condition, because it may cause a fatal or near-fatal hemorrhage during surgical procedures in the pharynx, especially tonsillectomy and adenoidectomy and drainage of peritonsillar abscess. We report a case of a left internal carotid artery tortuosity as an oropharyngeal mass.

• 보건행정학회지
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• 제7권1호
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• pp.100-124
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• 1997

In order to suggest the strategies for participation in the PPS(Prospective Payment System), analyses were performed based on variations in utilization pattern and changes in revenues of hospitals in 10 selected KDRGs. The data was collected from the claims data of a tertiary hospital in Kyunggido from September 1, 1995 to August 31, 1996. The studies consisted of 1, 718 inpatients diagnosed for lens procedures, tonsilectomy &/or adenoidectomy, appendectomy with complicated principal diagnosis, Cesarean section, or vaginal delivery without any complications. The resources used in each KDRG were measured including average length of stay, total charges, number of orders, intensity of medical services, frequencies of medical services, the rate of non-reimbursable charges, and the rate of non-reimbursable orders. Then, the changes in hopital revenues due to the composition of medical fee schedules under the PPS were estimated as follows: 1) The variations in average lenght of stay, total charges, number of orders, the intensity of medical services, the frequency of medical services, the rate of non-reimbursable charges, and the rate of non-reimbursable orders among the 10 KDRGs were comparatively small. 2) The average lenght of stay was the longest(6.0 days) for appendectomy with complicated principal diagnosis, while it was the shortest(2.1 days) for two vaginal deliveries. Statistically differences existed in the average length of stay among physicians and among the dates of admission in several KDRGs. 3) The total charges were the highest for lens procedures(1, 716, 000 won), while the lowest charges were for two vaginal deliveries(558, 000 won). Statistically differences in the total charges were found among physicians in several KDRGs: however, there were no differences with the dates of admission. 4) The number of orders was the greatest(155) for appendectomy with complicated principal diagnosis, while it was the smallest(75) for the two vaginal deliveries. Statistical differences in the number of orders did not exist among physicians in the KDRGs. 5) Significant differences were found in the intensity of medical services, and in the frequency of medical services among physicians in the KDRGs. 6) The rate of non-reimbursable charges for each KDRG was not related to the rate of non-reimbursable orders. The rate of non-reimbursable orders was the highest(36.0%) for lens procedures, while the lowest rate(11.6%) was for appendectomy with complicated principal diagnosis. The rate of non-reimbursable charges was the highest(39.4-39.7%) for vaginal deliveries, while the lowest rate(13.1%) was for tonsillectomy &/or adenoidectomy(<17 ages). 7) If the physician's practicing style were not change under the PPS, the hospital revenuses could be increased by 10%, and the portion of patient payment could be decreased by 1.4-22.4%. However, the non-reimbursable charges for showed little change between two reimbursement systems. Based upon the above findings, this hospital could be eligible for participation in the PPS(Prospective Payment Systm). However, the process of diagnosis and treatment should be standardized, inentifying methods to reduce cost and to assure quality of medical care. Furthermore, consideration should be given to finding ways to increase patient volume.

• 대한기관식도과학회:학술대회논문집
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• 대한기관식도과학회 1972년도 춘계종합 학술대회 초록집
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• pp.17.1-17
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• 1972

편도적출은 우리 이비인후과 임상에서 평소에 다반사로 행해지는 수술의 하나이라 하겠다. 수술술기의 개량, 마취의 발달과 더불어 각종 항생제의 발견등은 편도 적출술에 따르는 여러 가지 합병증을 감소시켰지만, 이중 수술중 또는 수술후에 왕왕 당하는 출혈문제는 가장 흔한 합병증의 하나이며 술자에게는 골치거리의 하나이기도 하여 아직껏 국내외에서 그 보고가 끊어지지 않고 있다. 특히 본증례에서와 같이 본태성 질환으로 인한 출혈의 해결에 있어서는 더욱 복잡곤란한 문제가 많을 것으로 생각된다. 혈우병은 1950년대에 이르러 각 Factor가 발견되어 현재는 혈우병 A.B.C.로 나뉘고 있다. 본증례는 11세의 남아로서 편도 척출술전에는 혈우병의 유무가 인지 못되었던 예로서 수술후 수술창에서 계속되는 출혈로 혈액응고장애를 가진 질환이라고 생각되어 여러 가지 검사결과 P.T.C의 결여로 오는 혈우병 B란 진단을 얻었기에 교훈적이고 귀중한 체험을 얻었다고 생각되어 보고하는 바이다. 환자는 수차의 수혈과 비인강탐폰 등의 방법으로 겨우 지혈되어 수술 20일만에 수술창이 치유되어 퇴원하였다.

• 대한구순구개열학회지
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• 제11권1호
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• pp.13-22
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• 2008

Velopharyngeal insufficiency(VPI), characterized by hypernasal resonance and nasal air emission, is a speech disorder that can significantly compromise speech intelligibility. Cleft palate, previously repaired cleft palate and submucous cleft palate are associated with VPI. Less commonly, patients may acquire it after adenoidectomy with or without tonsillectomy or as a result of neuromuscular dysfunction. Comprehensive evaluation by a VPI team includes medical assessment focusing on airway obstructive symptoms, perceptual speech analysis, MRI and instrumental assessment. Options for intervention include speech therapy, intraoral prosthetic devices and surgery. Surgical methods can be categorized as palatal, palatopharyngeal or pharyngeal procedures. Each surgical approach has its strengths and limitations. Oro-maxillofacial surgeons are increasingly involved in the referral, evaluation, and treatment of velopharyngeal function. Therefore, understanding of physiology, anatomic structures, evaluation and treatment protocols in VPI is very important. This article presents protocol for evaluation of velopharyngeal function with a focus on indications for surgical interventions.

• Archives of Plastic Surgery
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• 제32권5호
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• pp.660-662
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• 2005

It is well documented that adenoidectomy is attributed to hypernasality in certain cases, but not clear that the enlarged tonsils affect the quality of speech. Hypertrophied tonsils may cause and complicate the problem of velopharyngeal incompetency. The huge tonsils prevent lateral pharyngeal walls from a medial movement and interfere velar elevation, being hypernasality. Hyponasality developes as the tonsils encroach in nasopharyngeal space. Voluminous tonsils also interfere airflow in the oropharyneal passage and produce the phenomenon of cul-de-sac resonance or muffled sound. The authors and et al. present a case of velopharyngeal insufficiency accompanied with hypertrophic tonsils. Improving the lateral constricting pharyngeal wall and velar elevation after tonsillectomy minimized the velopharyngeal gap. Accordingly, the procedures of sphincter pharyngoplasty and palatal lengthening resolved the problem of hypernasality instead of pharyngeal flap. Tonsillectomy prior to pharyngeal flap surgery tends to reduce the postoperative airway problems. Sometimes, however, only tonsillectomy does without pharyngeal flap. Surgical approach by stages and intermittent evaluation are recommended at intervals of at least six weeks.

• 수면정신생리
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• 제11권2호
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• pp.106-109
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• 2004

소아의 폐쇄성 수면 무호흡증은 흔히 편도 아데노이드 비대증으로 인해 발생하는 것으로 알려져 있으나 비만, 두개 악안면 기형 등 다양한 원인에 의해서도 발생할 수 있다. 소아의 폐쇄성 수면 무호흡증은 야뇨증, 사건 수면, 행동 장애 등과 같은 다양한 합병증을 동반할 수 있다. 그 원인이 편도 아데노이드 비대증이면 수술적인 제거를 통해 증상 호전을 기대할 수 있으나 비만 등 다른 원인에 의한 것이라면 지속성 상기도양압술과 체중 감량 및 생활습관 변화를 통한 치료가 필요하다. 저자들은 편도 아데노이드 절제술 시행 후에도 심한 폐쇄성 수면 무호흡증이 지속되고 다양한 합병증이 나타난 환아에서 상기도양압술로 무호흡 관련 증상 및 동반된 합병증의 호전을 보인 1례를 경험하였기에 보고한다.

• The Korean Journal of Pain
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• 제12권2호
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• pp.200-204
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• 1999

Background: Patient-controlled analgesia (PCA) has proven to be safe and effective in children from age 5 years, and older and compares favourably with continuous morphine infusion in the older child. We compared fentanyl and butorphanol for opioid use in PCA with ketorolac to determine a suitable drug combination for post-tonsillectomy pain control. Methods: We studied 60 patients, aged 5~12 yrs, undergoing tonsillectomy with or without adenoidectomy under general anesthesia using $N_2O-O_2$-enflurane. Patients were randomly assigned to receive fentanyl $250\;{\mu}g$ (Group 1: n=30) or butorphanol 5 mg (Group 2: n=30) mixed with ketorolac 90 mg and ondansetron 4 mg diluting 100 ml of 5% D/W solutions intravenously via PCA pump after operation. PCA pump were programmed to deliver a 0.05 ml/kg loading dose, 0.01 ml/kg/hr basal infusion, 0.01 ml/kg on demand bolus, 6 min lockout intervals between doses and 4 bolus hourly limit. Total infusion dosage of PCA drug, VAS pain scores, side effects and satisfaction score of both groups were monitored for 48 hrs. Results: Total infusion dosages were fentanyl $170.6\;{\mu}g$ with ketorolac 61.4 mg (Group 1) and butorphanol 2.8 mg with ketorolac 50.4 mg (Group 2). Total infusion dosage, quality of analgesia, side effects and overall satisfaction didn't differ between two groups. Conclusions: Both fentanyl and butorphanol mixed with ketorolac were effective for post-tonsillectomy pain control using PCA pump in children as young as 5 years old.

• Journal of Preventive Medicine and Public Health
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• 제36권2호
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• pp.147-152
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• 2003

Objectives : To develop a Diagnosis-Related Group (DRG) fraud candidate detection method, using data mining techniques, and to examine the efficiency of the developed method. Methods ; The Study included 79,790 DRGs and their related claims of 8 disease groups (Lens procedures, with or without, vitrectomy, tonsillectomy and/or adenoidectomy only, appendectomy, Cesarean section, vaginal delivery, anal and/or perianal procedures, inguinal and/or femoral hernia procedures, uterine and/or adnexa procedures for nonmalignancy), which were examined manually during a 32 months period. To construct an optimal prediction model, 38 variables were applied, and the correction rate and lift value of 3 models (decision tree, logistic regression, neural network) compared. The analyses were peformed separately by disease group. Results : The correction rates of the developed method, using data mining techniques, were 15.4 to 81.9%, according to disease groups, with an overall correction rate of 60.7%. The lift values were 1.9 to 7.3 according to disease groups, with an overall lift value of 4.1. Conclusions : The above findings suggested that the applying of data mining techniques is necessary to improve the efficiency of DRG fraud candidate detection.

• Child Health Nursing Research
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• 제8권4호
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• pp.400-413
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• 2002

The purpose of this study was to evaluate the effect of informational intervention on postoperative pain following tonsillectomy in children. This study was performed on 30 children, aged 5-15 years, undergoing tonsillectomy and their parents by providing informational intervention with colored figure; operation procedure and information. Pain assessment was done by Pain Questionnaire. The results from this study were as follows : 1. Children in experimental group with mean 16.07 had lower pain scores than control group with mean 14.87 at 4th hours after operation(p<0.05). It showed 'significant difference' and first hypothesis was adopted. 2. Children in experimental group with mean 20.60 had lower pain scores than control group with mean 17.27 at 8th hours after operation(p<0.05). It showed 'significant difference' and second hypothesis was adopted. 3. Children in experimental group with mean 28.80 had lower pain scores than control group with mean 25.70 at 24th hours after operation(p<0.05). It showed 'significant difference' and third hypothesis was adopted. 4. When we analyzed the time difference and difference between two groups simultaneously by repeated measure ANOVA, the significant difference was not found. And so 'the experiential group with operation-related information will show the lower pain sense than the control group just as the time flows after operation', fourth hypothesis was rejected. Generally, it was found that providing information about operation to children and their parents reduced effectively postoperative pain in children, but in clinical settings there are minimum preoperative information-providing because of insufficient time and inconvenience although nursing staffs and patients know its needs. Conclusionally providing preoperative information should help children and their parents cope with Pre, Peri and Post operative events effectively.

• 한방안이비인후피부과학회지
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• 제11권1호
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• pp.269-283
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• 1998

Paranasal sinusitis, especially chronic is one of the most common diseases in the field of otolaryngology. It is similar to Bee Yeun(鼻淵) in oriental medicine. Most cases of sinusitis are due to anatomical abnormalities within ostiomeatal unit or disturbed mucocilliary flow. The ostiomeatal unit is the first place of contact with bacteria and allergens during aspiration, and it can be obstructed easily by minute mucosal swelling due to anatomical narrowness. Therefore the treatment of paranasal sinusitis is not easy and often leads to recurrences in spite of long term treatment or surgical therapy. We studied 83 patients who had visited our hospital with complaints of nasal symptoms; they had been diagnosed as having paranasal sinusitis through an endoscopy or CT scan in another hospital and were diagnosed as the paranasal sinusitis through a PNS series. The results were as follows: 1. Age and sex distribution: The most common occurence was found between 6-10 and 1-5 years old. The Males Were 52($62.7\%$) and Females were 31($37.3\%$). 2. By residence 58 cases lived in apts: 25 lived in houses. 3. The longest duration of disease varied from a lower of 13 to a higher of 36 months in 22 cases and from 7 to 12 months in 21 cases. 4. The most common complication & past history with otolaryngologic or allergic disease were adenoid or tonsil hypertrophy & tonsillectomy and adenoidectomy (21 cases). In decreasing order the others were atopic dematitis, otitis media with effusion and allergic rhinitis. 5. Distribution of paranasal sinus disease was most common in both maxillary sinuses in 52 cases. 12 cases showed a normal PNS X-ray series but these had been diagnosed as paranasal sinusitis with an endoscopy or CT scan in another hospital. 6. Common sinusitis - related symptoms were from highest incidence to lowest nasal obstruction, postnasal drip rhinorrhea, frontal headache, cough with sputum. 7. The most administered of prescription was Gamibangpoongtongsungsan and Sunbangpaedoksan extract. 8. In 26 cases the subjects showed significant improvement symptoms in PNS X-ray series : In 21 case showed partial improvement symptoms.