• Archives of Plastic Surgery
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• 제36권3호
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• pp.351-355
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• 2009

Purpose: Cervical necrotizing fasciitis tends to involve the deep soft tissues and spread caudally to the anterior chest and mediastinum, often resulting in major complications and death. It may rapidly spread into the thorax along fascial planes, and the associated diagnostic delay results in this descending necrotizing mediastinitis. So, aggressive multidisciplinary therapy with surgical drainage is mandatory. We present a very rare case of descending necrotizing mediastinitis with literature review. Methods: A 53 years old male visited our department 7 days after trauma in neck. His premorbid conditions and risk factors of necrotizing fasciitis were concealed hepatoma, trauma history, chronic liver disease, and nutrition deficit. Computed tomographic scans of the head and neck region were performed in this patient : signs of necrotizing fasciitis, were seen in the platysma, sternocleidomastoid, trapezius muscle and strap muscles of the neck. Fluid accumulations involved multiple neck spaces and mediastinum. At the time, he diagnosed as necrotizing fasciitis on his neck and anterior chest. Necrotic wound was excised serially and we treated this with the Vacuum - assisted closure(VAC, Kinetics Concepts International, San Antonio, Texas) system device. After appropriately shaping the sponge and achieving additional 3 pieces drainage tubes in the pockets, continuous negative pressure of 125 mmHg was applied. The VAC therapy was utilized for a period of 12 days. Results: We obtained satisfactory results from wide excision, abscess drainage with the VAC system, and then split thickness skin graft. The postoperative course was uneventful. Conclusion: The refined technique using the VAC system can provide a means of simple and effective management for the descending necrotizing mediastinitis, with better cosmetic and functional results. Finally, the VAC system has been adopted as the standard treatment for deep cervical and mediastinal wound infections as a result of the excellent clinical outcome.

• 한국산학기술학회논문지
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• 제18권1호
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• pp.202-209
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• 2017

우리나라는 고령화 사회로 빠르게 진입함에 따라 치매환자가 급속히 증가하고 있다. 본 연구는 대도시에 위치한 5개 V병원의 자료를 활용하여 12년간 치매 신환자의 특성 추이를 분석하고 향후 치매환자 증가 수요에 대처하고 치매환자 관리에 기초자료를 제공하고자하는 것이 목적이다. 5개 V병원의 전체 치매 신환자수는 2003년 410명이었으나 2014년에는 5,048명으로 11.3배 증가하였으며, 5개 병원중에서는 P병원이 2003년에 비해 2014년은 30.3배로 가장 많이 증가하였고, D병원은 6.0배 증가하여 병원간에 차이가 많았으나 전반적으로 5개 V병원 치매환자 수가 크게 증가한 것으로 나타났다. 연령별에서는 75세~84세군에서 40.4%로 가장 높았고, 85세 이상 20.2%로 65세 이상이 93.5%로 대부분을 차지하여 고령층에서도 치매환자의 비율이 높게 나타났다. 치매환자 유형별에서는 알츠하이머병이 44.4%로 가장 높게 차지하였으며, 상세불명의 치매는 33.3%, 혈관성치매가 20.4% 순이었다. 연구결과는 12년 동안 큰 폭으로 증가하였으며, 치매환자는 연령이 높을수록 발생률이 높기 때문에 앞으로 5개 V병원의 치매환자 수는 더욱 증가할 것이다. 치매환자 증가 수요에 따른 효과적인 치매관리를 위한 체계적이고 지속적인 추진방안이 요구된다.

• Journal of Korean Neurosurgical Society
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• 제29권6호
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• pp.778-785
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• 2000

Objectives : Intraoperative neurophysiologic monitoring(INM) is a well known useful method to reduce intraoperative neurological complications during neurosurgical procedures. Furthermore, INM is required in most cerebellopontine angle(CPA) surgery because cranial nerves or brain stem injuries can result in serious complications. Object of this study is to the correlation between the changes of intraoperative monitoring modalities during cerebellopontine angle tumor surgery and post-operative functional outcomes in auditory and facial functions. Material and Methods : Fifty-seven patients who underwent intraoperative neurophysiologic monitoring during CPA tumor surgery were retrospectively reviewed. Their lesions were as follows ; vestibular schwannomas in 42, other cranial nerve schwannomas in seven, meningiomas in five and cysts in three cases. Pre- and postoperative audiologic examinations and facial nerve function tests were performed in all patients. Intraoperative neurophysiologic monitoring modalities includes brainstem auditory evoked potentials(BAEP) and facial electromyographies(EMG). We compared the events of INM during CPA tumor surgeries with the outcomes of auditory and facial nerve functions. Results : The subjects who had abnormal changes during CPA tumor surgery were twenty cases with BAEP changes and facial EMG changes in twenty one cases. The changes of intraoperative neurophysiologic monitoring did not always result in poor functional outcomes. However, most predictable intraoperative monitoring changes were wave III-V complex losses in BAEP and continuous neurotonic activities in facial EMG. Conclusion : These results indicate that intraoperative neurophysiologic monitoring in CPA tumor surgery usually provide predictive value for postoperative functional outcomes.

• Journal of Acupuncture Research
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• 제29권5호
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• pp.139-149
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• 2012

Objectives : The aim of this study was to investigate clinical features of the patients admitted to the department of acupuncture and moxibustion in an oriental medicine hospital in order to provide clinical preliminary data for advancement of acupuncture and moxibustion Methods : Total 526 patients were admitted to the department of Acupuncture and Moxibustion in Dunsan Oriental Hospital of Daejeon University from September 1st, 2011 to August 31st, 2012. Of these patients 11 were discharged on the day that they were admitted and the remaining 526 patients who were hospitalized for over 2 days were investigated this study. We analyzed inpatients by discharge progress notes and medical records, using PASW statistics 18.0 for statistical analysis. Results : 1. There were 361 females(62.9%) and 213 males(37.1%). The age distribution was skewed to 40s and 50s and the average age of the patients was 42.91 years. 2. The prevalence of the diseases groups was in the order of musculoskeletal disease, neuromuscular disease, neuro-psychological disease, and EENT disease. The musculoskeletal disease and neuromuscular disease together made up 92% of all diseases. 3. The prevalence of individual diagnosis was in the order of Bell's palsy, cervical sprain, lumbar sprain, herniated lumbar disc, herniated cervical disc, and lumbar spinal stenosis. 4. There were 261 patients with single diagnosis and 193 with two and 120 with three or more diagnoses. The days of hospitalization significantly increased with the number of diseases the patients were diagnosed with. Conclusions : With high concentration of patients seen in certain disease groups, continuous efforts needed to expand the usage of acupuncture and moxibustion treatments to other disease groups and to explore and develop other diverse treatment methods for better outcome of the disease treated.

• 한국사회복지학
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• 제67권2호
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• pp.33-60
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• 2015

본 연구는 다문화 가족 부부의 이혼을 예방하고 이혼으로 인한 충격들을 완화할 수 있는 방안들을 마련하기 위해 이혼을 경험한 결혼이주여성 15명을 대상으로 국제결혼선택에서부터 결혼생활, 이혼, 이혼 후의 생활까지의 과정을 근거이론으로 분석하였다. 분석결과 중심현상은'어긋난 현실에 대한 저항(탈구)하다'였으며, 인과적 조건은'생존을 위해 탈출하다', '기대와 현실의 격차를 실감하다'였으며, 중재적 조건은'남편 실체 알게 되다','절망하다','마음 추수리지못함'이었으며, 맥락적 조건은'하녀 취급당하다', '가정폭력 피해자 되다', '일단 살고 보자고 결심함', '미래 삶의 담보 마련함', '주변화 되다', '이방인 의식이 들다'였다. 작용/상호작용 전략은'지지체계 구축 하다', '새 삶의 의욕 다지다', '사회 정체성 재구성 하다', 결과는'정착지 마련하다'였으며, 핵심범주는'해체를 통한 안전한 정착지 찾기'였다. 이혼유형은 대처성장형, 해방안주형, 생활눌림형, 유랑지속형으로 분류되었으며 이혼과정과 상황모형이 제시되었다. 이러한 결과를 바탕으로 다문화 가족 이혼예방과 이혼 후 충격을 완화할 수 있는 정책적, 실천적 방안을 제시하였다.

• 한국항해항만학회:학술대회논문집
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• 한국항해항만학회 2005년도 춘계학술대회 논문집
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• pp.263-271
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• 2005

해상 준설선을 이용한 항로의 준설시공 과정에서 중요한 점은 작업구역의 공간적 축소로 여유통항수역의 제공과 수면하의 위험물 배제로 안정항행을 제공하는 것이 기본이다. 이를 위해서는 준설선의 이동과 고정을 위한 보조장치의 적극적인 활용과 함께 부대 장비의 실시간 위치 확인, 실시간 준설수심 확인 및 작업정보 등을 통합적인 정보로 제공하여 준설 작업의 자동화를 꾀해야 한다. 그런데, 본 연구에서 스퍼드 제어시스템을 비치한 준설선은 준설 시공시 준설구역 내 준설점 위치로 이동을 스퍼드로 하고 스퍼드는 자동제어 기술을 적용하여 준설선이 능동적 이동에 의한 준설시공을 행하여 최소의 작업공간을 점유하게 되므로 항행하는 타 선박의 안전한 통과를 허용하면서 준설공사를 중단 없이 시공할수 있다. 또한, 스퍼드 활용 항로준설시스템은 스퍼드의 거동쾌적은 물론 전자해도와 함께 작업심도 자료를 동시에 제공하므로 신속한 작업성과까지도 제시할 수 있다는 점에서 기존의 관리시스템과는 비교가 된다. 시스템 평가를 위한 부상항에서의 시험시공결과 일일 작업 시 기존의 앵카시스템을 이용한 작업시간의 2배정도를 실제 투입할 수 있었으며, 준설시공 요건별 비교에서도 준비시간을 38% 절감할 수 있었으며, 준비작업에 필요한 작업인력을 1인 줄일 수 있는 것으로 나타났다.

• 대한예방한의학회지
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• 제21권1호
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• pp.107-119
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• 2017

Purpose : Recently, cancer has become a chronic disease that requires supervision because of early diagnosis and the development of therapeutic technology. As a result, cancer patients are interested in improving the quality of their lives besides the treatment of cancer itself. Therefore, it is necessary to conduct a qualitative research to understand the vivid experiences of cancer patients and structure their treatment experience. Among qualitative researches, grounded theory is developed based on the data collected in the field. The grounded theory research method is easy to analyze for the process and structure of the treatment experience. Therefore, the purpose of this study is to provide basic data on the integrated medical experience of cancer patients Methods : Participants were conveniently selected, and the criteria for selection were for those who had more than 1 month of hospitalization so that they could dictate their situation and experience in a meaningful manner. Data was collected through in-depth interviews and continued until the data were saturated through theoretical sensitivity and continuous comparison methods. The collected data were analyzed through the process of open-coding, axial coding, and selection coding, which are the research methods of grounded theory. Results : Cancer patients differ in their path, purpose, and attitudes depending on their respective situations and the internal and external resources of individuals. There is also a difference in the perception of their situation among the cancer patients and their families. Cancer patients were shown to recognize and cope with problems in the integrated medical treatment process, and have been classified into 6 different types after the results. Cancer patients showed positive changes in terms of physical, emotional, and lifestyle after their integrated medical treatment. Cancer patients perceived the integrated medical treatment process as a horizontal relationship structure and with diversity. Conclusions : The experience of integrated medical treatment of cancer patients is a process of rehabilitation that heals the body and restores life within the interaction of support system, contextual situation, and internal resources of the individual. Despite this, there is a need not only for the efforts of integrated medical service providers but also institutional support in the future with regards to the current weaknesses and points for improvement. In addition, there is a need for an objective criterion to measure the outcome of integrated medicine for the standardization of integrated medical services.

• Asian Pacific Journal of Cancer Prevention
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• 제14권11호
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• pp.6311-6314
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• 2013

Background: While 5-port laparoendoscopic radical prostatectomy is standard practice, efforts have been focused in developing a single port surgery for cosmetic reasons. However, this is still in the pioneering stage considering the challenging nature of the surgical procedures. We have therefore focused on reduced port surgery, using only 2-ports. In this study, we compared 2-port laparoendoscopic radical prostatectomy (2-port RP) and conventional 5-port laparoscopic radical prostatectomy (LRP) for clinically localized prostate carcinoma and evaluated the potential advantages of each. Materials and Methods: From January 2010 to December 2010, all 23 patients with clinically localized prostate cancer underwent LRP. Starting November, 2010, when we introduced the reduced port approach, we performed this procedure for 22 consecutive patients diagnosed with early-stage prostate cancer (cT1c, cT2N0). The patients were matched 1:1 to 2-port RP or LRP for age, preoperative serum PSA level, clinical stage, biopsy and pathological Gleason grade, surgical margin status, pad-free rates and post-operative pain. Results: There was a significant difference in operative time between the 2-port RP and LRP groups ($286.5{\pm}63.3$ and $351.8{\pm}72.4$ min: p=0.0019, without any variation in blood loss (including urine) ($945.1{\pm}479.6$ vs $1271.1{\pm}871.8ml$: p=0.13). The Foley catheter indwelling period was shorter in the 2 port RP group, but without significance ($5.6{\pm}1.8$ vs $8.0{\pm}5.6$ days: p=0.057) and the total perioperative complication rates for 2 port RP and LRP were comparable at 4.5% and 8.7% (p=0.58). There was an improvement in pad-free rates up to 6 months follow-up (p=0.090), and significantly improvement at 1 year (p=0.040). PSA recurrence was 1 (4.5%) in 2-port RP and 2 (8.7%) in LRP. Continuous epidural anesthesia was used in most of LRP patients (95.7%) and in early 2-port RP patients (40.9%). In these patients, average total amount of Diclofenac sodium was 27.8mg/patient in 2-port RP and 50.0mg/patient in LRP. Conclusions: Thus the reduced port approach is as efficacious as LRP in terms of many outcome measures, with significant cosmetic advantages and reduction in post surgical pain. This method can be readily performed safely and therefore can be recommended as a standard laparoscopic surgery for prostate cancer in the future.

• Journal of Plant Biology
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• 제35권4호
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• pp.403-408
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• 1992

장일식물인 Lemna gibba G3의 개화유도과정에 있어서 polyamine의 관련성을 조사하였다. 이 식물의 개화는 연속광하에서 agmatine, putrescine, spermidine 및 spermine에 의해 촉진되었으며 이들의 체내 합성억제물질인 methylglyoxal-bis(guanylhydrazone)(MGBG)과 cyclohexylamine(CHA)에 의해서 억제되었다. Polyamine은 영양생장률을 거의 일정한 수준으로 유지하면서 개화를 촉진시켰으며, 억제물질에 의한 개화억제는 오히려 영양생장률의 증가를 수반하였다. 이러한 현상은 이 물질들의 개화촉진 또는 억제효과가 생장률의 일반적인 촉진 또는 억제효과에 의한 것이 아니라 선택적으로 개화과정에 작용한 결과일 것이라는 추측을 뒷받침해 준다. 배양액의 첨가된 spermidine 또는 spermine의 개화촉진 폭은 배양액에 이들의 억제물질의 함유여부와 관계없이 거의 일정한 수준으로 나타났다. 이렇듯, 외부에서 공급된 후 체내에 흡수된 spermidine과 spermine의 개화에 대한 기여도가 한정되어 있는 것으로 보아 L. gibba G3의 개화유도과정이 식물체내에서 합성되는 spermidine과 spermine에 크게 의존하고 있을 것으로 판단된다. 한편, 개화유도과정이 시작되어 점차적으로 증가한 체내의 spermidine 함량은 개화가 유도되지 않은 경우에 비하여 24시간만에 약 2배의 수준에 도달하였다. 이렇듯 체내의 spermidine량이 급격히 증가된 사실은 체내의 polyamine의 질적 및 양적 변화가 L. gibba G3의 개화유도초기과정에서 매우 중요한 역할을 하고 있을 것이라는 가정을 뒷받침하는 또 하나의 예비적 증거라 할 수 있다.

• Asian Pacific Journal of Cancer Prevention
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• 제16권14호
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• pp.6033-6038
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• 2015

Background: Experience of lung cancer includes negative impacts on both physical and psychological health. Pain is one of the negative experiences of lung cancer. Cognitive behavioral therapy techniques are often recommended as treatments for lung cancer pain. The objective of this review was to synthesize the evidence on the effectiveness of cognitive behavioral therapy techniques in treating lung cancer pain. This review considered studies that included lung cancer patients who were required to 1) be at least 18 years old; 2) speak and read English or Thai; 3) have a life expectancy of at least two months; 4) experience daily cancer pain requiring an opioid medication; 5) have a positive response to opioid medication; 6) have "average or usual" pain between 4 and 7 on a scale of 0-10 for the day before the clinic visit or for a typical day; and 7) able to participate in a pain evaluation and treatment program. This review considered studies to examine interventions for use in treatment of pain in lung cancer patients, including: biofeedback, cognitive/attentional distraction, imagery, hypnosis, and meditation. Any randomized controlled trials (RCTs) that examined cognitive behavioral therapy techniques for pain specifically in lung cancer patients were included. In the absence of RCTs, quasi-experimental designs were reviewed for possible conclusion in a narrative summary. Outcome measures were pain intensity before and after cognitive behavioural therapy techniques. The search strategy aimed to find both published and unpublished literature. A three-step search was utilised by using identified keywords and text term. An initial limited search of MEDLINE and CINAHL was undertaken followed by analysis of the text words contained in the title and abstract, and of the index terms used to describe the article. A second search using all the identified keywords and index terms was then undertaken across all included databases. Thirdly, the reference list of all identified reports and articles were searched for additional studies. Searches were conducted during January 1991- March 2014 limited to English and Thai languages with no date restriction. Materials and Methods: All studies that met the inclusion criteria were assessed for methodological quality by three reviewers using a standardized critical appraisal tool from the Joanna Briggs Institute (JBI). Three reviewers extracted data independently, using a standardized data extraction tool from the Joanna Briggs Institute (JBI). Ideally for quantitative data meta-analysis was to be conducted where all results were subject to double data entry. Odds ratios (for categorical data) and weighted mean differences (for continuous data) and their 95% confidence intervals were to be calculated for analysis and heterogeneity was to be assessed using the standard Chi-square. Where statistical pooling was not possible the finding were be presented in narrative form. Results: There were no studies located that met the inclusion requirements of this review. There were also no text and opinion pieces that were specific to cognitive behavioral therapy techniques pain and lung cancer patients.Conclusions: There is currently no evidence available to determine the effectiveness of cognitive behavioural therapy techniques for pain in lung cancer patients.