• 보건행정학회지
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• 제16권2호
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• pp.77-95
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• 2006

The present study was conducted to examine the degree of variation in length-of-stay (LOS) among health care institutions participating in 17 diagnosis-related groups (DRGs) payment system and to find out hospital characteristics affecting the variation. Electronic medical claims data for treatments of severity classification '0' of 17 DRGs provided for two $years(2003{\sim}2004)$ were collected. For each DRG, the degree of variation in average LOS among health care institutions were analyzed using the random effect model. For DRGs showing significant differences in LOS, multiple regression analyses were performed to find out factors associated with LOS. Significant variations in LOS were observed 9 DRGs including unilateral/bilateral lens procedures, adult/child tonsilectomy, other anal procedures, bilateral adult/child herniorraphy, unilateral child herniorraphy, and hysterectomy, and hysterectomy using laparoscopic procedure. Among the 9 DRGs, five DRGs were selected to investigate the factors explaining for the variation. It was observed that the location of institution was significant predictors for all five DRGs. Within the same DRGs, LOS was significantly shorter among the institutions located in Seoul than those in other areas. As compared to clinics, hospitals and general hospitals/tertiary care institutions showed significantly longer LOS for DRGs of lens procedures, tonsilectomy, and other anal procedures. It is recommended that the institutions located in other than Seoul area benchmark the strategies of the institution in Seoul in efficiently managing LOS. Also, significant variation within the same severity classification such as other anal procedures implies the imminent need for improvement of patient classification system.

• The Korean Journal of Pain
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• 제11권2호
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• pp.253-257
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• 1998

Background: The purpose of this study was to examine the extent and evaluation of pain after total abdominal hysterectomy (TAH) and to establish correlation between three types of pain; pain at rest, pain with movement and pain with coughing (maximum pain). Methods: The present study compared quality of pain during pain management in 48 patients undergoing TAH. Patients received i.v. meperidine as loading dose in the recovery room and PCA with nalbuphine 90 mg, ketorolac 180 mg, buprenorphine 0.9 mg, droperidol 5 mg, plasma solution A 28 ml for 3 days. The PCA device used was the Baxter infusor$^{(R)}$ (PCA module PC-19-55, 0.5 ml/hr basal rate, 15 minute lockout interval). Patients were then interviewed on Operative Day (OPD), Postoperative Day 1, 2, and 3 (POD 1, 2 and 3) to assess their pain on a visual analogue scale (VAS) of 0 (none) to 10 (worst imaginable). Results: The mean pain score at rest was 2.0 on OPD and decreased to 0.7 on POD 3. The mean pain score with movement was 3.2 on OPD and decreased to 1.6 on POD 3. The mean pain score with coughing was 4.2 on OPD and decreased to 2.2 on POD 3. Conclusions: Patients' experience of three types of postoperative pain emphasizes the need for more effective pain management.

• Journal of Animal Science and Technology
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• 제57권3호
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• pp.7.1-7.7
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• 2015

To meet the increasing demands of specific pathogen free (SPF) minipigs in biomedical researches, 8 pregnant Chinese Wuzhishan minipigs (WZSP) sows with clear background were chosen to obtain SPF WZSP by hysterectomy. At $111{\pm}days2$ of the pregnancy, piglets were aseptically taken out from the sows and artificially suckled for 40 to 45 days in the positive isolators. Then, the piglets defined as F0 were transferred to barrier environment and fed with standard feeds. The original SPF colony was formed for breeding by selected piglets from F0 group of 6-8 months old. Biological characteristics of SPF WZSP were collected and further compared to those of conventional (CV) WZSP, including growth performance, reproductive performance, hematology and blood biochemistry, and major pathogens detection. As a result, 61 F0 piglets were obtained from 8 candidate sows, and 55 out of them survived. After strictly selection, 35 F0 piglets were used to form the original SPF colony, which produced 14 litters of SPF piglets defined as F1. Piglet survival rates, growth performance, and reproductive performance of SPF WZSP were similar to CV WZSP. Some hematology and blood biochemistry parameters showed significant differences between SPF and CV WZSP. Eighteen kinds of pathogens were identified to be free in F0 and F1 SPF colony by repeated pathogen detections. In conclusion, we established a satisfied SPF WZSP colony maintaining original characteristics, free of controlled diseases, and being proved to be a suitable laboratory animal.

• 여성건강간호학회지
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• 제3권1호
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• pp.72-81
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• 1997

The purpose of this study was to elucidate the effects of musical listening on anxiety in patients undergoing abdominal hysterectomy. On the basis of the research criterias, 46 patients were recruited from Kang-Nam St. Mary's Hospital in Seoul from October 1 to December 31, 1995. 20 patients of them were participated as the experimental group who received musical listening session with self-selected music tapes, while 26 patients as the control group who didn't receive that session. The musical listening sessions composed of 3 periods, the pre-operation evening, just before sleeping, the operation morning. There were no differences between two groups, in terms of age education, religion, the experience of operation, the perception of uterus, and the weight(%). The State-Trait Anxiety Inventory(STAI) was used to measure anxiety on all patients. And serum cortisol levels, fasting blood sugar levels, systolic and diastolic blood pressure were collected at the day before surgery and the operation day. The results were as follows : 1. There were no significant differences in State-Anxiety between the two groups. 2. The differences of serum cortisol level between the day before surgery and the operative day were significantly lower in experimental group than in control group(P=0.03). 3. The level of fasting blood sugar was significantly decreased in experimental group(P=0.01). 4. Systolic blood pressure level was significantly decreased in experimental group(P=0.02). While Diastolic blood pressure level was not significant between two groups. It is suggested imply that the musical listening during the perioperative period may alleviate the perioperative anxiety levels in patients undergoing abdominal hysterectomy.

• Archives of Plastic Surgery
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• 제38권3호
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• pp.329-332
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• 2011

Purpose: In developed countries, vesicovaginal fistula occur from various pelvic operations including total hysterectomy, leading to urinary leakage and incontinence. Although various methods have been proposed for adequate tissue coverage in fistula repair, the surgical treatment of is not simple and still controversial. We report a case of neobladder-vaginal fistula repair using modified Martius fat pad flap. Methods: A 62-year-old female patient underwent radical cystectomy with total abdominal hysterectomy and neobladder formation due to invasive bladder tumor 5 years ago. For 3 years following the operation, urine leakage was observed. Exploration demonstrated neobladder-vaginal fistula and primary repair including fistulectomy and direct closure was performed. Urinary incontinence relapsed 2 years after primary repair, and after demonstrating the recurrence of fistula on urography, repair of recurrent fistula was performed. After dissection of vagina and neobladder and closure of fistula by urologic surgeon, fibroadipose flap was elevated, rotated and advanced through the tunnel at vaginal sidewall, and interpositioned to the fistula site between neobladder and vagina. Results: There was no acute complication after the surgery and urethral catheter was extracted on the 8th day after the operation. During six month follow-up period after the operation, there is no clinical evidence of fistula recurrence. Conclusion: From our clinical experience and literature review, we think Martius fat pad flap is a useful technique in management of neobladder-vaginal fistula, for it provides enough vascularity, major epithelization surface and better lymphatic drainage, and also prevents overlapping of vesical, vaginal suture lines at the same time.

• Asian Pacific Journal of Cancer Prevention
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• 제16권14호
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• pp.5951-5956
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• 2015

Background: To evaluate the rate of pathologic high-risk factors, intermediate-risk factors, and treatment outcomes in early-stage cervical cancer patients undergoing radical hysterectomy and pelvic lymphadenectomy (RHPL). Materials and Methods: Medical records of stage IA-IIA1 cervical cancer patients who underwent RHPL during the 2006 to 2012 time period and patient follow-up data until December 2013 were reviewed. Results: Of 331 patients, 52 women (15.7%) had pathologic high-risk factors and 59 women (17.8%) had intermediate-risk factors without high-risk factors. All studied patients had an initial complete response. At median follow-up time of 40.9 months (range 1-103.3 months) and mean follow-up time of$ 43.3{\pm}25.3$ months, 37 women had disease recurrence and 4 women had died of disease. The most common site of recurrence was the pelvis (64.8%). Five-year and 10-year disease free survival rates were 96.1% and 91.5%, respectively. Five-year and 10-year overall survival rates were 100% and 99.4%, respectively. Independent factors related to recurrence were pelvic node metastasis (odds ratio [OR], 2.670; 95%CI, 1.001-7.119), and >1/3 cervical stromal invasion (OR, 3.763; 95%CI, 1.483-9.549). Conclusions: The rates of pathologic high-risk and intermediate-risk factors should be considered and disclosed when counseling patients regarding primary treatment by RHPL. Oncologic outcomes of primary surgical treatment for early-stage cervical carcinoma were found to be excellent.

• 여성건강간호학회지
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• 제10권4호
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• pp.351-359
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• 2004

Purpose: A descriptive study was conducted to examine the levels of distress, state anxiety, and physiologic responses in postoperative patients under patient controlled analgesia (PCA), and to determine correlations among the variables. Method: The study sample included women who underwent an elective hysterectomy procedure or other gynecologic surgeries(N=100). Subjective distress was assessed by visual analog scales around 8 hours postoperatively. Trained nurses collected objective distress data through observation of subject's behavior and vital signs. Data were analyzed with frequencies, percentages, means, Pearson correlation coefficients, ANOVA, and the Scheffe post test using SPSS/PC 11.0. Result: Subjective distress, objective distress, and state anxiety scores were relatively low, except pain scores(5.31 out of 10.0) among sub-scales of subjective distress. Women who had a total abdominal hysterectomy showed significantly higher levels of both subjective distress and state anxiety than those after a minor gynecologic surgery. In relationships among variables, subjective distress correlated positively with postoperative state anxiety, but not with the amount of analgesic medication, verified by further analysis on sub-scales of subjective and objective distress. The higher the levels of state anxiety, the higher the levels of tension, dyspnea, facial change, and systolic blood pressure observed. Conclusion: Regardless of effective pain management, most postoperatively experienced distress in gynecological patients was derived from surgery associated anxiety and pain. Specific psychological strategies should be established as well for those with high levels of state anxiety to facilitate prompt recovery.

• Asian Pacific Journal of Cancer Prevention
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• 제15권2호
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• pp.1035-1039
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• 2014

Aim: To evaluate the operative, oncologic and obstetric outcomes of the loop electrosurgical excision procedure (LEEP) in cases with cervical neoplasia. Materials and Methods: A retrospective cohort study was conducted on patients who were suspected of cervical neoplasia and therefore undergoing LEEP at Siriraj Hospital, Mahidol University, Thailand, during 1995-2000. Outcome measures included operative complications in 407 LEEP patients and long-term outcomes in the 248 patients with cervical intraepithelial neoplasia (CIN) who were treated with only LEEP. Results: There were 407 patients undergoing LEEP; their mean age was $39.7{\pm}10.5$ years. The histopathology of LEEP specimens revealed that 89 patients (21.9%) had lesions ${\leq}CIN$ I, 295 patients (72.5%) had CIN II or III, and 23 patients (5.6%) had invasive lesions. Operative complications were found in 15 patients and included bleeding (n=9), and infection (n=7). After diagnostic LEEP, 133 patients underwent hysterectomy as the definite treatment for cervical neoplasia. Of 248 CIN patients who had LEEP only, seven (2.8%) had suffered recurrence after a median of 16 (range 6-93) months; one had CIN I, one had CIN II, and five had CIN III. All of these recurrent patients achieved remission on surgical treatment with re-LEEP (n=6) or simple hysterectomy (n=1). A significant factor affecting recurrent disease was the LEEP margin involved with the lesion (p=0.05). Kaplan-Meier analysis showed 5-year and 10-year disease-free survival (DFS) estimates of 99.9%. Twelve patients became pregnant a total of 14 times, resulting in 12 term deliveries and two miscarriages - one of which was due to an incompetent cervix. Conclusions: LEEP for patients with cervical neoplasia delivers favorable surgical, oncologic and obstetric outcomes.

• 대한한의학회지
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• 제17권2호
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• pp.331-336
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• 1996

본 논문은 수술후 오심, 구토증에 대한 이침요법의 효과를 연구하기 위하여 시도되었다. 경희대학교 의과대학 부속병원에서 전신마취하에 복식 자궁절제술을 받기로 예정된 100명의 환자를 두 군으로 나누어 이침요법을 하지 않은 대조군과 이침요법을 시행한 실험군을 대상으로 연구를 하였다. 대상환자의 연령, 체중, 신장, 마취시간은 두 군간에 통계적으로 유의성있는 차이는 없었다. 수술후 12시간이내에 한번이라도 오심, 구역 및 구토가 발생된 환자는 대조군이 68%, 실험군이 30%으로 실험군이 대조군에 비하여 유의성있는 효과를 보였다. 이침요법에 의한 부작용은 나타나지 않았다. 이침요법은 복식 자궁절제술 후 오심, 구토를 부작용없이 예방하는데 상당한 효과가 있는 것으로 사려된다.

• 동의생리병리학회지
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• 제18권1호
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• pp.200-205
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• 2004

Uterine leiomyoma is the most common tumor in the female genital tract. Although the tumor is benign, it is of paramount importance since it often causes profuse menstrual bleeding, pressure symptoms, and infertility. Nevertheless, the etiology and patholphysiology of this abnormality remain poorly understood. The traditional definitive treatment for uterine leiomyomas is hysterectomy and, even today, symptomatic leiomyomas are the leading cause of hysterectomy in Korea. Clearly, the development of a safe, effective, and nonsurgical method of treatment for leiomyoma would be of great benefit to many women. The present study was designed to investigate the effect of Rhubarb on apoptosis in uterine leiomyoma cells. Results demonstrate that Rhubarb inhibited cell growth in dose-dependent manner. Cell growth significantly decreased to 60% of control in the treatment of Rhubarb (300㎍/㎖). Associated with the decreased response, there was a concomitant and significant delay of subG1 8.32% above baseline in the treatment of Rhubarb (300㎍/㎖). The delay of subG1 showed a dose-dependent manner, as evidenced by the flow cytometry. The reduced cellular viability on exposure to Rhubarb may represent the induction of apoptosis, at least in part, as concomitantly evidenced by enhanced DNA fragmentation, PARP cleavage and caspase 9 and decreased pro-caspase 3. In addition, Rhubarb decreased clAP1 expression levels in dose-dependent manner. Talcen together, there results suggest that Rhubarb can produce a potent inhibition effect of apoptosis and implicate the delay of G1 phase in the cell cycle and pathways of caspase 3 and 9 in the mechanism underlying inhibitory apoptosis effect of Rhubarb.