• Journal of Korean Neurosurgical Society
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• 제61권6호
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• pp.716-722
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• 2018

Objective : Lateral interbody fusion (LIF) is attractive as a less invasive technique to address anterior spinal pathology in the treatment of adult spinal deformity. Its own uses and benefits in treatment of adult degenerative scoliosis are undefined. To investigate the radiographic and clinical outcomes of LIF, and staged LIF and posterior spinal fusion (PSF) for the treatment of adult degenerative scoliosis patients, we analyzed radiographic and clinical outcomes of adult degenerative scoliosis patients who underwent LIF and posterior spinal fusion. Methods : Forty consecutive adult degenerative scoliosis patients who underwent LIF followed by staged PSF at a single institution were retrospectively reviewed. Long-standing 36" anterior-posterior and lateral radiographs were taken preoperatively, at inter-stage, 3 months, 1 year, and 2 years after surgery were reviewed. Outcomes were assessed through the visual analogue scale (VAS), 36-Item Short Form Health Survey (SF-36), and Oswestry Disability Index (ODI). Results : Forty patients with a mean age of 66.3 (range, 49-79) met inclusion criteria. A mean of 3.8 levels (range, 2-5) were fused using LIF, while a mean of 9.0 levels (range, 3-16) were fused during the posterior approach. The mean time between stages was 1.4 days (range, 1-6). The mean follow-up was 19.6 months. Lumbar lordosis was significantly restored from $36.4^{\circ}$ preoperatively up to $48.9^{\circ}$ (71.4% of total correction) after LIF and $53.9^{\circ}$ after PSF. Lumbar coronal Cobb was prominently improved from $38.6^{\circ}$ preoperatively to $24.1^{\circ}$ (55.8% of total correction) after LIF, $12.6^{\circ}$ after PSF respectively. The mean pelvic incidence-lumbar lordosis mismatch was markedly improved from $22.2^{\circ}$ preoperatively to $8.1^{\circ}$ (86.5% of total correction) after LIF, $5.9^{\circ}$ after PSF. Correction of coronal imbalance and sagittal vertebral axis did not reach significance. The rate of perioperative complication was 37.5%. Five patients underwent revision surgery due to wound infection. No major perioperative medical complications occurred. At last follow-up, there were significant improvements in VAS, SF-36 Physical Component Summary and ODI scores. Conclusion : LIF provides significant corrections in the coronal and sagittal plane in the patients with adult degenerative scoliosis. However, LIF combined with staged PSF provides more excellent radiographic and clinical outcomes, with reduced perioperative risk in the treatment of adult degenerative scoliosis.

• 병원약사회지
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• 제35권4호
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• pp.391-399
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• 2018

Background : The Antimicrobial Stewardship Program promotes interdisciplinary interventions and targeted recommendations for the proper utilization of antibiotics. In particular, the aim of the program is to avoid indiscriminate use of broad-spectrum antibiotics based on the documented literature on the significant impact of unsystematic usage of antibiotics on the distribution of antibiotic-resistant microorganisms. To improve the care process for pneumonia treatment using antimicrobial agents, institution-level guidelines were established and disseminated at the Seoul National University Bundang Hospital in April 2016. In this study, we evaluated changes in the physicians'antibiotic prescribing patterns both before-and after-the implementation of the guidelines. Methods : The electronic medical records of inpatients who were prescribed with one or more antibiotics in May 2014 (Group A) and May 2016 (Group B) were reviewed. Data on demographic characteristics, clinical outcomes, and antibiotic prescriptions were collected and the prescription records were compared both before- and after- the implementation of the guidelines. Results : A total of 180 patients were included in the study: 77 patients in group A and 103 patients in group B. The baseline characteristics of the patients were not significantly different between the two groups. Community-acquired pneumonia was the most common diagnosis in both the groups and the difference was not significant (68.8% vs. 67.9%; p=0.67). The type of antibiotic prescriptions used for empirical treatment was not different between the two groups. The most commonly prescribed empirical antibiotics were cephalosporins, with no significant difference (p=0.31). One of the most inappropriately used antibiotics was piperacillin/tazobactam and the rate of prescription was similar in both the groups (p=0.68). The rates of appropriate empirical selection of antibiotics remained unaltered between the two groups (67.5% vs. 71.8%; p=0.53). Conclusions : Implementation of the guidelines only exhibited no significant effect on the antibiotic prescribing patterns of physicians for the treatment of pneumonia. To improve the adequate use of empiric antibiotics, more active interventions and closer monitoring of the feedbacks should be additionally considered and evaluated in future studies.

• 대한골절학회지
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• 제30권4호
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• pp.186-191
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• 2017

목적: 이번 연구의 목적은 고령 인구의 골반 부전 골절에 대한 방사선적, 역학적 특징과 임상 경과를 알아보는 것이다. 대상 및 방법: 2010년 3월부터 2017년 5월까지 골반 부전 골절 환자를 대상으로 후향적 조사를 시행하였다. 환자의 인구학적 정보, 골밀도, 골표지자를 조사하였다. 단순 방사선 촬영과 컴퓨터 단층촬영을 비교하였다. 임상 경과 평가를 위해 이환된 합병증과 골절 6개월 이후 보행 능력을 비교하였다. 결과: 연구 대상 총 42명의 평균 나이는 76.5세였고, 1명을 제외하고는 모두 여성이었다. 초진 병원이 타 병원인 5예 중 골절 진단을 받지 못한 경우가 3예였다. 단순 방사선 사진에서 발견된 골절 외 컴퓨터 단층촬영에서 추가로 골절이 발견된 경우가 81.0%였다. 모두에서 보존적 치료를 시행하였다. 골절 후 보행 시작까지 걸린 시기는 평균 2.8주였으며 42명 중 1예를 제외한 전체 예(97.6%)에서 수상 전 보행 상태로 회복이 가능하였다. 결론: 골반 부전 골절을 진단하는 경우 단순 방사선 사진으로는 제한점이 있는 것을 확인하였다. 골반 부전 골절은 보존적 치료로 좋은 결과를 얻을 수 있었으며, 치명적인 합병증이 비교적 적게 발생하였다.

• 대한소아치과학회지
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• 제48권2호
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• pp.129-139
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• 2021

이 연구의 목적은 치면열구전색의 급여화 이후 치면열구전색 처치를 받은 소아청소년 환자들의 성별, 나이, 보험종류, 지역, 의료기관 등의 특성을 알아보는 것이다. 건강보험심사평가원의 환자표본자료를 이용하였으며 2010년부터 2017년까지 총 8,454,636명의 환자의 정보를 얻을 수 있었고 이중 치면열구전색 처치가 포함된 환자는 114,680명이었다. 여자에서 남자보다 치면열구전색 처치를 받은 비율이 더 높았고, 5 - 9세 집단이 다른 연령에 비하여 가장 많은 치면열구전색 환자 및 진료 비율을 보였다. 보험의 경우 건강보험을 가진 경우가 의료급여에 해당하는 환자에 비해 치면열구전색 진료를 받은 비율이 높았고 진료기관은 치과의원, 치과병원, 보건소 순으로 나타났다. 지역별 비교에서는 경기도가 가장 많은 치면열구전색 환자를 보였으나, 환자 비율의 경우 전북이 가장 높게 나타났다.

• 한국방사선학회논문지
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• 제16권2호
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• pp.77-85
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• 2022

본 연구는 설문조사를 통해 혈관조영검사실 종사자의 감염관리 실태를 조사하여 그에 따른 인식도와 수행도를 알아보고자 하였다. P지역에 소재한 종합병원급 이상 10개 병원의 혈관조영검사실에 근무하는 종사자 126명을 대상으로 2022년 1월 3일부터 1월 28일까지 설문조사를 실시하였으며 내용으로는 대상자의 일반적 특성 10문항과 혈관조영검사실의 감염관리의 주요 항목인 4개 영역 즉, 의료기관 내 감염관리체계, 개인위생, 혈관조영검사실 환경, 혈관조영검사실 장비로 구분한 총 56문항을 Likert 5점 척도로 측정하였다. 자료 분석은 SPSS for WindowTM release 25.0을 이용하여 통계 처리를 하였다. 일반적 특성에 따른 각 영역의 인식도와 수행도의 분석은 t-test, one-way ANOVA로 하였고 변수들 간의 관계는 Pearson 상관관계분석을 시행하였다. 결과로는 모든 영역에서 인식도가 수행도보다 높게 나타나 인식의 수준에 비하여 수행력이 낮음을 알 수 있었다. 또한 인식도와 수행도가 양의 상관관계를 보이고 있어 종사자의 인식 정도가 수행력에 유의한 영향을 미치는 감염관리의 중요한 변수임을 알 수 있었다. 따라서 효과적이고 체계적인 감염관리를 위해서 혈관조영검사실의 종사자는 감염관리의 수행도를 반드시 높여야 할 것이며 그러기 위해선 감염관리 교육이 필요할 것으로 생각되며 앞으로 혈관조영검사실 감염관리 지침이 체계화되어야 할 것으로 판단된다.

• 한국방사선학회논문지
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• 제17권2호
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• pp.249-255
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• 2023

본 연구는 방사선작업종사자, 방사선관계종사자 그룹의 방사선사들과 수시출입자로 분류된 예비 방사선사인 재학생의 임상실습 과정에서의 피폭선량을 측정하였다. 2021년 1월부터 1년 동안 인천소재의 C 대학병원의 방사선구역에서 근무하였던 방사선사들과 동 의료기관에서 7월 1일부터 8월 31일까지 임상실습을 이수한 121명의 학생들을 연구대상으로 하였다. 방사선 피폭선량으로 인하여 손상위험장기인 폐의 피폭선량으로 인한 부작용 발생확률을 평가하기 위하여 ICRP 103^[12]에 의거한 명목위험계수(Nominal Risk Factor)를 사용하였다. 임상실습기간 중 수시출입자로 분류된 방사선(학)과 학생들의 표층선량은 0.98 ± 0.14 mSv, 심부선량은 0.93 ± 0.14 mSv였다. 즉, 표층선량은 1,000,000당 6.7명, 심부선량은 6.4명이 폐의 피폭선량으로 인한 부작용 발생률이 있음이 나타났다. 이는 1년 피폭선량의 환산 값으로 방사선(학)과 교육과정이 3년 혹은 4년임을 고려하였을 때, 임상실습을 나가는 예비 방사선종사자들에 대한 체계적인 관리와 관심이 필요하며, 방사선의 확률적 영향과 관련하여 방사선 안전관리를 위한 기초자료로 활용될 것으로 사료된다.

• 한국방사선학회논문지
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• 제17권4호
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• pp.597-606
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• 2023

본 연구는 2022년 5월부터 2023년 2월까지 부산 지역 일개 의료기관을 내원한 환자들 중 경동맥 초음파 검사와 피검사를 모두 시행한 235명을 대상으로 후향적 분석을 시행하였다. 연구 목적은 경동맥 초음파를 통해 내중막 두께와 혈류속도를 측정하고 대상자들의 BMI 및 대사증후군 영향 인자들을 분석하여 내중막 두께와 혈류속도에 미치는 영향에 대하여 분석하고자 하였다. 경동맥 내중막 두께와 BMI의 상관관계 분석 결과 p=0.000으로 나타나 상관관계가 있는 것으로 확인되었다. 혈류속도와 BMI의 상관관계 분석 결과 p=0.015로 나타나 상관관계가 있는 것으로 확인되었다. 그밖에 연령(p=0.000), 공복혈당(p=0.002), 음주(p=0.006) 등이 경동맥 내중막 두께와 상관관계가 있는 것으로 나타났다. 경동맥 내중막 두께의 증가는 심뇌혈관질환으로 인한 이벤트의 증가를 발생시킨다. 따라서 경동맥 내중막 두께를 증가시키는 요인들을 배제 시키려는 노력이 반드시 필요하며 또한 다양한 예측 방법의 연구와 정기적인 검진을 통한 심혈관질환을 예방하는 것이 무엇보다 중요할 것이다.

• 대한화상학회지
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• 제22권1호
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• pp.1-9
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• 2019

Purpose: The aim of this study was to investigate the characteristics of Acute Kidney Injury Network (AKIN)-defined nephrotoxicity in patients undergoing intravenous colistimethate sodium (CMS) therapy for major burns. Methods: This retrospective study included burn patients who received more than 48 h of intravenous CMS between September 2009 and December 2015. Data collection was performed using the institution's electronic medical record system. Patients assigned to the developed nephrotoxic group experienced aggravation of current AKIN stage during CMS treatment; those assigned to the non-nephrotoxic group experienced no change in current or exhibited improved AKIN stage during CMS therapy. Results: A total of 306 patients were included in this study. All patients were grouped according to AKIN stage: AKIN 0 (n=152); AKIN 1 (n=6); AKIN 2 (n=9); AKIN 3 (n=139). The baseline creatinine (Cr) level was 0.73 mg/dL. The incidence of nephrotoxicity was 50.3% according to AKIN stage; overall mortality was 45.8%. The non-nephrotoxic group consisted of 127 (74.7%) patients and 43 (25.3%) were in the developed nephrotoxic group. In patients requiring continuous renal replacement therapy (CRRT), baseline Cr level was 0.83 mg/dL, pre-CMS Cr level was 1.17 mg/dL, and post-CMS Cr level was 1.34 mg/dL. Conclusion: CMS can be administered without signs of nephrotoxicity for a certain period (approximately 1 week), it can be used relatively safely for 2 weeks. Application of CMS is a reasonable option for treating infections caused by multi-drug resistant gram-negative bacteria in patients with major burns. The caution should be exercised nevertheless.

• Korean Journal of Radiology
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• 제22권7호
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• pp.1172-1184
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• 2021

Objective: The purposes of this study were to analyze the radiation doses for pediatric abdominopelvic and chest CT examinations from university hospitals in Korea and to establish the local diagnostic reference levels (DRLs) based on the body weight and size. Materials and Methods: At seven university hospitals in Korea, 2494 CT examinations of patients aged 15 years or younger (1625 abdominopelvic and 869 chest CT examinations) between January and December 2017 were analyzed in this study. CT scans were transferred to commercial automated dose management software for the analysis after being de-identified. DRLs were calculated after grouping the patients according to the body weight and effective diameter. DRLs were set at the 75th percentile of the distribution of each institution's typical values. Results: For body weights of 5, 15, 30, 50, and 80 kg, DRLs (volume CT dose index [CTDI_vol]) were 1.4, 2.2, 2.7, 4.0, and 4.7 mGy, respectively, for abdominopelvic CT and 1.2, 1.5, 2.3, 3.7, and 5.8 mGy, respectively, for chest CT. For effective diameters of < 13 cm, 14-16 cm, 17-20 cm, 21-24 cm, and > 24 cm, DRLs (size-specific dose estimates [SSDE]) were 4.1, 5.0, 5.7, 7.1, and 7.2 mGy, respectively, for abdominopelvic CT and 2.8, 4.6, 4.3, 5.3, and 7.5 mGy, respectively, for chest CT. SSDE was greater than CTDI_vol in all age groups. Overall, the local DRL was lower than DRLs in previously conducted dose surveys and other countries. Conclusion: Our study set local DRLs in pediatric abdominopelvic and chest CT examinations for the body weight and size. Further research involving more facilities and CT examinations is required to develop national DRLs and update the current DRLs.

• Korean Journal of Radiology
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• 제24권3호
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• pp.259-270
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• 2023

Objective: It is unknown whether artificial intelligence-based computer-aided detection (AI-CAD) can enhance the accuracy of chest radiograph (CR) interpretation in real-world clinical practice. We aimed to compare the accuracy of CR interpretation assisted by AI-CAD to that of conventional interpretation in patients who presented to the emergency department (ED) with acute respiratory symptoms using a pragmatic randomized controlled trial. Materials and Methods: Patients who underwent CRs for acute respiratory symptoms at the ED of a tertiary referral institution were randomly assigned to intervention group (with assistance from an AI-CAD for CR interpretation) or control group (without AI assistance). Using a commercial AI-CAD system (Lunit INSIGHT CXR, version 2.0.2.0; Lunit Inc.). Other clinical practices were consistent with standard procedures. Sensitivity and false-positive rates of CR interpretation by duty trainee radiologists for identifying acute thoracic diseases were the primary and secondary outcomes, respectively. The reference standards for acute thoracic disease were established based on a review of the patient's medical record at least 30 days after the ED visit. Results: We randomly assigned 3576 participants to either the intervention group (1761 participants; mean age ± standard deviation, 65 ± 17 years; 978 males; acute thoracic disease in 472 participants) or the control group (1815 participants; 64 ± 17 years; 988 males; acute thoracic disease in 491 participants). The sensitivity (67.2% [317/472] in the intervention group vs. 66.0% [324/491] in the control group; odds ratio, 1.02 [95% confidence interval, 0.70-1.49]; P = 0.917) and false-positive rate (19.3% [249/1289] vs. 18.5% [245/1324]; odds ratio, 1.00 [95% confidence interval, 0.79-1.26]; P = 0.985) of CR interpretation by duty radiologists were not associated with the use of AI-CAD. Conclusion: AI-CAD did not improve the sensitivity and false-positive rate of CR interpretation for diagnosing acute thoracic disease in patients with acute respiratory symptoms who presented to the ED.