• Health Policy and Management
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• v.6 no.1
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• pp.29-58
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• 1996

This study was conducted to identify the factors that affect the output of health conters. An analystical model employed in this study was developed by modifying 'input-output model' and 'organizational behavior model'. Data were collected form two source; the 1995 report of thealth center which was submitted to the Ministry of Health and Welfare and a mail survey questionary of officers at health center, including 66 directors and 1,768 staffs of the health centers in southern region. The major findings are as follows: That analysis has identified the factors associated with dependent variables: medical services provided by the health center and health program performance(HPP). The number of primary medical facilities was negatively associated with health center performance while the number of staffs, job satisfaction, and professional background of health center directors were positively associated. These independent variables accounted for 40.1% of the variance of dependent variables. The variance of HPP was significantly explained by the number of health subcenter and primary health post, priority level of public health program by hief executive officers(CEOs) and legislator. A significant relationship was found between leadership types of health center directors and the performance of maternal and child health program. Considering these results, the authors suggested that the role in medical care service of health center in the should be rearranged at local level because medical care service of the health center is competing with primary medical facilities in the same region. It is also suggested that educational efforts be made to improve leadership of the health center directors and concern with public health program by the CEOs and legislators of local governments.

• Journal of The Korean Society of Clinical Toxicology
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• v.19 no.1
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• pp.31-37
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• 2021

Purpose: Acetaminophen (APAP) is a widely available drug responsible for a large part of drug-induced hepatotoxicity in developed countries. Although acetaminophen overdose cases in Korea are being continuously reported, there are no reports related to the level of this drug in the patient's blood or of laboratory analysis at emergency departments (ED). This study sought to analyze the acetaminophen overdose cases at a toxicological laboratory and to survey APAP analysis services offered at select EDs. Methods: We analyzed the demographic and analytic data at a toxicological laboratory run by the National Emergency Medical Center (NMC) in 2019-2020. We surveyed the APAP laboratory service in the 38 regional emergency medical centers (EMCs) and 68 local EMCs near the toxicological laboratory. Results: We studied 175 acute poisoning cases (112 women) with positive blood APAP results (mean age 47.0±24.1 years). Suicide attempts comprised 40.0% of the cases and 30.3% APAP overdose events. In the univariate analysis, we observed that patients were significantly younger, with fewer underlying medical diseases. There were a higher number of APAP overdose events, more favorable initial mental status, more toxic quantity intake in the above treatment line group (p<0.05), In multivariate analysis, the toxic amount intake was significantly more frequent in the above treatment line group (p<0.01). Hospital APAP analysis services were available in six EMCs (3/38 regional and 3/68 local). The hospital blood APAP level reporting intervals were shorter than outside-hospital laboratory services (p<0.01, regional 7.0±3.0 vs. 40.6±27.5, local 5.3±3.1 vs. 57.9±45.1 hours). The NMC toxicological laboratory reporting interval was shorter than the other outside-hospital laboratories (p<0.01, regional 5.7±0.6 vs. 50.2±22.7 local 7.5±3.0 vs. 70.5±41.5 hours). Conclusion: Over the treatment line group, toxic amount intake was significantly more frequent. Only six of 106 EMCs have their own APAP analysis service in their hospitals.

• Radiation Oncology Journal
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• v.34 no.3
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• pp.177-185
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• 2016

Purpose: To investigate whether preoperative chemoradiotherapy (PCRT) followed by local excision (LE) is feasible approach in clinical T2N0 rectal cancer patients. Materials and Methods: Patients who received PCRT and LE because of clinical T2 rectal cancer within 7 cm from anal verge between January 2006 and June 2014 were retrospectively analyzed. LE was performed in case of a good clinical response after PCRT. Patients' characteristics, treatment record, tumor recurrence, and treatment-related complications were reviewed at a median follow-up of 49 months. Results: All patients received transanal excision or transanal minimally invasive surgery. Of 34 patients, 19 patients (55.9%) presented pathologic complete response (pCR). The 3-year local recurrence-free survival and disease free-survival were 100.0% and 97.1%, respectively. There was no recurrence among the patients with pCR. Except for 1 case of grade 4 enterovesical fistula, all other late complications were mild and self-limiting. Conclusion: PCRT followed by an LE might be feasible as an alternative to total mesorectal excision in good responders with clinical T2N0 distal rectal cancer.

• Korean Journal of Oriental Medicine
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• v.13 no.2 s.20
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• pp.15-25
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• 2007

Neo-Confucianism(性理學) which provided an ideological base to found Chosun Dynasty which substituted for Koryu Dynasty, presented In-Cheong(仁政) as ideal statecraft. In-Cheong(仁政) is realizing spirit of In(仁) which means a forever creating power(生生之心), for that reason it was a natural result that the ruling class of Chosun Dynasty had interest in medical science. Therefore they remarked 'In-Cheong(仁政) has achieved' when medical books were published, also remarked Hwal-In-Seo(活人署） as an institute of realizing Wang-Cheong(王政) while Hwal-In-Seo(活人署) was placed in very low civil service grade, although the ruling class classified medical science as a Chap-Hak(雜學) which means not essential but necessary knowledge, and ranked it much lower than Confucianism. While had improved medical service system of Korea Dynasty, Chosun Dynasty had special interest in local medicine: expanding provincal medical centers, educating a medical student(醫生) in a medical school who was core human power in local medicine, etc. Nevertheless the local medicine was still depressed. The reasons are ; not providing enough medical center, not much fund to run each center and mobilizing a medical student(醫生) for miscellaneous labor. Depressed local medicine had changed when 士族 came to have an interest in medical science. 士族 had read a lots of medical books from the early Chosun Dynasty. 16th century they even wrote some books on medicine by themselves based on their experience as a provincial governor.　On the other hand Yi-Mun-Geon(李文楗) who wrote Muk-Jae Diary belongs to the latter. He did not use the art of acupucture. He was a civil official in Seoul, so he could get a lots of books and enough medical stuffs. After a while. he was exiled in Seong-Ju(星州) and took part in local medicine there. The local medicine was depressed in Seong-Ju(星州) at that time. Yi-Mun-Geon(李文楗) was a kind of medical consultant as well as a local doctor. Such medical doings by Sa-Jok(士族) may be a moment that provide power to local Sa-Jok(士族). Sa-Jok(士族) themselves were enthusiastic in treating their sick slaves because the slaves were financial foundation of Sa-Jok(士族). After 17th century, however, the relative importance which Sa-Jok(士族) in the country had held in 16th century had decreased gradually while professional doctors bad increased.

• Endocrinology and Metabolism
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• v.33 no.4
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• pp.459-465
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• 2018

Background: Differentiated thyroid carcinoma (DTC) shows a very good prognosis, but older patients have a higher recurrence rate and those show poor prognosis than younger patients. The aim of this study was to determine the clinical outcomes of thyroid cancer patients who experienced recurrence in old age according to the treatment strategy used. Methods: This retrospective observational cohort study was conducted at Asan Medical Center, Seoul, Korea. Among DTC patients with no evidence of disease after initial treatment, we enrolled 86 patients who experienced recurrence at an age >65 years from 1994 to 2012. Sixty-nine patients had local recurrence and 17 patients showed distant metastasis. Results: The mean age of patients at recurrence was 72 years. Patients were followed up for a median of 4.1 years after recurrence. Sixty-three of the 69 patients with local recurrence received additional treatment, while the other six received conservative care. The cancer-specific mortality rate was 15.5% in the local recurrence group. Airway problems were the main cause of death in patients who did not receive further treatment for local recurrence. Among the 17 patients with distant metastasis, 10 underwent specific treatment for metastasis and seven received only supportive management. Seven of those 17 patients died, and the cancer-specific mortality rate was 35% in the distant metastasis group. Conclusion: The overall cancer-specific mortality rate was 20% in DTC patients in whom recurrence was first detected at an age >65 years. Mortality due to uncontrolled local disease occurred frequently in patients who did not receive definitive management for recurrence.

• Journal of Trauma and Injury
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• v.29 no.4
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• pp.116-123
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• 2016

Purpose: To develop an inclusive and sustainable trauma system as the assessment of burden of injuries is very much important. The purpose of this study was to evaluate the estimates and characteristics of abdominal traumatic injuries. Methods: The data were extracted from the National Emergency Department Information System. Based on Korean Standard Classification for Disease 6th version, which is the Korean version of International Classification of Disease 10th revision, abdominal injuries were identified and abdominal surgeries were evaluated with electronic data interchange codes. Demographic factors, numbers of surgeries and clinical outcomes were also investigated. Results: From 2011 to 2014, about 24,696 patients with abdominal trauma were admitted to the hospitals annually in South Korea. The number of patients who were admitted to regional and local emergency medical centers was 8,622 (34.91%) and 15,564(63.02%), respectively. Based on National Emergency Department Information System, liver was identified as the most commonly injured abdominal solid organ (39.50%, 9,754/24,696, followed by spleen (17.57%, 4,338/24,696) and kidney (12.94%, 3,195/24,696). Conclusion: This study shows that the demand for abdominal trauma care is considerable in South Korea and most of the patients with abdominal trauma were admitted to regional or local emergency centers. The results of this study can be used as good source of information for staffs to ensure proper delivery of abdominal trauma care in trauma centers nationally.

• Journal of Korean Foot and Ankle Society
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• v.17 no.3
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• pp.215-219
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• 2013

Purpose: To review the outcomes of surgical treatment for superficial peroneal nerve entrapment. Materials and Methods: Ultrasonogram was used for diagnosis and surgical treatment. Seven superficial peroneal nerve entrapment were surgically treated with follow up of average 16 months (range, 6~29 months). Three patients were male and four patients were female with mean age 36.7 years (range, 19~51 years). Four cases developed after repetitive ankle sprain and three cases had no etiology. Results: Operation was performed mini-open and subcutaneous fasciotomy under local anesthesia. The results were excellent in two cases, good in four cases, fair in one case. Conclusion: Ultrasonogram was useful for diagnosis and surgical treatment of superficial peroneal nerve entrapment syndrome.

• Journal of Korean Neurosurgical Society
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• v.41 no.3
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• pp.186-189
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• 2007

Metastasizing mixed tumors [MMT] of salivary glands are inexplicably metastasize maintaining benign histology. There is no pathologic and flow cytometric analysis criteria to predict the metastasis. MMT is known to metastasize by local implantation, vascular and lymphatic embolization after multiple surgery to local recurrences of primary tumor. However, multiple metastasis including cranium and spine occurred even without surgery to the primary tumor in this case. No pathological evidence of malignancy could be found in both primary and metastatic tumor. MMT is considered as an low grade malignancy based on clinical behavior rather than histologic evidence, such as low mortality rate, long delay of metastasis after primary lesion. Cranial metastasis is also extremely rare and only two cases have been reported. We report this unusual case with a literature review.

• Journal of Veterinary Clinics
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• v.23 no.2
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• pp.197-201
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• 2006

A 2-year-old female mongrel dog was referred to the Veterinary Medical Center of Chungbuk National University due to anorexia, depression and weight loss after the administration of exogenous estrogen for contraception in the local hospital. Although the dog was medicated with antibiotics and fluid for two weeks in the local hospital, there was a deterioration in the patient's general condition. Therefore the dog was referred to our Veterinary Medical Center. Hematological and biochemical analysis showed non-regenerative anemia, thrombocytopenia, severely immature leukocytosis, hyperbilirubinemia, hyperglycemia and elevated serum alkaline phosphatase, gamma-glutamyltransferase, and lactate dehydrogenase. Abdominal ultrasonography showed double line of gallbladder and irregular hypertrophic wall of uterus. On the basis of these examination's results and history taking, final diagnosis was exogenous estrogen-induced myelotoxicosis with cholecystitis and endometritis. The symptomatic therapy for estrogen toxicosis was performed for 26 days after the final diagnosis. However, the symptom had no response to therapy except endometritis and anemia. On day 135 after administration of estrogen, platelet and neutrophil count were normalized, but monocytic leukocytosis was occurred.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.17
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• pp.7695-7700
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• 2015

Background: HER2/neu overexpression on cell membranes of breast cancer cells is due to HER2/neu gene amplification and it is important to identify potential candidates for anti HER2 therapy with trastuzumab. IHC, FISH and CISH are standard FDA approved assays currently used to determine HER2 status in routine practice. The aim of this study was to determine HER2 gene amplification, using the CISH method in breast carcinoma samples which had IHC +2 reactions. Materials and Methods: This study was conducted from 2008-2010 using 334 consecutive breast carcinoma samples referred from local laboratories to Mehr Hospital. CISH assays were performed for all cases, and IHC tests were also done for determining efficacy and accuracy of local labs. HER2 status in local IHC tests was compared with central IHC and CISH results. Results: Of 334 breast cancer patients, 16 were negative for HER2 IHC (0, +1), 201 cases were equivocal (+2), and 31 positive (+3). Of 334 referral cases, 88 were CISH positive (26.3%) and 246 were CISH negative (73.7%). Of 201 IHC +2 cases, HER2 gene amplification was observed in 42 cases (kappa: 0.42). A 29.9% concordance was found between local IHC and central IHC. Sensitivity and specificity of local IHC were 90% and 53.8%, respectively. Conclusions: Low accuracy of IHC results in local labs was associated with the following factors: using former FDA-approved criteria for HER2 interpretation, utilizing non-validated kits, and lack of any quality assurance program. Therefore, following the new 2014 ASCO/CAP guideline and comprehensive quality assurance should be implemented to ensure accuracy of HER2 testing.