• Archives of Plastic Surgery
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• 제33권4호
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• pp.445-448
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• 2006

Purpose: The nose is the most prominent skeletal feature of the face and is thus prone to frequent injury. Closed reduction of nasal bone fractures can be performed under general or local anesthesia. However, the benefits and the drawbacks in either form of anesthesia chosen are seldom perceived by the surgeon. A retrospective study was performed to assess the differences in the outcome among the two groups subjected to surgery under different type of anesthesia and to introduce our method of local anesthesia and its adequacy. Methods: Two hundred and fifteen patients during a 2-year period were included in the study. 2% Lidocaine mixed with 1:100,000 epinephrine was injected on the anterior ethmoid nerve and the periosteum. Assessment factors included intra-operative adequacy of analgesia, post-operative analgesic requirement and functional and aesthetic outcome of surgery. Results: 19 patients were manipulated under general anesthesia and 196 patients were manipulated under local anesthesia on the anterior ethmoidal nerve and dorsal periosteum. No statistically signigicant variable in performance of surgery could be attributed to the mode of anesthesia employed(p > 0.05). Four patients experienced complications after reduction. One developed septal deviation and three nasal obstruction. But, no secondary operations were needed. Conclusion: Anterior ethmoidal nerve block and dorsal periosteal injection of 2% Xylocaine, combined with topical intranasal 4% lidocaine and epinephrine provided sufficient analgesia comparable to that of general anesthesia.

• Journal of Korean Neurosurgical Society
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• 제29권12호
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• pp.1600-1605
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• 2000

Objective : World Health Organization and International Labour Organization, in June 8, 1999, requested that working conditions should be reformed ethically right and economically solid for 2.7 billion world labour force. The purpose of this study is to request compensable surgical therapeutic options and to suggest the renewal in cognizance criteria for worker's compensation, especially in spondylolisthesis. Methods : Regarding spondylolisthesis, we obtained data from Korea Labor Welfare Corporation(KLWC). Spinal disease occurrence incidences and medical fees of National Federation of Medical Insurance(NFMI) were analysed. The compensated 122 spinal instrumented cases included 117 male and 5 female patients, aged from 23 to 72 years old(mean : $45{\pm}9.85$). We compared Korean and Foreign Workers Compensation Law. Results : Numbers of herniated nucleus pulpus(78 cases), spinal fractures(34 cases) and dislocations(4 cases) were claimed after spinal interbody fusion operation and were compensated. These compensated degenerative diseases, work related illness, occurred in the course of work. A case of 52-year old spondylolisthesis patient with Disability Grade 8 was compensated by KLWC, according to its occurrence at work by accident. With exception of trauma at work by accident, current cognizance criteria were too narrow to be compensable, especially in surgical therapeutic option, for worker's spondylolisthesis. Conclusion : Considering both worker's compensation law and clinical pathologic progress, we believe that spondylolisthesis should be regarded as a compensable occupation related disease if and when aggravates rapidly in the course of work. We suggest a new cognizance standard to KLWC for labour welfare and proper worker's compensation.

• 지식경영연구
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• 제16권1호
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• pp.209-224
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• 2015

Previous studies provided that limiting the number of services provided in hospital had influences in decreasing cost in delivering medical services. Hospitals could have positive effects on their profit by concentrating small number of services which they have comparative advantages. This study purposed to analyze the relationship between the concentration status of hospitals and medical charge for inpatients. National Inpatient sample data provided by the Health Insurance Review and Assessment Service (HIRA) for three years, 2009 to 2011 was used to compute the three concentration indices (Information Theory Index (ITI), Internal Herfindahl Index (IHI), and number of distinct Diagnosis-Related Groups (DRGs) treated) and total medical charge per inpatient case in each year. It was also used to select the control variables such as bed size, number of doctors per 100 beds, and locations. The ordinary least square regression models were developed and tested for hospital and general hospitals separately. The results showed that the total medical charge per inpatient case was significantly differed depending on the concentration indices, and there were positive relationships in ITI and IHI. The number of distinct DRGs had different directions in regression coefficients depending on the locations and hospital types. Hospitals had larger absolute standardized regression coefficients compare to those of general hospitals. However, their effects could be varied by the hospital types, number of doctors, and locations. It seems that hospitals have more influences on medical charges by concentrating their services than general hospitals. Study results provide knowledges to hospital administrators that concentration strategy can positive influences on the performance of small size hospitals.

• Journal of Korean Neurosurgical Society
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• 제46권4호
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• pp.328-332
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• 2009

Objective : The purpose of this study was to establish new fusion criteria to complement existing Brantigan-Steffee fusion criteria. The primary purpose of intervertebral cage placement is to create a proper biomechanical environment through successful fusion. The existence of a traction spur is an essential predictable radiologic factor which shows that there is instability of a fusion segment. We studied the relationship between the existence of a traction spur and fusion after a posterior lumbar interbody fusion (PLIF) procedure. Methods : This study was conducted using retrospective radiological findings from patients who underwent a PLIF procedure with the use of a cage without posterior fixation between 1993 and 1997 at a single institution. We enrolled 183 patients who were followed for a minimum of five years after the procedure, and used the Brantigan-Steffee classification to confirm the fusion. These criteria include a denser and more mature bone fusion area than originally achieved during surgery, no interspace between the cage and the vertebral body, and mature bony trabeculae bridging the fusion area. We also confirmed the existence of traction spurs on fusion segments and non-fusion segments. Results : The PLIF procedure was done on a total of 251 segments in 183 patients (71 men and 112 women). The average follow-up period was $80.4{\pm}12.7$ months. The mean age at the time of surgery was $48.3{\pm}11.3$ years (range, 25 to 84 years). Among the 251 segments, 213 segments (84.9%) were fused after five years. The remaining 38 segments (15.1%) were not fused. An analysis of the 38 segments that were not fused found traction spur formation in 20 of those segments (52.6%). No segments had traction spur formation with fusion. Conclusion : A new parameter should be added to the fusion criteria. These criteria should be referred to as 'no traction spur formation' and should be used to confirm fusion after a PLIF procedure.

• 한국콘텐츠학회논문지
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• 제10권4호
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• pp.198-205
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• 2010

본 연구는 암발생 이후, 가발착용을 하게된 100명의 여성 암환자를 대상으로 실시하였다. 조사는 두 번에 실시되었으며, 첫번째 조사는 항암 부작용으로 인하여 탈모가 시작된 여성암환자가 가발을 착용하기 전에 실시되었고, 두번째 조사는 동일인을 대상으로 가발착용 후 1달이 지난 시점에 실시되었다. 연구목적은 여성암환자에게 있어서 가발사용 전후의 건강에 대한 인식변화, 가발에 대한 인식변화, 가발관련 정책적인 지원방안에 대한 의견을 조사 분석하고, 가발착용이 건강적인 측면과 사회적 측면으로 가져오는 영향과 인식변화에 대해서 분석하였다. 수집된 자료는 빈도분석을 하여 일반적인 사항에 대해 분석하였고 짝비교 분석을 통해 가발착용 전후의 다양한 변화와 가발착용 등에 대한 인식변화와 삶의 질 변화 등을 파악하였다. 이러한 내용을 통해 전반적으로 탈모여성암환자의 가발착용이 삶의 질에 미치는 영향을 전반적으로 파악하고자 하였다. 결론적으로 본 연구를 통해 탈모여성암환자를 위한 정부차원의 급여지원과 병원차원의 교육지원하는 것이 필요하다는 것을 파악하였다.

• 의료법학
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• 제12권1호
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• pp.11-39
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• 2011

[ ${\S}27$ ]Abs. 3 das Gesuntheitsdienstgesetz (the Medical Service Act) in Korea lautet: Niemand in der Absicht, sich oder einem Dritten einen $Verm{\ddot{o}}gensvorteil$ zu verschaffen, der Medizininstitut bzw. dem Mediziner (die Medizinerin) den Patienten vorstellen, ${\ddot{u}}bweweisen$, verleiten oder einen anderen zu dieser Handlung anstiften darf, wie z.B. die Selbstbeteiligung des Patienten nach dem Krankenkassengesetz (the National Health Insurance Act) oder dem Gesetz ${\ddot{u}}ber$ Beistand der ${\ddot{a}}rztlicher$ Betreuung (the Medical Care Assistance Act) skontieren oder befreien, Geld offerieren oder dem Allgemeinheit das Verkehrswesen anbieten usw. Nach dem Wortlaut ist jedoch unklar, ob unter diese Vorschriften der Fall subsumiert werden kann, wenn eine Medizininstitut bzw. ein(e) Mediziner(in) in der Absicht, sich einen $Verm{\ddot{o}}gensvorteil$ zu verschaffen, sich den Patienten verleitet. Nach dem Korean Supreme Court ist eine Medizininstitut bzw. ein(e) Mediziner(in) nur dann das Subjekt der Verleitungshandlung, wenn sie bzw. er ein Mittel gegen fairen oder $ordungsm{\ddot{a}}{\beta}ien$ Medizinmarkt verwendet oder dem Patienten eine ${\ddot{a}}rztlich$ rechtswidrige Behandlung (z.B. einen rechtswidrigen Schwangerschaftsabbruch) verspricht. In diesem Beitrag wird dagegen die Auffassung mittels der teleologischen Reduktion vertritt und argumentiert, dass ein ${\ddot{a}}rztlich$ rechtswidriges Behandlung nach dem Rechtsgut und dem Normzweck unter ${\S}27$ Abs. 3 das Gesuntheitsdienstgesetz nicht subsumiert werden, sondern allein nach eigenem Unrecht bestraft werden kann.

• 대한예방한의학회지
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• 제21권2호
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• pp.15-22
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• 2017

Objectives : This study was conducted to identify awareness and satisfaction of herbal medicine preparations in Korean medicine doctor(KMD). Methods : The questionnaire consisted of three professors of Korean medicine based on previous researches and reports. The pilot survey was conducted to five KMDs who work in local clinic to get face validity. Based on the results of the pilot survey, three professors of Korean medicine completed the final version. Online surveys was conducted to member of the association of Korean medicine from march 25 to april 6 in 2016. Results : The proportion of patients who prescribe herbal medicine was not significantly correlated to gender (p=0.346), but significantly correlated to age(p<0.01), specialty(p=0.017), monthly income(0.022), and clinical experience(p<0.001). The most common reason for using the herbal preparations which is covered by NHI (National Health Insurance) was due to patient's payment(39.3%). Likewise, the most common reason for using the herbal preparations which is not covered by NHI was various kind of prescription(34.1%). Conclusions : The utilization of herbal preparations could be enhanced by expansion of NHI cover range of herbal preparations.

• Archives of Reconstructive Microsurgery
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• 제25권2호
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• pp.25-28
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• 2016

Purpose: Reconstruction of small defects of the dorsal fingers and toes is a challenging task. Although adipofascial flap is widely used for these areas, additional refinements are warranted. In this paper, we define the appropriate defect size in the finger and toes that can be treated with the adipofascial flap, refine its surgical indications and present a few surgical tips. Materials and Methods: Twelve patients with dorsal defects of the fingers and toes were treated with a random-type adipofascial turn-over flap and skin graft. If the defect area exceeded the size that could be covered by a conventional design, the flap base was designed in oblique or curvilinear fashion to lengthen the flap. For accurate defect coverage, the width of the flap base was designed in an asymmetrical shape depending on the defect configuration, varying the width from 0.3 to 1.0 cm, as opposed to the standard 0.5 to 1.0 cm width. Moreover, the lateral limit of the flap was defined as the lateral axial line. The size of the defect ranged from $3.0{\times}1.7cm$ to $1.5{\times}1.3cm$. Results: All flaps survived completely. Gliding function of the hand was well preserved and there was no evidence of tendon adhesion. Conclusion: The small defect in the dorsal finger and toe can be defined as less than one phalanx-length, measuring about $3.0{\times}2.0cm$ in size. If the defect exceeds this dimension, it is recommended that a different option be considered. We believe the adipofascial flap is an excellent option for treating small defects.

• 디지털융복합연구
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• 제14권2호
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• pp.501-507
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• 2016

본 연구의 목적은 좌업생활자와 생산직 근로자들의 심혈관계 위험요인을 알아보고, 이 두 직군간의 심혈관 질환 위험률 간의 관계를 규명하는데 있다. 연구 대상자는 S지역에 위치한 사업장에서 2015년 건강검진을 시행한 만20세 이상 근로자 620명을 대상으로 사무직과 생산직으로 구분하여 연구하였다. 본 연구의 자료처리는 Windows SPSS ver.18.0을 이용하였다. 연속형 변수는 기술통계량을 통해 평균과 표준편차를 제시하고, 그룹간의 유의한 차이는 독립t검정을 이용하여 비교하였다. 범주형 변수는 빈도수와 비율을 산출하여 chi-square test를 이용하여 분석하였다. 통계처리의 유의수준은 p<.05로 하였다. 사무직은 생산직 보다 흡연, 과다음주, 중등도 이상 신체활동 비실천, 총콜레스테롤 이상, 중성지방 이상, 저밀도콜레스테롤 이상 빈도가 통계적으로 유의하게 높았다. 사무직이 생산직 보다 주음주량, 총콜레스테롤, 중성지방, 저밀도콜레스테롤, 수축기혈압, 심혈관질환 위험률은 통계적으로 유의하게 높았다. 사무직과 생산직의 일평균 흡연량, 공복 시 혈당, 이완기혈압은 통계적으로 유의하지 않았다.

• 대한임상독성학회지
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• 제13권1호
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• pp.36-39
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• 2015

Copper sulfate is a copper compound used widely in the chemical and agriculture industries. Most intoxication occurs in developing countries of Southeast Asia particularly India, but rarely occurs in Western countries. The early symptoms of intoxication are nausea, vomiting, diarrhea, and abdominal cramps, and the most distinguishable clue is bluish vomiting. The clinical signs of copper sulfate intoxication can vary according to the amount ingested. A 75-year old man came to our emergency room because he had taken approximately 250 ml copper sulfate per oral. His Glasgow Coma Scale (GCS) score was 14 and vital signs were blood pressure 173/111 mmHg, pulse rate 24 bpm, respiration rate 24 bpm, and body temperature $36.1^{\circ}$ .... Arterial blood gas analysis (ABGa) showed mild hypoxemia and just improved after 2 L/min oxygen supply via nasal cannula. Other laboratory tests and chest CT scan showed no clinical significance. Three hours later, the patient's mental status showed sudden deterioration (GCS 11), and ABGa showed hypercarbia. He was arrested and his spontaneous circulation returned after 8 minutes CPR. However, 22 minutes later, he was arrested again and returned after 3 minutes CPR. The family did not want additional resuscitation, so that he died 5 hours after ED visit. In my knowledge, early deaths are the consequence of shock, while late mortality is related to renal and hepatic failure. However, as this case shows, consideration of early definite airway preservation is reasonable in a case of supposed copper sulfate intoxication, because the patients can show rapid deterioration even when serious clinical manifestation are not presented initially.