• 성인간호학회지
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• 제12권4호
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• pp.517-532
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• 2000

The purpose of this study was to develop a critical pathway for case management of patients who have received Lumbar Laminectomy because of low back pain, arm and leg numbness, and radiating pain in the leg. For this study, a preliminary critical pathway was developed through a review of the literature including five critical pathways which are currently being used in the USA. In order to identify the overall service contents required by these patients, 30 cases were analyzed. These cases were taken from medical records of those with Lumbar Laminectomy between January, 1998 and December, 1998 in the department of neurosurgery at the Pusan National University Hospital in Pusan. An expert validity test was done for the preliminary critical pathway, a clinical validity test was also done using 12 patients with Lumbar Laminectomy between October 1, 1999 and January 31, 2000. After these processes, the final critical pathway was developed. The results are summarized as follows. 1. The vertical axis of the critical pathway includes the following eight items: assessment, consultation, diet, test, medication, treatment, activity, education/ discharge planning. The horizontal axis includes the time from the start of hospitalization to discharge. Analysis of the 30 medical records was done. analysis of the service contents showed the horizontal axis of the preliminary critical pathway was set from hospitalization to the 12th post operation day and the vertical axis was set to include eight items, the contents which should have occurred, according to the time frames of the horizontal axis. 2. As a result of the expert validity test, it was found that among the 233 items, 203 showed over 88% agreement and 30 of them showed less than 88% agreement, which were then revised or deleted from the critical pathway. At the preliminary meeting for the clinical validity test, the time of hospitalization on the horizontal axis was shortened to the 10th post operation day. A clinical validity test was done with 12 patients with Lumbar Laminectomy. All the cases progressed according to the critical pathway although some variances were noted in assessment, consultation, test, medication, and treatment. 3. Based on these results, a final critical pathway was determined. In conclusion, this critical pathway is partially applicable to the care of patients with Lumbar Laminectomy and needs further investigation.

• Journal of Acupuncture Research
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• 제33권4호
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• pp.109-119
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• 2016

Objectives : The aim of this study is to give a statistical basis for the characteristics of patients who received cooperative medical care after being referred from Western medical departments to the Department of Acupuncture and Moxibustion in a Korean medical hospital. Methods : The request records were searched for cooperative medical treatment at the Department of Acupuncture and Moxibustion in a Korean medical hospital between September 1st, 2011 and August 31, 2016, based on the Order Communication system(OCS). The records were reviewed and retrospectively analyzed according to the patient's general characteristics, the chief diagnosis code based on the 7th Korean standard classification of diseases(KCD-7) before and after the cooperative medical care in the Department of Acupuncture and Moxibustion, and the actual treatment measures which patients received as a result of the cooperative medical care. Results : Among the 2702 records, 1549 patients were included in the analysis. The male to female ratio was 1 : 1.17. Sexagenarians formed the highest age group and the number of patients whose age was over 50 was 1176(75.92 %). The surgery department requested the cooperative care from the department of Acupuncture and Moxibustion for the highest number of patients, 1194(77.08 %). When analysing specific medical departments, Neurosurgery, General Surgery, Neurology, Otorhinolaryngology, and Physical medicine and rehabilitation followed. The frequency of chief diagnosis code used before the cooperative medical care was in the order of I, C, G, S, and M code, from highest to lowest. The order of the codes after the cooperative medical care was the same. Acupuncture treatment was the most frequently-used measure after the cooperative medical care. Following were infrared, moxibustion, transfer, herbal acupuncture, cupping, electroacupuncture, and so on. Conclusion : This study provides a statistical basis for the demands placed on the Department of Acupunture and Moxibustion for cooperative medical care with the Western medical department. Based on the present condition of cooperative medical care, more preparation and effort is required for its activation.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제34권1호
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• pp.41-52
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• 2012

Purpose: Triangulation is the process of determining the location of a point by measuring angles to it from known points at either end of a fixed baseline. This point can be fixed as the third point of a triangle with one known side and two known angles. The aim of this study was to find a clinically adaptable method for applying an optical tracking navigation system to orthognathic surgery and to estimate its accuracy of measuring the bone displacement by use of triangulation methods. Methods: In orthognathic surgery, the head position is not fixed as in neurosurgery, so that a head tracker is needed to establish the reference point on the head surface byusing an optical tracking system. However, the operation field is interfered by its bulkiness that makes its clinical use difficult. To solve this problem, we designed a method using an Aquaplast splinting material and a mini-screw in applying a head tracker on a patient's forehead. After that, we estimated the accuracy of measuring displacements of the ball marker by an optical tracking system with a conventional head tracker (Group A) and with a newly designed head tracker (Group B). Measured values of ball markers' displacements by each optical tracking system were compared with values obtained from fusion CT images for an estimation of accuracy. Results: The accuracy of the optical tracking system with a conventional head tracker (Group A) is not suitable for clinical usage. Measured and predictable errors are larger than 10 mm. The optical tracking system with a newly designed head tracker (Group B) shows 1.59 mm, 6.34 mm, and 9.52 mm errorsin threeclinical cases. Conclusion: Most errors were brought on mainly from a lack of reproducibility of the head tracker position. The accuracy of the optical tracking system with a newly designed head tracker can be a useful method in further orthognathic navigation surgery even though the average error is higher than 2.0 mm.

• 한국의학물리학회지:의학물리
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• 제18권4호
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• pp.194-201
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• 2007

감마나이프는 한 번에 수 Gy의 선량을 조사하는 일반 방사선 치료에 비하여 훨씬 많은 수십 Gy의 고선량을 한 번에 조사하기 때문에 조사되는 방사선량의 절대값 측정이 매우 중요하다. 그러나, 감마나이프의 물흡수선량 절대 측정값을 검증하는 연구는 많지 않다. 더욱이, 물팬텀 사용을 규정한 국제원자력기구(International Atomic Energy Agency: IAEA) TRS-398 프로토콜을 적용하여 물흡수선량을 측정한 연구는 보고되고 있지 않다. 본 연구에서는 IAEA TRS- 398 프로토콜을 이용하여 감마나이프 C모델의 물흡수선량을 측정하는 실험을 하였다. 본 실험에서는 IAEA TRS-398에 규정한 바를 최대한 따르면서 물팬텀을 제작하여 감마나이프 C모델의 물흡수선량을 측정하고, 감마나이프 제작사에서 제공하는 플라스틱 팬텀에서 측정한 값과 비교하였다. 이온함으로는 Capintec 사의 PR-05P mini-chamber 두 개를 사용하였고, 전리계로는 PTW사의 UNIDOS를 사용하였다. 측정 결과 물팬텀에서 측정한 감마나이프 모델C의 물흡수선량은 제작사의 플라스틱팬텀에서 측정한 값에 비하여 1.38% 크게 나타났다- 따라서, 현재 국내 감마나이프센터에서 사용하고 있는 제작사에서 제공하고 물흡수선량 측정 프로토콜에는 물팬텀 대신 플라스틱팬텀을 사용하는 데 따른 기온적인 문제점이 있는 것으로 판단된다. 결론적으로 IAEA TRS-398프로토콜을 직접적으로 감마나이프 물흡수선량 측정에 적용하는 것은 기준조건을 만족시킬 수 없기 때문에 불가능한 것으로 판단되며, 새로운 프로토콜을 작성하거나, 물팬텀과 기존의 플라스틱 팬텀으로 측정한 값 사이의 변환계수를 제공하는 것이 현실적인 대안이 될 것이다.

• Investigative Magnetic Resonance Imaging
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• 제4권2호
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• pp.94-99
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• 2000

목적 : 국한적 수분억제 생체내 양성자 자기공명분광학을 사용하여 만성 알코을 중독자와 정상 건강인의 뇌대사물질의 비율을 비교평가하였다. 대상 및 방법 : 만성 알코을 중독자 10명,정상 건강인 10명의 좌측 소뇌와 basal ganglia의 관심부위 $2{\times}2{\times}2{\;}\textrm{cm}^3$를 각각 선택하여 STEAM펄스시퀀스를 이용하였다 Creatine (Cr)을 기준으로 Marquart알고리즘을 이용하여 각 대사물질의 비율을 산출하였다. 결과 만성 알코을 중독자의 특징적인 소견은 정상인과 비교하여 볼 때 N-acetyl aspartate (NAA)/Cr비율이 감소하였다. 그러나 Choline (Cho)/Cr등 다른 대사비율은 정상인과 유이한 차이를 발견할수 없었다. NAA/Cr비율은 임상평가와 상당한 상호관계가 있는 것으로 나타났다. 결론 : 본 예비실험 결과는 만성 알코을 중독자의 NAA/Cr의 비율 감소를 토대로 환자 소뇌의 신경세포 소실을 추정할 수 있었다. NAA/Cr비율은 향후 만성 알코을 중독자의 임상평가를 추정할수 있는 대사표준으로 사용될 수 있음을 시사해주고 있다. 따라서 생체내 양성자 자기공명분광법은 양성자 비율을 토대로 만성 알코을 중독자의 임상평가에 유용한 방법으로 사용될 수 있으리라 사료된다.

• Macromolecular Research
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• 제9권5호
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• pp.267-276
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• 2001

In order to endow with new bioactive functionality from demineralized bone particle (DBP) as natural source to poly(L-lactide) (PLA) synthetic biodegradable polymer, porous DBP/PLA as natural/synthetic composite scaffolds were prepared and compared by means of the emulsion freeze drying and solvent casting/salt leaching methods for the possibility of the application of tissue engineered bone and cartilage. For the emulsion freeze drying method, it was observed that the pore size decreased in the order of 79$\mu\textrm{m}$ (PLA control) > 47$\mu\textrm{m}$ (20% of DBP) > 23 $\mu\textrm{m}$ (40% of DBP) > 15$\mu\textrm{m}$ (80% of DBP). Porosities as well as specific pore areas decreased with increasing the amount of DBR. It can be explained that DBP acts like emulsifier resulting in stabilizing water droplet in emulsion. For the solvent casting/salt leaching method, a uniform distribution of well interconnected pores from the surface to core region were observed the pore size of 80 ∼70 $\mu\textrm{m}$ independent with DBP amount. Porosities as well as specific pore areas also were almost same. For pore size distribution by the mercury intrusion porosimeter analysis between the two methods, the pore size distribution of the emulsion freeze drying method was broader than that of the solvent casting/salt leaching method due to the mechanism of emulsion formation. Scaffolds of PLA alone, DBP/PLA of 40 and 80%, and DBP powder were implanted on the back of athymic nude mouse to observe the effect of DBP on the induction of cells proliferation by hematoxylin and eosin staining for 8 weeks. It was observed that the effect of DBP/PLA scaffolds on bone induction are stronger than PLA scaffolds, even though the bone induction effect of DBP/PLA scaffold might be lowered than only DBP powder, that is to say, in the order of DBP only > DBP/PLA scaffolds of 40 and 80% DBP > PLA scaffolds only for osteoinduction activity. In conclusion, it seems that DBP plays an important role for bone induction in DBP/PLA scaffolds for the application of tissue engineering area.

• 한국의료질향상학회지
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• 제10권1호
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• pp.28-41
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• 2003

Background : Because unplanned readmissions to intensive care unit(ICU)might be related with undesirable patient outcomes, we investigated the pattern of and reason for unplanned ICU readmission to provide baseline data for reducing unplanned returns to ICU. Methods : The subjects included all patients who readmitted to ICU during the same hospitalization at a tertiary referral hospital between January 1st and June 30th 2002. Quality improvement(QI) nurse collected the data through medical records and a medical director reviewed the data collected. Results : 1) The average unplanned ICU readmission rate was 5.6%(gastroenterology 14.6%, pediatrics 12.7%, pulmonology 11.9%, neurosurgery 6.3%, general surgery 5.3%, chest surgery 3.9%, and cardiology 3.3%). 2) Among the unplanned readmissions, more than 50% of cases were from patients older than 60 years, and the main categories of diagnose at hospital admission were neurologic disease(29.9%) and cardiovascular disease(27.6%). 3) Of unplanned ICU readmissions, 41.8% had recurrence of the initial problems, 44.8% had occurrence of new problems. And 9.7% required post-operative care after unplanned operations. 4) The most common cause responsible for unplanned ICU readmission were respiratory problem(38.3%) and cardiovascular problem(14.3%). 5) About 40% of unplanned ICU readmission occurred within 3 days after ICU discharge. 6) Average length of stay of the readmitted patients to ICUs were much longer than that of non-readmitted patients. 7) Hospital mortality rate was much higher for unplanned ICU readmitted patients(23.6%) than for non-readmitted patients(1.5%) (P<0.001). Conclusions : This study showed that the unplanned ICU readmitted patients had poor outcomes(high morality and increased length of stay). In addition study results suggest that more attention should be paid to patients in ICU with poor respiratory function or elderly patients, and careful clinical decisions are required at discharged from ICU to general ward.

• Journal of Trauma and Injury
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• 제26권3호
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• pp.163-169
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• 2013

Purpose: This study was conducted to confirm the anatomic conformity of the new periarticular locking plates designed by Zimmer on Korean adult bones and to identify the structures at risk during the application of these implants. Methods: The study was performed on the humerus, radius, and tibia of 10 adult cadavers(6 males and 4 females) procured from the cadaveric lab of our hospital. Anteroposterior (AP) and lateral X-rays were taken to confirm that the cadavers were free of any unusual lesions or anatomic variations. We used the 3.5-mm proximal humerus plate, 2.7-mm distal radius plate, 3.5- and 5.0-mm proximal tibia plates, and 3.5-mm distal tibia plate developed by Zimmer, Inc. (Zimmer periarticular locking plate). The longest plate from each group was used to confirm anatomical conformity. Standard approaches were used for each area, and soft tissue was retracted in order to pass the plate beneath the muscle. The position of the plate was confirmed using standard AP and lateral view X-rays. After this procedure had been completed, the region was dissected along the length of the implant to determine the conformity of the implant to bone and the penetrations of screws into the articular surface or violations of any vital structures, such as nerves, blood vessels, or tendons. Results: Excellent anatomical conformity was observed with Zimmer periarticular locking plates for Korean adults. The tibial nerve and the posterior tibial artery were found to be structures at risk when applying a distal tibial plate. Conclusion: Additional posterolateral fixation is recommended when dealing with cases of tibial plateau fracture when the fracture line extends to the posterolateral cortex. We recommend taking proper views using 10~15 degrees of internal rotation to ensure correct screw length and, thus, avoid penetration of vital structures and tendons.

• Radiation Oncology Journal
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• 제12권1호
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• pp.109-115
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• 1994

본 연구의 목적은 뇌정위적 방사선수술시 최적 선량분포를 얻기 위하여 빠른 multiple isocenter 계획을 효과적으로 수행할 수 있는 방법을 개발하는 데 있다. 18cm 직경의 구형 머리 팬톰과 정확한 선량 알고리듬을 이용하여 선량값을 계산한 뒤 fltting 기술을 이용하여 빠른 구형선량 모델을 개발하였다. 구형선량 모델을 이용하여 single isocenter에 대한 선량값은 합산에 의하여 쉽게 얻어졌다. Isocenter들간의 이동에 따른 선량분포의 변화를 이용하여 컴퓨터 자동추적 방법이 개발되었으며, isocenter 간격 및 collimator 크기가 빠른 시간내에 결정될 수 있었다. 구형선량모델은 beam data에 의한 선량데이타와 같은 선량분포를 나타냈으며 고속으로 삼차원 선량계산을 가능하게 하였다. 컴퓨터 자동추적 방법은 지금까지의 시행착오적 방법에 비해 보다 빠르게 최적 isocenter setting을 제공할 수 있었다. 구형선량모델 및 컴퓨터 자동추적방법은 multiple isocenter를 이용한 수술 계획시 최적선량 분포를 보다 빨리 얻을 수 있었다.

• Radiation Oncology Journal
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• 제11권1호
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• pp.59-67
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• 1993

1979년 12월부터 1989년 9월까지 서울대학병원 치료방사선과에서 두개인두종으로 수술 및 수술후 방사선치료를 시행받은 23명의 환자에 대해 적정 치료원칙을 제시하기 위하여 후향적 분석조사를 시행하였다. 모든 환자에서 근치적 수술을 시도하였으나 수술후 전산화단층촬영 소견상 종양이 남아있는 전절제군 8예 및 부분절제군 15예가 이분석에 포함되었다. 수술소견상 낭형 13예 ($57{\%}$), 고형 4예 ($17{\%}$), 혼합형이 6예 ($26{\%}$)로 나타났고 20세이하군에서는 낭형이 더 많은 수에서 나타났다. 5년 및 10년 생존율은 각각 $95{\%},\;81{\%}$를 보였고, 5년 및 10년 종양 조절율은 각각 $74{\%},\;51{\%}$였다. 수술정도에 따른 결과의 차이는 보이지 않았고 소아 및 청소년군에서 성인군보다 좀더 나은 결과를 보였으나 통계적으로 유의하지는 않았다. 두개인두종에 있어서 완전절제술이 시행되기 어려운 경우 부분절제술후 방사선치료가 유용한 것으로 사료된다.