• Archives of Reconstructive Microsurgery
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• 제21권1호
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• pp.14-20
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• 2012

Purpose: Defect after ablation of hypopharyngeal cancer often requires reconstruction by free tissue transfer. Since neo-hypopharynx is totally buried, various methods have been suggested for monitoring. We propose a modified design of anterolateral thigh (ALT) free flap for reconstruction of pharyngolaryngectomy defect, which has an exteriorized part for clinical monitoring and allows for primary closure. Materials and Methods: Three consecutive patients with hypopharyngeal cancer were reconstructed with ALT flap with modified design: 1) distal part of flap was elongated into fusiform shape and used as exteriorized monitoring segment with a deepithelized bridge and 2) proximal part was designed as curve so the maximum width of the flap was reduced to less than 10 cm. Results: Patient 1, 2 had uneventful postoperative course with healthy skin color and fresh pin prick bleeding. In patient 3, defect after cancer ablation was shorter than usual and deepithelized bridge was longer. When the general hemodynamic status of the patient was aggravated in postoperative course, the color of monitoring skin was changed. Viability of the whole flap was confirmed by endoscopy. However, leakage developed after 3 weeks and repair was necessary. In all patients the donor sites were closed primarily. Conclusion: By the modified design of ALT flap, clinical monitoring can be possible by examining exteriorized monitoring flap and also donor site can be closed primarily. However possibility of false positive exists and technical caution and patient selection is needed because of danger of leakage.

• Journal of Chest Surgery
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• 제19권4호
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• pp.618-626
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• 1986

Univentricular heart is a rare congenital cardiac anomaly in which the atrial chambers are connected to only one ventricular chamber and it consists of a diverse group of cardiac malformation characterized by both AV valves or a common AV valve opening into the same ventricle, or the presence of only a solitary AV valve. In spite of recent development in cardiac surgery, corrective operations for univentricular heart still have high mortality and complication rate. Twenty eight patients underwent corrective operation for univentricular heart at Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital from February 1979 to July 1986. Of the 28 patients, 7 patients were operated on by ventricular septation and 21 patients by modified Fontan operation. Of the 28 patients, 19 patients were male and 9 patients female and ages ranged from 5 months to 18 years old with the average age of 7.3 years. There were 2 mortalities in 7 patients operated on by septation with the mortality rate of 28.6% and 5 complications, 3 complete AV block, 1 low cardiac output and 1 arrhythmia. All survived patients are being followed up without specific problem till now. There were 10 mortalities in 21 patients operated on by modified Fontan operation with the mortality rate of 47.6% and 10 complications, 2 low cardiac output, 2 respiratory failure necessitating tracheostomy, 2 persistent cyanosis, 2 arrhythmia, 1 missing of left AV valve in situs inversus patient due to misdiagnosis and one rupture of closed right AV valve. Incremental risk factors for operative mortality are young age less than 5 years old, anomalous pulmonary and systemic venous drainage and atrial septation procedure. In 11 survived patients, 9 patients show good follow-up results but one patient complains of persistent cyanosis and another one patient is suffered from CHF. In our series, results of corrective operation for univentricular heart shows continuing improvement but still high mortality and complication rate. So there must be continuing improvement in surgical result by selection of patient, by adequate decision making for timing and method of operation and by improving operative methods.

• 한국임상약학회지
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• 제29권3호
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• pp.193-201
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• 2019

Background and Objective: Since the introduction of hospital pharmacy residency programs in 1983, hospital pharmacists in South Korea have been expected to expand their roles. However, their services and the outcomes have not been fully understood. In this study, we conducted a systematic review of Korean hospital pharmacist-provided interventions with regard to intervention type, intervention consequences, and target patient groups. Methods: A literature search of the following databases was performed: Embase, PubMed, Medline, KoreaMed, RISS, KMbase, KISS, NDSL, and KISTI. The search words were "hospital pharmacist", "clinical pharmacist", and "Korea". Articles reporting clinical or economic outcome measures that resulted from hospital pharmacist interventions were considered. Numeric measures for the acceptance rate of pharmacist recommendations were subjected to meta-analysis. Results: Of the 1,683 articles searched, 44 met the inclusion selection criteria. Most articles were published after 2000 (81.8%) and focused on clinical outcomes. Economic outcomes had been published since 2011. The interventions were classified as patient education, multidisciplinary team work, medication assessment, and guideline development. The outcome measures were physicians' prescription changes, clinical outcomes, patient adherence, economic outcomes, and quality of life. The acceptance rate was 80.5% (p < 0.005). Conclusion: Studies on pharmacist interventions have increased and showed increased patient health benefits and reduced medical costs at Korean hospital sites. Because pharmacists' professional competency would be recognized if the economic outcomes of their work were confirmed and justified, studies on their clinical performance should also include their economic impact.

• 한국의료질향상학회지
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• 제27권1호
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• pp.58-69
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• 2021

Purpose:In this study, we reviewed existing victim support programs implemented in Korea to aid in the development of psychosocial support programs for patients and guardians who have experienced patient safety incidents. Methods: We reviewed similar programs: a support program for suicide survivors operated by the Korea Psychological Autopsy Center (Korea Foundation for Suicide Prevention), a family harmony program for workers in industrial accidents operated by the National Center for Forest Therapy, and the support services for crime victims provided by the Korean Crime Victims Support Association. We reviewed the contents of each website and conducted interviews with key personnel from each institution. Results: The support program for families who have experienced suicide was developed based on the suicide prevention project at the Central Psychological Autopsy Center. The family harmony program for workers who suffered industrial accidents is operated by the National Center for Forest Therapy at the behest of the Korean Workers' Compensation and Welfare Service. The Korean Crime Victims Support Association was established by the Ministry of Justice in accordance with the Crime Victim Protection Act and provides support to victims of crime. Each program was designed and implemented considering the objectives and goals, defining their recruitment plans as well as the selection criteria for their participants, and creating quality content that adequately addressed the struggles of their participants. Conclusion: The summarization of the various types of victim support programs in this study can be helpful in the future development of psychosocial support programs for victims of patient safety incidents.

• BMB Reports
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• 제56권8호
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• pp.463-468
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• 2023

Screening for genetic defects in the cells should be examined for clinical application. The Pearson syndrome (PS) patient harbored nuclear mutations in the POLG and SSBP1 genes, which could induce systemic large-scale mitochondrial genome (mtDNA) deletion. We investigated iPSCs with mtDNA deletions in PS patient and whether deletion levels could be maintained during differentiation. The iPSC clones derived from skin fibroblasts (9% deletion) and blood mononuclear cells (24% deletion) were measured for mtDNA deletion levels. Of the 13 skin-derived iPSC clones, only 3 were found to be free of mtDNA deletions, whereas all blood-derived iPSC clones were found to be free of deletions. The iPSC clones with (27%) and without mtDNA deletion (0%) were selected and performed in vitro and in vivo differentiation, such as embryonic body (EB) and teratoma formation. After differentiation, the level of deletion was retained or increased in EBs (24%) or teratoma (45%) from deletion iPSC clone, while, the absence of deletions showed in all EBs and teratomas from deletion-free iPSC clones. These results demonstrated that non-deletion in iPSCs was maintained during in vitro and in vivo differentiation, even in the presence of nuclear mutations, suggesting that deletion-free iPSC clones could be candidates for autologous cell therapy in patients.

• 한국콘텐츠학회논문지
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• 제15권9호
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• pp.403-410
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• 2015

MRI는 1970년을 시작으로 자장 세기와 수신 채널 수, 촬영시간의 단축 등으로 많은 발전을 해 오고 있으며, 병원 또한 각종 전산 시스템과 무선 네트워크의 발전으로 인해 각종 진료 영상장비로부터 디지털 영상을 획득, 저장 및 관리하게 되었다. 하지만, 국내 대학들은 고가의 실습장비와 유지비로 인하여 자체에서는 실습을 하지 못하고 있으며 임상 실습에 의존하고 있다. 이에 윈도우즈 운영체제의 PC상에서 MR 환자의 검사 프로그램을 개발하여 학생들이 많이 다루어 봄으로써 임상에서 근무하기 전 많은 도움을 주고자 하였다. MRI Simulator의 Relational Database 설계는 각 기능과 자료의 특성에 따라 7개의 Table로 구성하였으며, 환자정보 설계는 임상에서의 환자등록 방법을 기준으로 각 단계별 기능을 분류 하였다. 또, 검사를 위한 기본 정보 설정을 가정하여 각각의 설정 값 및 그 내용을 분류 하였다. 실행 단계별 메뉴는 한 눈에 볼 수 있도록 왼편에 배열을 하였다. 환자 등록은 이름, 성별, 고유번호, 생년월일, 몸무게 등 기초정보를 입력하고, 환자의 자세와 검사 방향을 설정하였다. 또, 검사부위와 Pulse Sequence을 나열하고, 선택하도록 분류하였다. 그리고 Protocol 이름과 부가 인자들를 입력할 수 있도록 하였다. 최종 화면은 검사 영상과 환자 정보, 검사 조건 등을 확인할 수 있도록 설계하였다. 이 프로그램을 통해 환자정보의 입력과 검사조건의 변경을 학습해봄으로써 이론과 실습을 통한 용어의 이해에 많은 도움을 주어 실제 임상근무에서 배우는 시간을 단축시킬 수 있다.

• Journal of Korean Neurosurgical Society
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• 제63권4호
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• pp.427-432
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• 2020

Three randomized control trials (RCTs), published in 2013, investigated efficacy of mechanical thrombectomy in large vessel occlusions and did not show better results compared to intravenous (IV) recombinant tissue-type plasminogen activator (tPA) alone. However, most clinicians treating stroke consider mechanical thrombectomy as the standard treatment rather than using IV tPA alone. This paradigm shift was based on five RCTs investigating efficacy of mechanical thrombectomy in acute ischemic stroke conducted from 2010 to 2015. They demonstrated that mechanical thrombectomy was effective and safe in acute ischemic stroke with anterior circulation occlusion when performed within 6 hours of stroke onset. There are four reasons underlying the different results observed between the trials conducted in 2013 and 2015. First, the three RCTs of 2013 used low-efficiency thrombectomy devices. Second, the three RCTs used insufficient image selection criteria. Third, following the initial presentation at the hospital, reperfusion treatment required a long time. Fourth, the three RCTs showed a low rate of successful recanalization. Time is the most important factor in the treatment of acute ischemic stroke. However, current trends utilize advanced imaging techniques, such as diffusion-weighted imaging and multi-channel computer tomographic perfusion, to facilitate the detection of core infarction, penumbra, and collateral flows. These efforts demonstrate that patient selection may overcome the barriers of time in specific cases.

• 한국병원경영학회지
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• 제21권4호
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• pp.45-54
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• 2016

The purpose of this study is to identify patient and hospital characteristics with pulmonary tuberculosis and to analyze factors which were influencing length of stay and treatment. The Korean National Hospital Discharge In-depth Injury Survey database from 2006 to 2012 was used for analysis. Study subjects were 4,704 patients and analyzed by using frequency, chi-square and logistic regression through using STATA 12.0. To avoid selection bias, we used propensity score matching. Analysis results show that the length of stay and treatment of pulmonary tuberculosis was different between insurance types. Patients characteristic(female, comorbidity, admission by outpatient department, medical insurance type) and hospital characteristic(500-999 beds, over 1000 beds) significantly influence length of stay. Admission by outpatient department and over 1000 beds are significantly influence treatment. Based on these findings, it is necessary to clarify between length of stay and treatment outcome by medical aids beneficiaries and audit hospitals follow discharge guidelines in pulmonary tuberculosis patients.

• 대한두개안면성형외과학회지
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• 제21권6호
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• pp.337-344
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• 2020

Facial paralysis is a devastating disease, the treatment of which is challenging. The use of the masseteric nerve in facial reanimation has become increasingly popular and has been applied to an expanded range of clinical scenarios. However, appropriate selection of the motor nerve and reanimation method is vital for successful facial reanimation. In this literature review on facial reanimation and the masseter nerve, we summarize and compare various reanimation methods using the masseter nerve. The masseter nerve can be used for direct coaptation with the paralyzed facial nerve for temporary motor input during cross-facial nerve graft regeneration and for double innervation with the contralateral facial nerve. The masseter nerve is favorable because of its proximity to the facial nerve, limited donor site morbidity, and rapid functional recovery. Masseter nerve transfer usually leads to improved symmetry and oral commissure excursion due to robust motor input. However, the lack of a spontaneous, effortless smile is a significant concern with the use of the masseter nerve. A thorough understanding of the advantages and disadvantages of the use of the masseter nerve, along with careful patient selection, can expand its use in clinical scenarios and improve the outcomes of facial reanimation surgery.

• 대한디지털의료영상학회논문지
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• 제15권2호
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• pp.45-53
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• 2013

Purpose : Fixed way of mAs previously Low Extremity Computed Tomography Angiography(LECTA) examination were used. Automatic Current Selection(ACS) to use for the purpose of reducing the dose when Low Extremity Computed Tomography Angiography examining patients. Materials and methods : Were analyzed from July 2011 to July 2012 MDCT examination of Dose Length Product(DLP) LECTA 116 Case. It was defined as previous inspection methods(Old protocol). CT workstation is set to 100 mAs and 150 mAs protocol based on the patient's weight 70kg examined by LECTA. We defined as 'New protocol' that applies to ACS. The data collection period are 76 cases from October 2012 to January 2013 Results : 1. Average Total DLP of 'Old protocol' is 3602.943 $mGy^*cm$. 2. Average Total DLP of 'New protocol' is 1762.977 $mGy^*cm$. 3. Due to the 'New Protocol' use of Total DLP was reduced by approximately 51 %. Phase-specific dose reduction is as follows. Pre(33.62 %), Artery(64.63 %), Delay(49.0 %) 4. Using One way ANOVA Analysis of fluctuations obtained DLP is as follows. 'Old protocol', 'New protocol' a value of P < 0.001, P = 0.882 values were obtained. Conclusions : Dose reduction of 51 % is a useful study that proves. The results obtained using the ACS, the effects of a dose reduction of 51 % was obtained. Therefore, it has been proven to be a useful way. Statistics using SPSS version came out of the 'Old protocol' P-value P < 0.0001. This result means that the DLP a large difference values. On the other hand, The results of the 'New protocol' was P = 0.882. These results means to that small and regularly was fluctuations of the dose. The use of ACS, you can get a reduction of the dose and will able to get the effect of reducing the dose errors.