• Clinical Endoscopy
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• 제56권4호
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• pp.423-432
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• 2023

Compared to endoscopic mucosal resection (EMR), colonoscopic endoscopic submucosal dissection (C-ESD) has the advantages of higher en bloc resection rates and lower recurrence rates of colorectal neoplasms. Therefore, C-ESD is considered an effective treatment method for laterally spread tumors and early colorectal cancer. However, C-ESD is technically more difficult and requires a longer procedure time than EMR. In addition to therapeutic efficacy and procedural difficulty, safety concerns should always be considered when performing C-ESD in clinical practice. Bleeding and perforation are the main adverse events associated with C-ESD and can occur during C-ESD or after the completion of the procedure. Most bleeding associated with C-ESD can be managed endoscopically, even if it occurs during or after the procedure. More recently, most perforations identified during C-ESD can also be managed endoscopically, unless the mural defect is too large to be sutured with endoscopic devices or the patient is hemodynamically unstable. Delayed perforations are quite rare, but they require surgical treatment more frequently than endoscopically identified intraprocedural perforations or radiologically identified immediate postprocedural perforations. Post-ESD coagulation syndrome is a relatively underestimated adverse event, which can mimic localized peritonitis from perforation. Here, we classify and characterize the complications associated with C-ESD and recommend management options for them.

• Child Health Nursing Research
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• 제9권2호
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• pp.140-148
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• 2003

Purpose: The purpose of this study was to examine the nurses' knowledge and attitude to pain management in children and explore the status of pain management in clinical practice. Method: The subjects were 131 nurses enrolled in 3 university affiliated hospitals. Questionnaire method was utilized for data collection. Data was analyzed by SPSS statistical program. Result: The result was as follows: 1. The overall mean score of the pain knowledge was 16.88 (58.2％). The percentages of correct response in test subsections were pain assessment 45.5, choice of medication and drug action 48.7, and pain statement 79.6 respectively. 2. 70.3％ of the nurses agreed or strongly agreed that the procedural pain should always be eliminated. And, 44.3％ of the nurses agreed or strongly agreed that post-operative treatment of pain in children should always aim at eliminating the pain completely. 3. There was a significant relationship between pain attitude and knowledge related facts about pain(r=.217, p<.01). 4. When asked to identify the point of self-reported pain on a 0-10 scale at which the nurse would give medication, point 7 was mostly identified (29％). 5. Only 19.8％ of the nurses utilized pain rating scale to assess children's pain. 6. The nonpharmacologic interventions nurses used most were position change, emotional support, and massage. 7. 68.7％ of the nurses indicated that they learned about pain management from their current working environment. Also, Mostly helpful resource identified in increasing their pain management knowledge and skills was the continuing education program. Conclusion: The findings showed that there was a need to develop educational program for adequate pain management for children. Further research study is recommended to examine the effectiveness of the intervention methods for children's pain.

• 한국간담췌외과학회지
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• 제26권4호
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• pp.355-362
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• 2022

Backgrounds/Aims: Postoperative fluid collection is a common complication of pancreatic resection without clear management guidelines. This study aimed to compare outcomes of endoscopic ultrasound (EUS)-guided trans-gastric drainage and percutaneous catheter drainage (PCD) in patients who experienced this adverse event after pancreaticoduodenectomy (PD). Methods: Demographic and clinical data and intervention outcomes of 53 patients who underwent drainage procedure (EUS-guided, n = 32; PCD, n = 21) for fluid collection after PD between January 2015 and June 2019 in our tertiary referral center were retrospectively analyzed. Results: Prior to drainage, 83.0% had leukocytosis and 92.5% presented with one or more of the following signs or symptoms: fever (69.8%), abdominal pain (69.8%), and nausea/vomiting (17.0%). Within 8 weeks of drainage, 77.4% showed a diameter decrease of more than 50% (87.5% in EUS vs. 66.7% in PCD, p = 0.09). Post-procedural intravenous antibiotics were used for an average of 8.1 ± 4.3 days and 12.4 ± 7.4 days for EUS group and PCD group, respectively (p = 0.01). The EUS group had a shorter post-procedural hospital stay than the PCD group (9.8 ± 1.1 vs. 15.8 ± 2.2 days, p < 0.01). However, the two groups showed no statistically significant difference in technical or clinical success rate, reintervention rate, or adverse event rate. Conclusions: EUS-guided drainage and PCD are both safe and effective methods for managing fluid collection after PD. However, EUS-guided drainage can shorten hospital stay and duration of intravenous antibiotics use.

• Korean Journal of Radiology
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• 제25권9호
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• pp.773-787
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• 2024

Local ablation for hepatocellular carcinoma (HCC), a non-surgical option that directly targets and destroys tumor cells, has advanced significantly since the 1990s. Therapies with different energy sources, such as radiofrequency ablation, microwave ablation, and cryoablation, employ different mechanisms to induce tumor necrosis. The precision, safety, and effectiveness of these therapies have increased with advances in guiding technologies and device improvements. Consequently, local ablation has become the first-line treatment for early-stage HCC. The lack of organized evidence and expert opinions regarding patient selection, pre-procedure preparation, procedural methods, swift post-treatment evaluation, and follow-up has resulted in clinicians following varied practices. Therefore, an expert consensus-based practical recommendation for local ablation was developed by a group of experts in radiology and hepatology from the Research Committee of the Korean Liver Cancer Association in collaboration with the Korean Society of Image-guided Tumor Ablation to provide useful information and guidance for performing local ablation and for the pre- and post-treatment management of patients.

• Journal of Chest Surgery
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• 제57권3호
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• pp.291-299
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• 2024

Background: Postoperative pain management following minimally invasive repair of pectus excavatum (MIRPE) remains a critical concern due to severe post-procedural pain. Promising results have been reported for cryoanalgesia following MIRPE; however, its invasiveness, single-lung ventilation, and additional instrumentation requirements remain obstacles. Serratus anterior plane block (SAPB) is a regional block technique capable of covering the anterior chest wall at the T2-9 levels, which are affected by MIRPE. We hypothesized that SAPB would be a superior alternative pain control modality that reduces postoperative pain more effectively than conventional methods. Methods: We conducted a retrospective study of patients who underwent MIRPE between March 2022 and August 2023. The efficacy of pain control was compared between group N (conventional pain management, n=24) and group S (SAPB, n=26). Group N received intravenous patient-controlled analgesia (IV-PCA) and subcutaneous local anesthetic infusion. Group S received bilateral continuous SAPB with 0.3% ropivacaine after a bilateral bolus injection of 30 mL of 0.25% ropivacaine with baseline IV-PCA. Pain levels were evaluated using a Visual Analog Scale (VAS) at 1, 3, 6, 12, 24, 48, and 72 hours postoperatively and total intravenous rescue analgesic consumption by morphine milligram equivalents (MME). Results: Mean VAS scores were significantly lower in group S than in group N throughout the 72-hour postoperative period (p<0.01). Group S showed significantly lower MME at postoperative 72 hours (group N: 108.53, group S: 16.61; p<0.01). Conclusion: SAPB improved immediate postoperative pain control in both the resting and dynamic states and reduced opioid consumption compared to conventional management.

• Korean Journal of Radiology
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• 제22권2호
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• pp.263-280
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• 2021

Percutaneous transthoracic needle biopsy (PTNB) is one of the essential diagnostic procedures for pulmonary lesions. Its role is increasing in the era of CT screening for lung cancer and precision medicine. The Korean Society of Thoracic Radiology developed the first evidence-based clinical guideline for PTNB in Korea by adapting pre-existing guidelines. The guideline provides 39 recommendations for the following four main domains of 12 key questions: the indications for PTNB, pre-procedural evaluation, procedural technique of PTNB and its accuracy, and management of post-biopsy complications. We hope that these recommendations can improve the diagnostic accuracy and safety of PTNB in clinical practice and promote standardization of the procedure nationwide.

• Journal of Korean Neurosurgical Society
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• 제49권1호
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• pp.20-25
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• 2011

Objective: Due to longer life spans, patients newly diagnosed with unruptured intracranial aneurysms (UIAs) are increasing in number. This study aimed to evaluate how management of UIAs in patients age 65 years and older affects the clinical outcomes and post-procedural morbidity rates in these patients. Methods: We retrospectively reviewed 109 patients harboring 136 aneurysms across 12 years, between 1997 and 2009, at our institute. We obtained the following data from all patients: age, sex, location and size of the aneurysm(s), presence of symptoms, risk factors for stroke, treatment modality, and postoperative 1-year morbidity and mortality. We classified these patients into three groups: Group A (surgical clipping), Group B (coil embolization), and Group C (observation only). Results: Among the 109 patients, 56 (51.4%) underwent clipping treatment, 25 (23%) patients were treated with coiling, and 28 observation only. The overall morbidity and mortality rates were 2.46% and 0%, respectively. The morbidity rate was 1.78% for Clipping and 4% for coiling. Factors such as hypertension, diabetes mellitus, hypercholesterolemia, smoking, and family history of stroke were correlated with unfavorable outcomes. Two in the observation group refused follow-up and died of intracranial ruptured aneurysms. The observation group had a 7% mortality rate. Conclusion: Our results show acceptable favorable outcome of treatment-related morbidity comparing with the natural history of unruptured cerebral aneurysm. Surgical clipping did not lead to inferior outcomes in our study, although coil embolization is generally more popular for treating elderly patients, In the treatment of patients more than 65 years old, age is not the limiting factor.

• Korean Circulation Journal
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• 제54권9호
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• pp.565-576
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• 2024

Background and Objectives: The K-ELUVIA study aimed to investigate the clinical effectiveness and safety of Eluvia^TM, a polymer-coated, paclitaxel-eluting stent, for femoropopliteal artery disease using data from a prospective Korean multicenter registry. Methods: A total of 105 patients with femoropopliteal artery disease who received endovascular treatment (EVT) with Eluvia^TM stents at 7 Korean sites were enrolled in a prospective cohort and followed for 2 years. The primary endpoint was the 2-year clinical patency. The secondary endpoint was 2-year freedom from clinically driven target lesion revascularization (TLR). Results: Mean patient age was 68.2±10.4 years, and most patients (82.7%) were male. Mean lesion length was 168.3±117.6 mm. Chronic total occlusion was found in 57.7% of patients. Trans-Atlantic Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) type C or D lesions were present in 46.1% of patients. Procedural success was achieved in 99.0% of patients. The clinical patency rate was 84.4% at 1 year after EVT and 76.3% at 2 years post-EVT. The freedom from TLR rate was 89.1% at 1 year after EVT and 79.1% at 2 years post-EVT. Chronic total occlusion (hazard ratio [HR], 3.53; 95% confidence interval [CI], 1.08-11.67; p=0.039) and smaller mean stent diameter (HR, 0.40; 95% CI, 0.16-0.98; p=0.044) were identified as independent predictors of loss of clinical patency at 2 years. Conclusions: The K-ELUVIA study demonstrated favorable 2-year clinical effectiveness and safety outcomes of Eluvia stent for femoropopliteal artery lesions in real-world practice.

• 환경정책연구
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• 제8권3호
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• pp.27-51
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• 2009

본 연구는 도시화 과정의 하나로 일어나는 개발사업이 지속가능한 형태로 추진되기 위한 방안을 모색하였으며, 그 중에서도 현재 대규모 개발사업인 신도시를 중심으로 적용하고 있는 환경생태계획의 실태와 문제점을 심층 검토하고 개선방안을 도출하고자 하였다 특히 도시 관련 개발사업 중 크게 구분할 수 있는 도시개발사업(도시개발법에 근거)과 택지개발사업(택지개발촉진법에 근거)의 입지 및 개발방식의 차별성을 고려하여 개선방안을 제시하였다. 우선, 선행 연구결과들을 바탕으로 설정한 원칙과 문제점에 근거하여 환경생태계획 대상 사업 규모를 설정하였으며, 환경생태계획의 절차적 개선방안에서는 크게 입지 및 지구지정 단계, 개발계획단계, 실시계획 단계, 사후관리 단계로 구분하여 문헌과 전문가 의견수렴을 바탕으로 문제점 및 해결방안을 제시하였다. 계획체계 측면 개선을 고려한 환경생태계획의 내용적 범위는 계획의 개요, 환경생태구상, 공간구조 골격 구상, 도시환경 재생 및 영향 저감계획으로 구분하여 도출되었다. 특히 도시개발사업은 복원 혹은 새롭게 창출해야 하는 조성녹지 확보와 이를 고려한 생태적 연결성 확보, 그리고 생태면적률 확보가 택지개발사업은 보전지역과 환경용량, 광역녹지축 등의 고려가 차별성 있게 고려되어야할 것으로 보인다. 이상의 결과들을 종합하여 환경생태계획과 개발계획, 환경성평가 각각의 기능과 연계성을 정립하였으며, 이들 간의 연계성 정립을 통해 장기적으로 지속가능한 토지개발이 가능한 형태로 발전될 것으로 판단되었다.

• 항공우주정책ㆍ법학회지
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• 제35권2호
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• pp.41-74
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• 2020

과징금 제도는 태생적으로 효율성을 DNA로 가지고 있다. 법령을 위반한 사업자로부터 부당한 수익을 회수하거나, 사업면허를 박탈하거나 영업중지를 명하는 행정처분이 오히려 일반 소비자의 권익을 침해하게 되는 경우 금전적인 제재수단을 통해 동일한 효과를 거둘 수 있는 제도가 바로 과징금이다. 게다가 위법을 입증하기 위해 긴 시간과 막대한 비용이 소요되는 재판절차에 비해 행정관청의 일방적인 부과 명령만으로 효력을 발휘하므로 정부입장에서는 여간 편한 것이 아니다. 그런데 우리나라 항공분야 과징금 부과제도에 있어서 절차적 정당성이 잘 갖춰져 있는지는 의문이다. 외국의 입법례와 비교할 때, 우리나라의 항공분야 과징금 제도는 부과금액의 규모나 부과절차에서 몇 가지 아쉬운 점들을 발견할 수 있기 때문이다. 본 논문은 우리나라 항공분야에서 처분되는 과징금 제도의 개선방향을 연구할 목적으로 집필되었다. 다만 고액 과징금의 문제점이나 당사자의 방어권 보장 등에 관한 여러 쟁점은 선행연구에서 다루고 있는 바, 본 연구는 항공안전 분야 과징금제도에 있어서 항공선진국이라 할 수 있는 미국의 제도를 깊이 있게 살펴 봄으로써 우리나라 제도의 개선방향을 탐구하려는 의도에서 연구를 진행하였다. 우선 미국 연방항공청(Federal Aviation Administration, FAA)의 항공분야 행정제재의 특성과 미국 항공 과징금 제도를 개괄적으로 살펴보기로 하였다. 나아가 최근 항공안전 관리에 대한 패러다임의 변화로 종래의 사후적인 항공사고 관리행정에서 사전적이고 예방적 조치로서 항공안전 자율보고를 중시하는 새로운 경향을 ASAP를 비롯한 각종 제도를 중심으로 살피고자 하였다. 또한 미국 FAA가 채택하고 있는 과징금 부과에 관한 정형적 절차에 대해서도 고찰하였다. 위와 같은 검토를 바탕으로 본 논문은 우리나라 항공안전에 관한 보고제도의 개선방향도 살펴보았다.