• 제목/요약/키워드: Prompt NO

검색결과 218건 처리시간 0.025초

Transient Neonatal Diabetes Mellitus Managed with Continuous Subcutaneous Insulin Infusion (CSII) and Continuous Glucose Monitoring

  • Kim, Min Soo;Kim, Sung Eun;Lee, Na Yeong;Kim, Seul Ki;Kim, Shin Hee;Cho, Won Kyoung;Cho, Kyoung Soon;Jung, Min Ho;Suh, Byung-Kyu;Ahn, Moon Bae
    • Neonatal Medicine
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    • 제28권1호
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    • pp.41-47
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    • 2021
  • Neonatal diabetes mellitus can be categorized as transient, permanent, or syndromic, and approximately half of the cases are transient. We present a case involving a term newborn who showed overt progression of transient neonatal diabetes mellitus, with complete remission within 6 months. On the second day of life, the patient presented with tachypnea, hyperglycemia, and decreased serum levels of C-peptide and insulin. Continuous subcutaneous infusion of insulin and continuous glucose monitoring were well tolerated. The patient showed a normal growth pattern, with no hyperglycemic or hypoglycemic episodes at 6 months of age. As it is rare and often asymptomatic, hyperglycemia may be attributed to various factors, including intrauterine environment, perinatal stress, and diverse genetic background. Therefore, consistent blood glucose monitoring and prompt early insulin therapy are crucial for any term newborns with persistent hyperglycemia, to prevent further diabetic complications. Moreover, continuous subcutaneous insulin infusion and the utilization of continuous glucose monitoring devices are the most effective and practical management strategies.

The Effects of a Trauma Team Approach on the Management of Open Extremity Fractures in Polytrauma Patients: A Retrospective Comparative Study

  • Sakong, Seungyeob;Lim, Eic Ju;Cho, Jun-Min;Choi, Nak-Jun;Cho, Jae-Woo;Oh, Jong-Keon
    • Journal of Trauma and Injury
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    • 제34권2호
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    • pp.105-111
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    • 2021
  • Purpose: Open extremity fractures require prompt antibiotic medication and initial debridement surgery to reduce the infection rate and restore functional stabilization. We aimed to report the effects and positive outcomes of a trauma team approach on the management of open extremity fractures in polytrauma patients. Methods: This retrospective review included all polytrauma patients with open extremity fractures admitted between March 2009 and December 2019. Patients were divided into two groups according to whether they were treated before or after the implementation of the trauma team approach (March 2014). We analyzed the outcomes in each group with respect to the time interval until the doctor's arrival, total length of stay in the emergency department, the time interval until initial antibiotic treatment and operation, whether the initial operation was performed within 24 hours, and the rate of deep infections. Results: A total of 123 patients met the inclusion criteria. There were no statistically significant differences in demographic characteristics. The time interval until the doctor's arrival (64.12±49.2 minutes vs. 19.82±15.23 minutes; p=0.035) and initial antibiotic treatment (115.47±72.12 minutes vs. 48.78±30.12 minutes; p=0.023) significantly improved after implementing the trauma team approach. The union rate was not significantly different. However, the time interval until initial debridement, opportunity for initial debridement within 24 hours, and the rate of deep infections demonstrated better results. Conclusions: The reduced time interval until initial antibiotic treatment and debridement could be attributed to the positive effect of the trauma team approach on the management of open extremity fractures in polytrauma patients.

양극성장애로 오인된 LGI1 자가면역성뇌염 (Anti-LGI1 Antibody Encephalitis)

  • 김은수;이희준;전상원;조성준
    • 생물정신의학
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    • 제27권2호
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    • pp.112-116
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    • 2020
  • Leucine rich glioma inactivated (LGI1) encephalitis is an uncommon neurological disorder rarely encountered in clinical practice. However, it is a potentially fatal autoimmune syndrome that can decrease the level of consciousness, possibly progressing to coma. Additionally, unless diagnosed and promptly treated, it can cause permanent cognitive impairment. Since LGI1 encephalitis can initially present with psychiatric symptoms, there can be delays in reaching a proper diagnosis. This report describes a case of a 47-year-old woman with LGI1 antibodies-associated limbic encephalitis who initially presented with psychosis. Her blood tests were normal and no MRI and EEG abnormalities were found. Cerebrospinal fluid analysis was negative for other possible infectious causes. Three months after admission, she was found to be LGI1 antibody positive. LGI1 encephalitis should be suspected in patients with symptoms such as memory loss, confusion, seizures, and psychiatric symptoms. Prompt diagnosis and treatment of LGI1 encephalitis are warranted because prognosis becomes worse when such actions are delayed.

Surgical Rib Fracture Fixation: Early Operative Intervention Improves Outcomes

  • James Dixon;Iain Rankin;Nicholas Diston;Joaquim Goffin;Iain Stevenson
    • Journal of Chest Surgery
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    • 제57권2호
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    • pp.120-125
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    • 2024
  • Background: This study aimed to assess the outcomes of patients with complex rib fractures undergoing operative or nonoperative management at our major trauma center. Methods: A retrospective review of all patients who were considered for surgical stabilization of rib fractures (SSRF) at a single major trauma center from May 2016 to September 2022 was performed. Results: In total, 352 patients with complex rib fractures were identified. Thirty-seven patients (11%) fulfilled the criteria for surgical management and underwent SSRF. The SSRF group had a significantly higher proportion of patients with flail chest (32 [86%] vs. 94 [27%], p<0.001) or Injury Severity Score (ISS) >15 (37 [100%] vs. 129 [41%], p<0.001). No significant differences were seen between groups for 1-year mortality. Patients who underwent SSRF within 72 hours were 6 times less likely to develop pneumonia than those in whom SSRF was delayed for over 72 hours (2 [18%] vs. 15 [58%]; odds ratio, 0.163; 95% confidence interval, 0.029-0.909; p=0.036). Prompt SSRF showed non-significant associations with shorter intensive care unit length of stay (6 days vs. 10 days, p=0.140) and duration of mechanical ventilation (5 days vs. 8 days, p=0.177). SSRF was associated with a longer hospital length of stay compared to nonoperative patients with flail chest and/or ISS >15 (19 days vs. 13 days, p=0.012), whilst SSRF within 72 hours was not. Conclusion: Surgical fixation of complex rib fractures improves outcomes in selected patient groups. Delayed surgical fixation was associated with increased rates of pneumonia and a longer hospital length of stay.

한 단계 자가 산부식 접착제의 적용 방식이 미세인장 결합강도에 미치는 효과 (Influence of application methods of one-step self-etching adhesives on microtensile bond strength)

  • 최철규;손성애;하진희;허복;김현철;권용훈;박정길
    • Restorative Dentistry and Endodontics
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    • 제36권3호
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    • pp.203-210
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    • 2011
  • 연구목적: 이 연구의 목적은 다양한 방식의 한 단계 자가 부식 접착제의 적용이 직접 복합 레진 수복의 미세 인장 강도에 미치는 영향을 평가하는 것이었다. 연구 재료 및 방법: 36개의 발거된 대구치를 사용하여, 3종류의 한 단계 자가 부식 접착제(Clearfil Tri-S Bond, Adper Prompt L-Pop, G-Bond)와 적용 방식에 따라 12개의 군으로 나누었다. 접착제를 다음의 방식으로 상아질에 적용하였다. 1) single coating, 2) double coating, 3) manual agitation, 4) ultrasonic agitation. 접착제 적용 후, 광중합 복합 레진으로 수복하였다. 24시간 동안 실온의 증류수에 보관한 후, 각 군당 15개의 시편을 준비하여 미세인장 결합 강도를 측정하였다. 결과: Manual agitation, ultrasonic agitation군은 single coating, double coating군에 비해 유의하게 높은 미세인장 결합 강도를 보였다. Double coating군은 single coating군에 비해 유의하게 높은 미세인장 결합 강도를 보였으며, manual agitation군과 ultrasonic agitation군 간에는 미세인장 결합 강도의 유의한 차이가 없었다. 접착제 종류에 따라 미세인장 결합 강도의 유의한 차이가 있었고, 그 중 Clearfil Tri-S Bond가 가장 높았다. 결론: 한 단계 자가 산부식 접착제의 적용 방법과 재료에 따라 미세인장 결합 강도에 유의한 차이가 있었다. 접착제 종류에 관계없이 manual agitation과 ultrasonic agitation은 유의하게 높은 미세인장 결합강도를 보였다.

유치와 영구치에서 치과용 접착제의 전단결합강도 (THE SHEAR BOND STRENGTH OF DENTAL ADHESIVES ON PRIMARY AND PERMANENT TEETH)

  • 최진영;최남기;박영준;최충호;양규호
    • 대한소아치과학회지
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    • 제34권4호
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    • pp.579-589
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    • 2007
  • 본 연구에서는 최근에 개발된 치과용 접착제를 대상으로 유치와 영구치의 법랑질과 상아질에 대한 결합력을 비교 평가하여 임상에서 상아질 접착제를 적절하게 선택하는데 도움을 주고자 시행하였다. 실험재료로 Adper Scotchbond Multi-purpose Plus Adhesive (SM; 3M ESPE, USA), Adper Single bond 2 (SB; 3M ESPE, USA), Clearfil SE Bond (SE; Kuraray Medical Inc., Japan), Adper Prompt L-Pop (PL; 3M ESPE, USA), G-Bond (GB; GC Cooperation Toyko, Japan)를 이용하여 전단결합강도를 평가하여 다음과 같은 결과를 얻었다. 1. 유치 법랑질에서 전단결합강도는 SM이 $28.47{\pm}7.93\;MPa$로 가장 높았고 SB ($28.18{\pm}6.84$), PL ($24.02{\pm}6.14$), SE ($21.70{\pm}6.56$), GB ($17.70{\pm}6.68$) 순이었다. SM과 SB는 SE보다 통계적으로 유의하게 높은 결합강도를 보였으며, SM, SB, PL은 GB보다 높았다(p<0.05). 2. 유치 상아질에서 전단결합강도는 SE가 $28.72{\pm}14.44MPa$로 가장 높았고, PL ($20.10{\pm}6.13$), SM ($17.72{\pm}10.65$), SB ($15.48{\pm}2.66$), GB ($10.10{\pm}5.45$) 순이었으며 SE와 GB간에는 유의한 차이가 있었으나, 다른 군들 간에는 유의한 차이가 없었다. 3. 영구치 법랑질에서의 전단결합강도는 SB가 $28.36{\pm}5.68\;MPa$로 가장 높았고 SM ($22.77{\pm}4.63$), PL ($22.05{\pm}6.57$), SE ($21.74{\pm}4.62$), GB ($15.60{\pm}6.75$)순이었다. SB는 다른 접착제보다 통계적으로 유의하게 높은 결합력을 나타냈으며, GB는 가장 낮은 결합력을 보였다(p<0.05). 4. 영구치 상아질에서의 전단결합강도는 SM이 $28.22{\pm}5.56\;MPa$로 가장 높았고, SB ($21.68{\pm}7.44$), SE ($20.13{\pm}9.88$), GB ($14.30{\pm}6.81$), PL ($14.18{\pm}5.88$)순이었으며, SM은 PL, GB와 유의한 차이가 있었다(p<0.05). 5. 유치의 법랑질과 상아질 간에는 SM, SB, GB에서 유의한 차이가 있었고, 영구치 법랑질과 상아질 간에는 PL에서 유의한 차이가 있었다(p<0.05). 6. 유치 법랑질과 영구치 법랑질 간에는 모든 접착제에서 유의한 차이가 없었으나, 유치 상아질과 영구치 상아질 간에는 SM과 SB에서 유의한 차이가 있었다(p<0.05).

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타액오염이 치면열구전색제의 전단결합강도에 미치는 영향 (THE INFLUENCE OF SALIVARY CONTAMINATION ON SHEAR BOND STRENGTH OF PIT AND FISSURE SEALANT BY USE OF SEVERAL BONDING AGENTS)

  • 박소연;최성철;최영철;김광철;박재홍
    • 대한소아치과학회지
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    • 제39권2호
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    • pp.153-159
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    • 2012
  • 본 연구는 치면열구전색술의 시술과정에 발생될 수 있는 타액오염이 치면열구전색제의 전단결합강도에 미치는 영향을 알아보고자 하였으며, 수종의 접착제를 이용하였을 경우, 각 단계의 타액오염이 통상적인 치면열구전색술에서의 전단결합강도와의 차이를 알아보고자 하였다. 56개의 우식이 없는 발치된 치아를 이용하여 시행하였으며, 3개의 군에서 타액오염을 시키는 술식단계에 따라 다음과 같이 7개의 군으로 나누어 실험을 시행하였다. 각 군을 산부식만 시행한 경우(Group A와 B), Adper$^{TM}$ Single Bond를 적용한 경우(Group C, D, E), Adper$^{TM}$ Prompt L-pop을 적용한 경우(Group F, G)로 나누어 실험군의 치면에 타액을 10초간 적용하였다. 치면열구전색제를 적용시키고 열순환을 시행하였으며, 전단결합강도를 측정하여 다음과 같은 결과를 얻었다. 1. 통상적인 치면열구전색술에서는 타액오염시 전단결합강도가 유의성 있게 감소하였다(p<0.05). 그러나, 접착제를 적용한 뒤 치면열구 전색술을 시행한 군에서는 접착제의 종류나 오염을 시킨 단계에 따른 유의성있는 차이는 나타나지 않았다. 2. 타액오염을 시키지 않고 치면열구전색술을 시행한 군들에서는 Adper$^{TM}$ Single Bond가 높은 결합강도를 보였으나 유의성있는 차이를 보이지 않았다. 3. 파절편 검사결과 접착제를 사용한 대부분의 군들에서 응집성 파절이 관찰된 반면 접착제를 사용하지 않은 군들에서는 접착성 파절이 관찰되었다.

복합레진의 exponential 중합법이 상아질접착제의 미세인장접착강도에 미치는 영향 (EFFECT OF THE EXPONENTIAL CURING OF COMPOSITE RESIN ON THE MICROTENSILE DENTIN BOND STRENGTH OF ADHESIVES)

  • 성소래;서덕규;이인복;손호현;조병훈
    • Restorative Dentistry and Endodontics
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    • 제35권2호
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    • pp.125-133
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    • 2010
  • 접착제를 통해 치아에 접착되는 상부의 복합레진의 빠른 중합은 접착제층에 높은 중합수축응력을 발생시킨다. 중합수축응력을 경감시키기 위해서, LED 광중합기의 하나인 Elipar FreeLight 2 (3M ESPE, USA)에서는 최초 5초 이내에 광강도를 증가시키는 exponential 중합법을 채택하고 있다. 본 연구에서는 짧은 시간내에 광강도를 증가시키는 exponential 중합법이 복합레진의 초기 중합수축속도를 효과적으로 조절할 수 있는지를 알아보기 위해 접착제 적용 후 상부의 복합레진을 exponential 중합법과 continuous 중합법으로 중합하여 상아질접착제의 미세인장접착강도를 비교하였다. 3M사의 Scotchbond Multipurpose Plus (MP), Single Bond 2 (SB), 및 Adper Prompt (AP)의 세 종류의 접착제를 발치한 대구치의 교합면 상아질에 제조사의 지시에 따라 적용하고, 혼합형 복합레진인 Denfil (Vericom, Korea)을 두 가지광중합방법으로 중합하였다. 접착 후 48시간에 미세인장접착강도를 측정하고, 파절면은 FE-SEM.으로 관찰하였다. 그 결과, 각각의 접착제에서 중합방법에 따른 접착강도의 차이는 관찰할 수 없었다(Two-way ANOVA, p > 0.05). MP와 SB의 미세인장접착강도는 AP에 비해 유의하게 높았다(p < 0.05). 대부분의 파절시편에서는 혼합형 파절이 가장 많이 관찰되었으나, 중합방법에 따른 파절양상의 차이는 없었다. 결론적으로 5초 이내의 짧은 시간에 광강도를 증가시키는 exponential 중합법은 continuous 중합법과 비교하여 상아질접착제의 미세인장접착강도에 영향을 주지 않았다.

Concise Bedside Surgical Management of Profound Reperfusion Injury after Vascular Reconstruction in Severe Trauma Patient: Case Report

  • Chung, Hoe Jeong;Kim, Seong-yup;Byun, Chun Sung;Kwon, Ki-Youn;Jung, Pil Young
    • Journal of Trauma and Injury
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    • 제29권4호
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    • pp.204-208
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    • 2016
  • For an orthopaedic surgeon, the critical decisions to either amputate or salvage a limb with severe crushing injury with progressive ischemic change due to arterial rupture or occlusion can become a clinical dilemma at the Emergency Department (ED). And reperfusion injury is one of the fetal complications after vascular reconstruction. The authors present a case which was able to save patient's life by rapid vessel ligation at bedside to prevent severe reperfusion injury. A 43-year-old male patient with no pre-existing medical conditions was transported by helicopter to Level I trauma center from incident scene. Initial result of extended focused assessment with sonography for trauma (eFAST) was negative. The trauma series X-rays at the trauma bay of ED showed a multiple contiguous rib fractures with hemothorax and his pelvic radiograph revealed a complex pelvic trauma of an Anterior Posterior Compression (APC) Type II. Lower extremity computed tomography showed a discontinuity in common femoral artery at the fracture site and no distal run off. Surgical finding revealed a complete rupture of common femoral artery and vein around the fracture site. But due to the age aspect of the patient, the operating team decided a vascular repair rather than amputation even if the anticipated reperfusion time was 7 hours from the onset of trauma. Only two hours after the reperfusion, the patient was in a state of shock when his arterial blood gas analysis (ABGA) showed a drop of pH from 7.32 to 7.18. An imminent bedside procedure of aseptic opening the surgical site and clamping the anastomosis site was taken place rather than undergoing a surgery of amputation because of ultimately unstable vital sign. The authors would like to emphasize the importance of rapid decision making and prompt vessel ligation which supply blood flow to the ischemic limb to increase the survival rate in case of profound reperfusion injury.

의무기록정리율의 문제점과 개선책 (COMPLETION RATE OF THE MEDICAL RECORDING: PROBLEMS AND MEASURES FOR IMPROVEMENT)

  • 김세철;김민순
    • 한국의료질향상학회지
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    • 제1권1호
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    • pp.110-118
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    • 1994
  • As the first step to improve the medical recording for the hospitalized patients, we tried to identify problems of completion rate of the medical recording and made the completion rate of the medical recording within due date known to the public in the hospital and commended the best Department and resident officially. The results were as follows: 1. The average number of the medical recordings per a recorder by years of residency(average number to quorum) was 293.3(398.8) in 1st year, 82.5(68.1) in 2nd year, 21.2(8.3) in 3rd year, and 20.5(1.9) in 4th year-residents. There was only 2 residents who prepared the medical recordings more than the average of 125.6 recordings per a resident. 2. Among 13 Departments, the medical recording was wholly put in charge of the 1st year-resident in 6 Departments. The duty was shared with the 2nd year-resident in 5 Departments and the 3rd year-resident in 1 and the 4th year-resident in Only 1 Department. 3. The more the cases requiring the medical recording, the lower the completion rate(80% less than 100 recordings, 70% in 100-299, 60% in 300-399 and 33.3% in more than 400). 4. There was no difference in the completion rate of the medical recording before(1991) and after(1993) a public nitice(1992). However, 4 Departments showed improvement of 21-45% in the completion rate, and no case was found where billing for medical assurance was postponed due to delayed completion of the medical recording. 5. The completion rate was relatively low(72-78%) from January to March. The main reasons were shortage of men power due to preparation of board examination, attendance to military duty, and lack of training in the medical recording for the new 1st year-residents. 6. The official commendation of the best Department and resident by letters did not improve the completion rate of the medical recording. In conclusion, The main reason of the low completion rate of the medical recording was the fact that the 1st year-residents were almost exclusively responsible for the medical recording. Hence, it is mandotory that this practice gets staffs' attention to improve the completion rate. Public notice of the completion rate of the medical recording shows prompt improvement of the completion rate. Prize money rather than commendation by a letter for the best Department would also be more effective to improve the quality of medical recording.

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