• Radiation Oncology Journal
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• 제33권4호
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• pp.284-293
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• 2015

Purpose: To determine failure patterns and survival outcomes of T4N0-1 non-small cell lung cancer (NSCLC) treated with definitive radiotherapy. Materials and Methods: Ninety-five patients with T4N0-1 NSCLC who received definitive radiotherapy with or without chemotherapy from May 2003 to October 2014 were retrospectively reviewed. The standard radiotherapy scheme was 66 Gy in 30 fractions. The main concurrent chemotherapy regimen was $50mg/m^2$ weekly paclitaxel combined with $20mg/m^2$ cisplatin or AUC 2 carboplatin. The primary outcome was overall survival (OS). Secondary outcomes were failure patterns and toxicities. Results: The median age was 64 years (range, 34 to 90 years). Eighty-eight percent of patients (n = 84) had an Eastern Cooperative Oncology Group performance status of 0-1, and 42% (n = 40) experienced pretreatment weight loss. Sixty percent of patients (n = 57) had no metastatic regional lymph nodes. The median radiation dose was EQD2 67.1 Gy (range, 56.9 to 83.3 Gy). Seventy-one patients (75%) were treated with concurrent chemotherapy; of these, 13 were also administered neoadjuvant chemotherapy. At a median follow-up of 21 months (range, 1 to 102 months), 3-year OS was 44%. The 3-year cumulative incidences of local recurrence and distant recurrence were 48.8% and 36.3%, respectively. Pretreatment weight loss and combined chemotherapy were significant factors for OS. Acute esophagitis over grade 3 occurred in three patients and grade 3 chronic esophagitis occurred in one patient. There was no grade 3-4 radiation pneumonitis. Conclusion: Definitive radiotherapy for T4N0-1 NSCLC results in favorable survival with acceptable toxicity rates. Local recurrence is the major recurrence pattern. Intensity modulated radiotherapy and radio-sensitizing agents would be needed to improve local tumor control.

• 농촌의학ㆍ지역보건
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• 제18권1호
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• pp.77-91
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• 1993

농촌지역 주민들의 보건의료원에 대한 인식도 및 이용양상을 파악하여 보건의료원 제도와 관련된 연구에 기초자료를 제공하고자 1990년 9월 24일부터 90년 9월 28일 까지 5일간 정상북도 울진군 소재 국민학교 3개교와 중학교 3개교의 학부모들에게 설문지를 배부, 회수된 832가구의 가구원 754명을 대상으로 분석한 결과를 요약하면 다음과 같다. 응답자는 남자 60.3%, 여자 39.7%였고 연령은 30, 40대가 81.3%로 대부분을 차지하였으며, 교육수준은 고졸이 40.3%, 의료보장형태로는 지역의료보험이 44.1%를 차지하였다. 응답자의 58.4%가 보건의료원이라는 명칭을 알고 있었는데, 응답자의 학력과 수입이 높을 수록 그리고 거주지역이 보건의료원에 근접한 지역일수록 보건의료원에 대한 인식도가 높았다(p<0.01). 보건의료원의 진료사업 내용중에서 의료보호대 상자 진료와 치과진료를, 각각 35.1%와 31.0%가 알고 있었으며, 보건예방서비스 사업에서는 예방접종사업을 36.1%로 가장 많이 인지하고 있었는데, 학력과 지리적 근접도가 높을수록 보건의료원의 사업내용 인지도는 높게 나타났다. 보건의료원의 연간 외래이용율과 예방서비스 이용율은 대상자 100명당 11.1회 및 4.5회였으며, 입원이용율은 10,000명당 34.6회였다. 보건의료원 이용동기는 잘나아서(45.7%), 약이 좋아서 (45.2%), 거리가 가까워서(42.9%) 순이었다. 일반병의원과 비교해서 보건의료원의 진료수준이 더 좋다고 응답한 이용자는 16.3% 였고, 더 못하다는 19.0%였다. 또한 보건의료원의 진료비가 저렴하다고 한 응답자는 61.5%인데 비해 비싸다고한 경우는 3.9%였다. 보건의료원 이용시의 교통수단으로는 도보가 55.0%, 버스가 35.5%로 대부분이었다. 보건의료원 이용시 느낀 불편사항으로는 장시간 대기가 46.7%로 가장 많았고, 그 다음으로 이용시간이 제한되어 있어서가 17.8%였다. 보건의료원을 한번도 이용하지 않은 이유로는 아픈적이 없어서가 33.5%, 교통이 불편하고 거리가 멀어서가 28.0%, 장시간 대기한다고 해서가 12.8%순으로 나타났다. 이상과 같이 아직도 보건의료원에 대한 인식이 낮고, 잘못 인식하고 있는 주민이 많기 때문에 보건의료원에 대한 전반적인 홍보가 필요할 것으로 보이며, 보건의료원의 이용율을 높이기 위해서는 의료시설, 장비확충과 더불어 의료진의 보강이 필요하고 관리의 효율성도 고려해야 할 것으로 생각된다.

• 한국농촌건축학회논문집
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• 제19권4호
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• pp.9-16
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• 2017

There are an increasing number of healthcare facilaties, especially branch offices, in rural areas to serve the aging population living there. However, there has been a gradual decline in the ratios of recognition, satisfaction and utilization by people who live in the regions. A significant reason of declining the ratios should be the population decline, but the most of population hierarchy shows the groups of elderly people over 60. This result appears to be limited to visit the public health centers. According to the result of population hierarchy, a branch office of public health center has been re-established as a complex welfare facility which can be fulfilled in the functions of basic medical supports and cultural supports. This research is focused on collecting the meaningful information of the status of physical facilities and utilization with 15branch offices of public health care centers in the rural regions near the city of Ik-San city. In addition, this research has a purpose of getting fundamental data for future architectural plans of the branch offices in rural regions with the results about the status of facility operation systems and users' needs.

• Radiation Oncology Journal
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• 제32권4호
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• pp.256-261
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• 2014

Purpose: We performed invasive thermometry to verify the elevation of local temperature in the liver during hyperthermia. Materials and Methods: Three 40-kg pigs were used for the experiments. Under general anesthesia with ultrasonography guidance, two glass fiber-optic sensors were placed in the liver, and one was placed in the peritoneal cavity in front of the liver. Another sensor was placed on the skin surface to assess superficial cooling. Six sessions of hyperthermia were delivered using the Celsius TCS electro-hyperthermia system. The energy delivered was increased from 240 kJ to 507 kJ during the 60-minute sessions. The inter-session cooling periods were at least 30 minutes. The temperature was recorded every 5 minutes by the four sensors during hyperthermia, and the increased temperatures recorded during the consecutive sessions were analyzed. Results: As the animals were anesthetized, the baseline temperature at the start of each session decreased by $1.3^{\circ}C$ to $2.8^{\circ}C$ (median, $2.1^{\circ}C$). The mean increases in temperature measured by the intrahepatic sensors were $2.42^{\circ}C$ (95% confidence interval [CI], 1.70-3.13) and $2.67^{\circ}C$ (95% CI, 2.05-3.28) during the fifth and sixth sessions, respectively. The corresponding values for the intraperitoneal sensor were $2.10^{\circ}C$ (95% CI, 0.71-3.49) and $2.87^{\circ}C$ (1.13-4.43), respectively. Conversely, the skin temperature was not increased but rather decreased according to application of the cooling system. Conclusion: We observed mean $2.67^{\circ}C$ and $2.87^{\circ}C$ increases in temperature at the liver and peritoneal cavity, respectively, during hyperthermia. In vivo real-time thermometry is useful for directly measuring internal temperature during hyperthermia.

• 한국병원경영학회지
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• 제11권2호
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• pp.16-31
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• 2006

Through investigating communication contents, extent of conflict, and its causes between medical residents and nurses/technicians, this study will provide the effective communication skills to ease interpersonal conflicts and maintain healthy partner relationships. This is a descriptive study to find out the communication contents, extent of conflicts and its causes between medical residents and nurses/technicians. Data were collected from April $1^{st}$, 2004 to April $8^{th}$, 2004 from 118 medical residents, 288 nurses, 85 radiology technicians and 107 laboratory technicians in 4 university hospitals in Seoul capital region. Data analysis was done with SPSS version 11.0 using descriptive statistics, ANOVA and chi-test. Interpersonal conflict towards medical residents were rated higher by nurses than technicians (Nurses > Technologists = Medical residents). Causes of conflict showed regional differences. In communication contents, all regions showed "Thank you" and "Well done" as most pleasant comments. Medical residents proved other medical residents' negative comments as most unpleasant and nurses and technicians proved residents' commanding phrases, disrespectful speech, and urging comments to be most unpleasant. Communication between the center members of the medical organization is very important in treating patients and understanding each other. For smooth conflict resolutions and maintaining healthy partner relationships, continued education and support for appropriate communication and interpersonal relationship skills is needed.

• Journal of Digestive Cancer Reports
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• 제8권1호
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• pp.1-50
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• 2020

Although surgery was the standard treatment for early gastrointestinal cancers, endoscopic resection is now a standard treatment for early gastrointestinal cancers without regional lymph node metastasis. High-definition white light endoscopy, chromoendoscopy, and image-enhanced endoscopy such as narrow band imaging are performed to assess the edge and depth of early gastrointestinal cancers for delineation of resection boundaries and prediction of the possibility of lymph node metastasis before the decision of endoscopic resection. Endoscopic mucosal resection and/or endoscopic submucosal dissection can be performed to remove early gastrointestinal cancers completely by en bloc fashion. Histopathological evaluation should be carefully made to investigate the presence of risk factors for lymph node metastasis such as depth of cancer invasion and lymphovascular invasion. Additional treatment such as radical surgery with regional lymphadenectomy should be considered if the endoscopically resected specimen shows risk factors for lymph node metastasis. This is the first Korean clinical practice guideline for endoscopic resection of early gastrointestinal cancer. This guideline was developed by using mainly de novo methods and encompasses endoscopic management of superficial esophageal squamous cell carcinoma, early gastric cancer, and early colorectal cancer. This guideline will be revised as new data on early gastrointestinal cancer are collected.

• Journal of Trauma and Injury
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• 제33권4호
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• pp.242-247
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• 2020

Purpose: The purpose of this study was to determine the incidence and characteristics of associated injuries in patients with spine trauma. Methods: Data of 3,920 consecutive patients admitted to a regional trauma center during a 3-year period were analyzed retrospectively. Results: Of the 3,920 patients who were admitted to the trauma center during the 3-year study period, 389 (9.9%) had major spinal injuries. Among these 389 patients, 303 (77.9%) had associated injuries outside the spine. The most common body region of associated injuries was the extremities or pelvis (194 cases, 49.4%), followed by the chest (154 cases, 39.6%) and face (127 cases, 32.6%). Of these 303 patients, 149 (64%) had associated injuries that required surgical treatment such as laparotomy or internal fixation. Associated injuries were more common in patients with lumbar injuries (93.3%) or multiple spinal injuries (100%) than in those with lower cervical injuries (67.4%). There was a significant correlation between the location of the spinal injury and the body region of the associated injury. However, distant associated injuries were also common. Conclusions: Associated injuries were very common in spinal injury patients. Based on demographic groups, the trauma mechanism, and the location of spinal injury, an associated injury should be suspected until proven otherwise. Using a multidisciplinary and integrated approach to treat trauma victims is of the paramount importance.

• 대한핵의학회지
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• 제25권1호
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• pp.46-52
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• 1991

Radioaerosol inhalation imaging (RII) has been used in radionuclide pulmonary studies for the past 20 years. The method is well accepted for assessing regional ventilation because of its usefulness, easy fabrication and simple application system. To evaluate its clinical utility in the study of impaired regional ventilation in bronchial asthma, we obtained and analysed RIIs in 31 patients (16 women and 15 men; age ranging 21-76 years) with typical bronchial asthma at the Department of Radiology, Kangnam St. Mary's Hospital, Catholic University Medical college, from January, 1988 to August, 1989. Scintiscans were obtained with radioaerosol produced by a BARC(Bhabha Atomic Reserch Center, India) nebulizer with 15 mCi of $^{99m}Tc-phytate$. The scanning was peformed in anterior, posterior and lateral projections following 5-minute inhalation of radioaerosol on sitting position. The scans were analyzed and correlated with the results of pulmonary function study and the findings of chest radiography. Fifteen patients had concomitant lung perfusion image with $^{99m}Tc-MAA$. Follow-up scans were obtained in 5 patients after bronchodilator therapy. The patients were divided into (1) attack type (4 patients), (2) resistant type (5 patients), (3) remittent type (10 patients) and (4) bronchitic type (12 patients). Chest radiography showed hyperinflation, altered pulmonary vascularity, thickening of the bronchial wall and accentuation of basal interstitial markings in 26 of the 31 patients. Chest radiographs were norma! in the remaining 5 patients. Regardless of type, the findings of RII were basically the same, and characterized by the deposition of radioaerosol in the central parts or in the main respiratory air ways along with mottled nonsegmental ventilation defects in the periphery. Peripheral parenchymal defects were more extensive than that of expected findings from clinical symptoms, pulmonary function test and chest radiograph. Broomstick sign was present in 17 patients. The abnormality of RII was poorly correlated with perfusion scans. In all 5 patients treated with bronchodilators, follow-up study demonstrated a decrease in the degree of radioaerosol deposition in the central air way with improved ventilation defects. This study indicates that RII is a useful technique for the evaluation of regional ventilation abnormality and the effect of treatment with bronchodilators in patients with bronchial asthma.

• Journal of Trauma and Injury
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• 제35권3호
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• pp.181-188
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• 2022

Purpose: Inferior vena cava (IVC) collapse is related to hypovolemia. Sonography has been used to measure the IVC diameter, but there is variation depending on the skill of the operator and it is difficult to obtain accurate measurements in patients who have a large amount of intestinal gas or are obese. As a modality to obtain accurate measurements, we measured the diameters of the IVC and aorta on trauma computed tomography scans and investigated the correlation between the IVC to aorta ratio and the shock index in blunt trauma patients. Methods: We retrospectively analyzed the medical records of 588 trauma patients who were transferred to the regional trauma center (level 1) of Wonkang University Hospital from March 2020 to February 2021. We included trauma patients 18 years or older who met the trauma activation criteria and underwent trauma computed tomography scans with intravenous contrast within 40 minutes of admission. The shock index was calculated from vital signs before trauma computed tomography scan, and measurements of the anteroposterior diameter of the IVC (AP), the transverse diameter of the IVC (T), and aorta were made 10 mm above the right renal vein in the venous phase. Results: Overall, 271 patients were included in this study, of whom 150 had a shock index ≤0.7 and 121 had a shock index >0.7. The T to AP ratio and AP to aorta ratio were significantly different between groups. Cutoffs were identified for the T to AP ratio and AP to aorta ratio (2.37 and 0.62, respectively) that produced clinically useful sensitivity and specificity for predicting a shock index >0.7, demonstrating moderate accuracy (T to AP ratio: area under the curve, 0.71; sensitivity, 59%; specificity, 87% and AP to aorta ratio: area under the curve, 0.70; sensitivity, 55%; specificity, 91%). Conclusions: The T to AP ratio and AP to aorta ratio are useful for predicting hemorrhagic shock in trauma patients.

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제4권6호
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• pp.57-65
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• 1998

According as the population has been having an advanced age, several problems which is due to the physical, spiritual, social and chronic diseases of the aged are occurred. And the necessity of domiciliary care or regional social facilities has come to offer a protection, care and medical services to them. Therefore, this study aims to represent the architectural data of a day-care center through comparative analysis with a foreign one, recognizing the necessity of the day-care center as a part of domiciliary care facilities As the method of this study, the concept and type of day-care services were founded with the operational realities. And the spatial composition of the present condition was investigated and analyzed.