• Korean Journal of Radiology
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• 제22권3호
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• pp.354-365
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• 2021

Objective: To investigate the diagnostic performance of contrast-enhanced ultrasound (CEUS) and its role as a second-line imaging modality after gadoxetate-enhanced MRI (Gd-EOB-MRI) in the diagnosis of hepatocellular carcinoma (HCC) among at risk observations. Materials and Methods: We prospectively enrolled participants at risk of HCC with treatment-naïve solid hepatic observations (≥ 1 cm) of Liver Imaging Reporting and Data System (LR)-3/4/5/M during surveillance and performed Gd-EOB-MRI. A total of one hundred and three participants with 103 hepatic observations (mean size, 28.2 ± 24.5 mm; HCCs [n = 79], non-HCC malignancies [n = 15], benign [n = 9]; diagnosed by pathology [n = 57], or noninvasive method [n = 46]) were included in this study. The participants underwent CEUS with sulfur hexafluoride. Arterial phase hyperenhancement (APHE) and washout on Gd-EOB-MRI and CEUS were evaluated. The distinctive washout in CEUS was defined as mild washout 60 seconds after contrast injection. The diagnostic ability of Gd-EOB-MRI and of CEUS as a second-line modality for HCC were determined according to the European Association for the Study of the Liver (EASL) and the Korean Liver Cancer Association and National Cancer Center (KLCA-NCC) guidelines. The diagnostic abilities of both imaging modalities were compared using the McNemar's test. Results: The sensitivity of CEUS (60.8%) was lower than that of Gd-EOB-MRI (72.2%, p = 0.06 by EASL; 86.1%, p < 0.01 by KLCA-NCC); however, the specificity was 100%. By performing CEUS on the inconclusive observations in Gd-EOB-MRI, HCCs without APHE (n = 10) or washout (n = 12) on Gd-EOB-MRI further presented APHE (80.0%, 8/10) or distinctive washout (66.7%, 8/12) on CEUS, and more HCCs were diagnosed than with Gd-EOB-MRI alone (sensitivity: 72.2% vs. 83.5% by EASL, p < 0.01; 86.1% vs. 91.1% by KCLA-NCC, p = 0.04). There were no false-positive cases for HCC on CEUS. Conclusion: The addition of CEUS to Gd-EOB-MRI as a second-line diagnostic modality increases the frequency of HCC diagnosis without changing the specificities.

• 한국응급구조학회지
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• 제9권2호
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• pp.111-128
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• 2005

Background: Cardiac arrest is one of the most critical diseases which can likely lead to severe cerebral disability or brain death when the cases can not recover their circulation within 10 minutes. Saving out-of-hospital cardiac arrest cases is a recent concern in Korea. Resuscitation has become an important multidisciplinary branch of medicine, demanding a spectrum of skills and attracting a plethora of specialities and organizations. The best survival can be achieved if all the following links have been optimized : rapid access, and early CPR, defibrillation and ACLS, Since the "Utstein Style" was advocated in 1991, many reports about out-of-hospital cardiac arrest have been published based on this guideline. These differences prevent valid inter-hospital and international comparisons. However, it is not known how effective resuscitation has become to the patients. In other words, there are no guidelines for reviewing, reporting, and conducting research on resuscitation in Korea. This dissertation aims to provide the basic data for a unified reporting guideline of resuscitation in Korea and evaluating the out-of-hospital factors associated with survival discharge of out-of-hospital cardiac arrest. Methods: As for this study, uses the collected data about Out-of-hospital cardiac arrests at 4 area, from January, 2005 to April. 2005. With a retrospective study, 174 cases were analyzed. The data was recorded based on the Out-of-Hospital Utstein Style. Results: Resuscitation was performed on 174 out-of-hospital cardiac arrest cases at the 4 area 14 patients(8.1%) recovered their spontaneous circulation. Overall, the ROSC of the out-of-hospital cardiac arrest patients was 8.1%, which was poorer than that of western countries. Gender distribution was 50 females(28.7%) and 124 males(71.3%), approximately twice as many males as females. ROSC of witnessed arrests was found out to be 97.7%. The ratio of the witnessed arrest groups showed higher results than that of unwitnessed arrest groups in the above-examined cases. Cardiac etiology consisted of cardiac(33.5%), non-cardiac(45.7%), trauma(20.1%), and unknown(6.0%). Cardiac was the best performance. Initial rhythm showed Ventricular Tachycardia/pulseless Ventricular Fibrillation in 8 patients(6.0%), asystole in 100(75.2%) and unknown in 25(18.8%). The results of the Ventricular Tachycardia/pulseless Ventricular Fibrillation showed higher results than the others cases, The proportion of the cardiogenic cause was 33.5%, which was only half of western countries. Ventricular Tachycardia/pulseless Ventricular Fibrillation is relatively rare. These differences were due to the prevalent pattern of Out-of-hospital cardiac arrest as well as prematurity of the EMSS. Bystander CPR was practiced on 13 patients(7.52%). ROSC was shown in 46.2% cases. CPR by EMT was carried out on 167 cases(96.5%). ACLS by EMf was rare. From collapse, 4 cases(2.6%) arrived to ED within 6 minutes. 13 (8.6%) within 10 minutes, and 49(32.5%) over 31 minutes. The sooner the patients arrived, the greater the ratio of ROSC and discharged alive became, and the same with collapse time to ROSC. As the results of the logistic regression analysis, ROSC was found out to be highly influenced by the time of ED arrival from collapse and Ventricular Tachycardia/pulseless Ventricular Fibrillation. Therefore, the ratio of ROSC depends on not any single factor but various intervention factors. Conclusion: This dissertation presents the following suggestions and directions of the study hereafter. First, the first step for a chain of survival should be taken to activate EMSS early with a phone as soon as cardiac arrests are witnessed. Second, it is keenly needed that emergency medical technicians should be increased through emergency education for living. Third, it is necessary to establish the emergency transportation system. Fourth, most of the Koreans have little understanding of EMT and the present operation systems have many problems, which should be fundamentally changed. Fifth, it is required to have an active medical control over Out-of-hospital CPR, And proper psychological supports should be given not only to patients themselves and their family but also individuals who are engaged in emergency situation. Finally, through studies hereafter on nationwide, comprehensive, and standard forms, it is needed to examine into the biological figures of human body, causes and trends of cardiac arrests, and then, to enhance the survival rate of Out-of-hospital cardiac arrests. Korean guidelines for Cardiopulmonary resuscitation need to be made.

• Korean Journal of Radiology
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• 제22권12호
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• pp.2094-2123
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• 2021

Incidental thyroid nodules are commonly detected on ultrasonography (US). This has contributed to the rapidly rising incidence of low-risk papillary thyroid carcinoma over the last 20 years. The appropriate diagnosis and management of these patients is based on the risk factors related to the patients as well as the thyroid nodules. The Korean Society of Thyroid Radiology (KSThR) published consensus recommendations for US-based management of thyroid nodules in 2011 and revised them in 2016. These guidelines have been used as the standard guidelines in Korea. However, recent advances in the diagnosis and management of thyroid nodules have necessitated the revision of the original recommendations. The task force of the KSThR has revised the Korean Thyroid Imaging Reporting and Data System and recommendations for US lexicon, biopsy criteria, US criteria of extrathyroidal extension, optimal thyroid computed tomography protocol, and US follow-up of thyroid nodules before and after biopsy. The biopsy criteria were revised to reduce unnecessary biopsies for benign nodules while maintaining an appropriate sensitivity for the detection of malignant tumors in small (1-2 cm) thyroid nodules. The goal of these recommendations is to provide the optimal scientific evidence and expert opinion consensus regarding US-based diagnosis and management of thyroid nodules.

• 한국간호교육학회지
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• 제9권1호
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• pp.51-63
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• 2003

The purpose of this study was to identify the prevalence of urinary incontinence of community residing climacteric women, and to identify the relationship between urinary incontinence and quality of life. The subjects of this study were 156 women(45 to 59 years old). Data was collected from Sep. 1 to Dec. 1 2002 by an interview or self-reporting by a structured questionnaire. The questionnaire was composed of items of general characteristics, urinary characteristics, and conditions of urinary incontinence, using the modified Henderickson's stress incontinence scale(1981), and the quality of life scale developed by RO, You Ja(1988). The data was analyzed by the SPSS/WIN program using descriptive statistics, Pearson correlation coefficients, t-test and AVOVA. The results of the study were as follows : 1. The prevalence of urinary incontinence was 76.3%. Of the incontinent women, 42.0% had experienced urinary incontinence for a period of one to three years. Frequency of urinary incontinence was once or twice per day for 42.9% of the urinary incontinent women. Most of the participation with urinary incontinence(91.6%) had mild leakage of urine. In the whole urinary incontinent women, 70.6% had never treated or managed their urinary incontinence. Most of the subjects(79.8%) were mildly incontinent, and the prevalence of moderate and severe urinary incontinence was 20.2%. The mean scores among the items of urinary incontinence, in descending order, were increase of abdominal pressure($1.45{\pm}1.05$), coughing($1.16{\pm}0.93$), and sneezing($1.03{\pm}0.92$). 2. The average score in the level in the quality of life variables was 3.12. The urinary incontinence and quality of life were correlated negatively(r=-0.103, p<0.001). 3. There were statistically significant differences in the score of climacteric woman's self reported quality of life according to : amount of urinary incontinence(F=12.68, P=0.001), duration of urinary incontinence(F=6.97, P=0.009), number of urinary incontinence(F=4.77, P=0.03), existence of urinary incontinence(t=148, P=0.05). In conclusion, this study was a preliminary study to provide nursing practice guidelines for climacteric woman with urinary incontinence. Nurses working with climacteric woman should develop and provide adequate care for the incontinent climacteric subjects. In future research, it is recommended to identify comprehensive factors related to urinary incontinence, including the effective management of urinary incontinence.

• 대한디지털의료영상학회논문지
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• 제12권1호
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• pp.33-41
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• 2010

National Cancer Screening Project and Korean Society of Breast Imaging recommend that breast cancer screening should be performed on those aged 40 and above. Nevertheless, this recommendation is usually ignored by a number of medical institutions. The purpose of this study is to emphasize the necessity of an age limitation in screening mammography. Ten institutions were randomly selected and telephone inquiries about patients' age limitation and internal guidelines were set up. The 3,214 women, who underwent screening mammography through 'GE Senography 2000D' in each hospital, were classified into five groups according to age(from 20s to 40s, at intervals of 5). And then, collected data was analyzed by a radiologist in accordance with ACR-BIRADS(American College of Radiology Breast Imaging Reporting and Data System), through which breast parenchymal density and the results of analysis were categorized in order to predict the sensitivity of mammography. Information about craniocaudal-view mammograms was automatically produced by use of GE Senography 2000D, and the average glandular dose was retrospectively analyzed through the program 'Excel 2007.' Two institutions did not set the age limitation. Other seven institutions internally allowed those who wanted to receive mammography regardless of age. Approximately 99% of those aged 20 to 29 were judged as having the dense breast. In those aged 35 to 39, breast parenchymal density tended to be lower, but the fatty breast to increase. In the case of 'category-zero' that does not need additional tests, the rate of 'heterogeneously dense' and 'extremely dense' reached to 83.1% and 15.1% respectively. Regarding dense breasts, there was no sufficient information for image reading. The glandular dose, applied to 3,214, was 1.47mGy on the average. In those aged 20 to 24 who are sensitive to radiation, the average glandular dose indicated 1.59mGy. Those aged 35 and above showed the lowest value, 1.43mGy. In those aged 35 to 39, the breast tended to change from denseness to fattiness. The average glandular dose was lowest in those aged 35 and above, which suggests that screening mammography should be periodically performed on those aged 35 and above in order that breast cancer may be early detected. On the other hand, in those aged less than 35, it is difficult to analyze mammograms due to the high density of breast parenchyma, and also retakes become frequent. In particular, subjects may be exposed to excessive doses. Accordingly, it should be substituted by breast self-examination or clinical breast examination. In case of need, it is advisable to perform ultrasonography.

• 한국응용과학기술학회지
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• 제37권4호
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• pp.925-935
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• 2020

본 연구는 사업장 보건관리자의 우수한 보건관리 활동과 동기를 파악하여 추후 보건관리자의 활동에 대한 가이드를 제시하기 위한 연구이다. 본 연구는 5년 이상 동일한 사업장에 근무한 사업장 보건 관리자 21명을 대상으로 연구에 대한 동의를 얻은 후 반구조화된 설문지를 이메일로 보내 자료를 수집하였으며 응답한 내용을 질적 분석하였다. 본 연구 결과 17개의 범주와 3가지 주제가 도출되었다. 도출된 주제는 보건관리자로서의 보람과 성취감, 보건관리자로서의 어려웠던 부분, 어려움은 이렇게 해결하자 이었다. 보건관리자는 근로자가 마음을 열어주고, 생활을 변화시키기며, 감사해 하며, 새로운 분야를 개척하는 것에 보람과 성취감을 느낀다고 하였다. 반면, 예측할 수 없는 건강, 조직문화의 변화, 질병을 비밀화하는 것, 보건관리자 업무가 편하다고 생각하는 사람들에 대해 어려움을 느꼈다. 이러한 어려움을 극복하는 방법으로 근로자의 마음을 읽어주고, 스스로 알게 하며, 기존 프로그램을 활용하며, 가장 어려운 사람을 내 편으로 하며, 자신의 성과를 알리는 것이 필요하다고 하였다. 본 연구 결과를 통하여 보건관리자는 자신의 전문성을 갖추기 위하여 노력하고, 건강관리 성과를 지속적으로 알려 사업장의 정책결정자와 근로자들에게 보건관리의 중요성을 설득할 필요가 있다. 또한, 우수한 보건관리자의 성공전략을 적극적으로 벤치마킹해야 할 것이다.

• 한국산학기술학회논문지
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• 제17권12호
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• pp.488-495
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• 2016

본 연구는 목조 건조물 문화재의 내진 대책과 보수 보강 개선에 관한 기초적인 연구이다. 현재 문화재 내진에 관한 규정은 문화재청의 '문화재 지진재해 등에 관한 규정'으로 문화재 지진발생 후의 피해 상황 보고체계만을 규정하고 있다. 한국은 2013년 이후, 일본의 '중요 문화재(건조물) 내진진단 내진보강 지침'을 참고로 하여 전문가의 내진점수평가 체계를 도입하는 연구가 진행되고 있다. 일본의 목조 건조물 문화재의 내진은 우리나라와 유사하게 전문가의 점수평가로 진단되지만, 지진 발생 전, 지진 발생 중, 지진 발생 후로 구분하여 관리되고 있다. 또한 '헤리티지 매니저'와 '문화재 닥터'를 운용하여 문화재의 상시적인 관리와 재난 발생 시 신속한 복구가 가능한 체계를 갖추고 있다. 우리나라의 목조 건조물 문화재의 지진 발생 후의 피해복구 중심의 관리체계를 벗어나 문화재의 상시적인 관리를 위한 전문가의 양성과 문화재 내진기준의 정립, 건축 관련 민간단체의 활용을 통한 상시적인 관리체계의 도입이 필요하다. 그리고 목조 건조물 문화재의 현황을 조사하여 개별 목조 건조물 문화재의 점검을 통한 다양한 내진진단 기법의 개발과 적합한 보수 보강 지침의 마련이 필요하다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제38권4호
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• pp.231-239
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• 2012

Objectives: This study sought to provide guidelines in order to decrease the incidence of nerve injury during mandibular ramus bone harvesting, and to improve understanding of the anatomical structure of the inferior alveolar canal (IAC) to include its distance from the exterior buccal cortex. Materials and Methods: In January and February 2009, 20 patients who visited the Wonkwang University Department of Oral and Maxillofacial Surgery reporting various conditions underwent cone beam computed tomography and were included in this study. Patients with missing left or right mandibular first molars or incisors, or who had jaw fracture or bone pathologies, were excluded. The reference point (R point) was defined as the point where the occlusal plane reached the anterior ramus of the mandible. The position of the IAC in relation to the R point, the buccal bone width (BW), the alveolar crest distance (ACD), the distance from the alveolar crest to the occlusal plane (COD), and the distance from the IAC to the sagittal plane (CS) were determined using proprietary image analysis software which produced cross-sectional coronal and axial images. Results: The distance medially from the R point to the IAC along the axial plane was $6.19{\pm}1.21mm$. The HD from the R point, posteriorly to IAC, in the lateral view was $13.07{\pm}2.45mm$, the VD from the R point was $14.24{\pm}2.41mm$, and the ND from the R point was $10.12{\pm}1.76mm$. The pathway of the IAC was positioned almost in a straight line along a sagittal plane within $0.56{\pm}0.70mm$. The distance from the buccal bone surface to the IAC increased anteriorly from the R point. Conclusion: Marking osteotomy lines in the retromolar area in procedures involving bone harvesting should be discouraged due to the risk of damage to IAC structures. Our measurements indicated that the area from the R point in the ramus of the mandible to 10 mm anterior can be safely harvested for bone grafting purposes.

• 대한수의학회지
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• 제46권4호
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• pp.295-304
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• 2006

Residual materials such as veterinary drugs, environmental contaminants, and pesticides are affecting food safety. High resolution techniques and quality controls are needed to analyze these materials from part per million to part per trillion quantities in food. In order to achieve quality results, standardized methods and techniques are required. Our laboratories were prepared to obtain a certificate of accreditation for ISO/IEC 17025 in the analytical criteria of animal drugs, dioxins, pesticides, and heavy metals. ISO together with IEC has built a strategic partnership with the World Trade Organization with the common goal of promoting a free and fair global trading system. ISO collaborates with the United Nations Organization and its specialized agencies and commissions, particularly those involved in the harmonization of regulations and public policies including the World Health Organization and CODEX Alimentarius for food safety measurement, management and traceability. Our goal was to have high quality analysts, proper analytical methods, good laboratory facilities, and safety systems within guidelines of ISO/IEC 17025. All staff members took requirement exams. We applied proficiency tests in the analysis of veterinary drugs (nitrofuran metabolites, sulfonamide and tetracyclines), dioxins, organophosphorus pesticides, and heavy metals (Cd, Pb, As) to the Food Analysis Performance Assessment Scheme (FAPAS) at Central Science Laboratory, Department for Environment Food and Rural Affairs (DEFRA), England. The results were very satisfactory. All documents were prepared, including system management, laboratory management, standard operational procedures for testing, reporting, and more. The criteria encompassed the requirements of ISO/IEC 17025:1999. Finally, the Korea Laboratory Accreditation Scheme (KOLAS) accredited our testing laboratories in accordance with the provisions of Article 23 of the National Standards Act. The accreditation will give us the benefit of becoming a regional reference laboratory in Asia.

• 대한임상검사과학회지
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• 제48권2호
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• pp.130-136
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• 2016

제주지역 종합병원 감염관리 현황을 조사하여, 병원감염관리 실태와 문제점을 파악하고자 하였으며 감염관리의 중요성을 인식시키고 감염관리 실무자로서 임상병리사의 역할 방안을 모색하기 위하여 제주특별자치도 제주시와 서귀포시에 위치한 종합병원 7개 기관을 대상으로 감염관리 현황을 설문지를 통하여 조사하였다. 제주지역 의료기관의 감염관리는 모든 기관이 감염관리실을 운영하고 전담인력을 구성하고 병원감염관리지침을 보유하고 수행하는 우수한 점을 보였지만, 대부분의 기관이 간호사 1인 구성의 감염관리실을 운영하여 전담인력 확보 및 미생물 관련 배양 판독, 다제내성균의 출현빈도, 감염통계 등 미생물 검사에 대한 내용을 보고 받는데 많은 부분 어려움을 호소하였다. 이에 감염관리의 실질적인 업무를 담당할 수 있는 임상병리사가 의료법 시행규칙에 있는 감염관리에 경험과 지식이 있는 사람으로 충분한 자질과 경험이 있다고 생각되며 감염관리실을 운영함에 있어 감염관리간호사와 미생물에 전문적인 지식을 갖춘 임상병리사(감염관리임상병리사)가 전담자로서 업무를 수행한다면 지금보다 더욱 발전된 감염관리실 운영이 될 것으로 보이며, 향후 감염관리를 제대로 하기 위해서는 전국적으로 종합병원을 비롯한 취약한 중소병원의 감염관리에 대한 전폭적 지원과 감염관리 전문 의료시스템 도입이 중요한 과제라 사료된다.