• 한국임상수의학회지
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• 제20권2호
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• pp.233-236
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• 2003

10년령의 중성화 되지 않은 암컷의 요크셔테리어가 건국대학교 부속 동물병원으로 진료가 의뢰되어 왔다. 환축은 얼굴과 복벽에 심각한 괴사성 피부염을 보였으며 또한 다음다뇨 및 다식증을 나타내었다. 병력청취와 신체검사, CBC, 혈액생화학 검사를 토대로 하여 부신피질기능항진증을 의심하였고, 나아가 ACTH 자극시험을 통하여 쿠싱증후 군이 확진되었다. 또한, High Dose Dexamethasone Suppression lest (HDDST)극 통하여 뇌하수체 의존성 부신피질 기능 항진증임을 알 수 있었다. Mitotane을 이용한 치료가 개시된후 심자한 피부문제와 PUPD등의 임상증상들이 개선되었다. 그 후 mitotane 처치가 적절히 이루어지고 잇는가를 검증하기 위해 ACTH의 추가적인 검사가 수행되었다. 이 임상증례는 심각한 피부문제를 가지고 있던 환축이 오진단되고 치료의 핵심을 찾지못해 1년 이상 지속된 환축이 mitotane을 이용하여 성공적으로 치료되어 유지되고 있음을 보여주는 증례이다.

• Clinical and Experimental Pediatrics
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• 제48권5호
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• pp.461-468
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• 2005

The major function of immune system is to protect infections. The immune systems are composed of innate and adaptive immunity. In adaptive immunity, the cellular and humoral components interact each other. Neonates and infants are infected frequently, because immune systems are naive and easy to expose to infectious agents. The complete history and physical examination is essential to evaluate the child with recurrent infections. The environmental risk factors of recurrent infections are day care center, cigarette smoke, and air pollution. The underlying diseases such as immunodeficiency, autoimmune diseases, allergy, and disorders of anatomy or physiology increase the susceptibility to infections. In immunodeficiency, infections are characterized by severe, chronic, recurrent, and unusual microbial agents infection. The defects of antibody production are susceptible to sinopulmonary bacterial infections. T cells defects are vulerable to numerous organisms such as virus, fungi, bacteria and etc. The screening tests for immune functions are the quantitative and qualitative measurements of each immune components. A complete blood count with white blood cell, differential, and platelet provide quantitative informations of immune components. Total complement and immunoglobulin levels represent the humoral component. Antibody levels of previously injected vaccines also provide informations of the antigen specific antibody immune responses. T cell and subsets count is quantitative measurement of cell mediated immunity. Delayed hypersensitivity skin test is a crude measurement of T cell function. The long term outcome of children with recurrent infections is completely dependent on the underlying diseases, the initial time of diagnosis and therapy, continued management, and genetic counscelling.

• Archives of Reconstructive Microsurgery
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• 제12권1호
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• pp.13-18
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• 2003

Fournier's gangrene is a synergistic necrotizing fasciitis of the perineal, perirectal and urogenital area and can be fatal unless treated in early stage. Perianal and urogenital infections are common causes of the disease but it can occur after artificial procedure on perineal area using by surgical instruments. It is mixed aerobic and anaerobic infection and E. coli is the most common causative bacteria. Untill now many investigators have focused on early diagnosis, preserving hemodynamic stability, broad-spectrum systemic antibiotics and treatment of underlying disease in management of Fournier's gangrene. The authors have experienced five patients of chronic liver disease whose necrotizing perineal infections developed spontaneously and treated them aggressively as described above and reconstructed perineal soft tissue defects using by various surgical methods, then we got good results both functionary and cosmetically. From now on, we would better reconstruct soft tissue defect of perineum with skin graft or pedicled flap in early stage when treat Fournier's gangrene, thereafter we can get an ultimate increase in patient's life quality.

• 대한의사협회지
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• 제61권11호
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• pp.662-669
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• 2018

The cutaneous melanoma has been regarded as rare disease entity in Korea for long time but it shows a silent growth recently. Furthermore the management of cutaneous melanoma including staging system, surgical principle, sentinel lymph node biopsy and subsequent complete node dissection and, most importantly, immunotherapy and target therapy against cutaneous melanoma recently. The incidence of cutaneous melanoma is steadily increasing in Korea but its increase is rapid recent 2 decades to 4.3 times and should be greater soon according to the steeper increase of life expectancy. New staging system proposed by American Joint Committee on Cancer (2017) includes changes in individual TNM category and stage groups, particularly from a prognostic viewpoint. Dermoscopy has been successfully introduced in the differential diagnosis of pigmented skin lesion focusing on cutaneous melanoma by non-invasive simple diagnostic tool. Sentinel lymph node biopsy was a issue of long debate whether survival benefit is real or not. Temporary conclusion about this question is reached after two large scale studies and immediate complete node dissection should be performed in a certain situations. Most important change is drug therapy focusing on immunotherapy and target therapy. Braf- and MEK-inhibitor, immune checkpoint inhibitor and PD-1 blocker has been proved to be effective as a sole or combination regimen against advanced and/or high-risk adjuvant setting of cutaneous melanoma. In conclusion, these remarkable changes will be reviewed shortly here.

• Journal of Korean Neurosurgical Society
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• 제50권6호
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• pp.532-534
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• 2011

Temple trauma that appears initially localized to the skin might possess intracranial complications. Early diagnosis and management of such complications are important, to avoid neurologic sequelae. Non-penetrating head injuries with intracranial hemorrhage caused by a driven bone fragment are extremely rare. A 53-year-old male was referred to our hospital because of intracerebral hemorrhage. He was a mechanic and one day before admission to a local clinic, tip of metallic rod hit his right temple while cutting the rod. Initial brain computed tomography (CT) and magnetic resonance imaging demonstrated scanty subdural hematoma at right temporal lobe and left falx and intracerebral hematoma at both frontal lobes. Facial CT with 3-D reconstruction images showed a small bony defect at the right sphenoid bone's greater wing and a small bone fragment at the left frontal lobe, crossing the falx. We present the unusual case of a temple trauma patient in whom a sphenoid bone fragment migrated from its origin upward, to the contralateral frontal lobe, producing hematoma along its trajectory.

• Archives of Plastic Surgery
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• 제34권1호
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• pp.77-80
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• 2007

Purpose: Purpura fulminans is a rare but rapidly progressive, serious, often life-threatening disorder in childhood, which is complicated with septic shock or disseminated intravascular coagulopathy during acute infection. It occurs first as acute-onset petechial rash, and spreads rapidly into full thickness skin and soft tissue necrosis. In the past, it had high mortality rate, up to 80%, but recently, survival rate has increased due to early diagnosis, and rapid advancement of critical care and antibiotics. From our experiences of PF management, we would like to review the pathophysiology and suggest the surgical treatment guideline about meningococcal induced purpura fulminans. Methods: Two cases of purpura fulminans over the last 3 years were reviewed retrospectively about reconstructive management. After they were treated resuscitative management initially by the critical intensive care, reconstructive surgery was performed by plastic surgeon as soon as the patients were vitally and mentally stable. Results: There were 6 procedures in case 1, and 3 procedures in case 2. The mean delayed period from admission with sepsis to the first surgical debridement was 24 days and 42 days, respectively. Total hospitalization period was 103 days and 69 days, respectively. All of them were treated with debridement and split thickness skin graft, but delayed debridement was superior to early one in the point of preserving much more tissues. Conclusion: From our experience, we suggest that conservative therapy to the wounds appears to be the best tool in the initial vitally unstable period in order to preserve as much tissues and functions as possible if no active inflammation and compartment syndrome are detective.

• 대한소아치과학회지
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• 제36권4호
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• pp.575-579
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• 2009

베체트병은 전신적 혈관염으로 여러 장기에 걸쳐 나타날 수 있으며, 현재로선 확진을 위한 검사 방법이 없으므로 병의 진단은 임상적 증상에 기초하여 내려진다. 구강 및 외음부의 재발성 궤양, 피부 병소, 안구 병소, 및 이상초과민검사(pathergy test)에 대한 반응을 기초로 진단을 내리며, 이 외에도 위장관과 중추신경계에 증상이 나타날 수 있다. 이 중 재발성 구강 궤양은 대부분의 베체트병 환자에서 나타나며, 많은 경우 베체트병의 첫번째 임상 증상으로 발현되기 때문에 치과 영역은 베체트병의 조기 진단에 있어서 중요한 위치에 있다. 본 증례에서 6세 여환은 반복되어 나타나는 재발성 구강 궤양으로 인한 동통 및 섭식 장애를 주소로 본원 소아치과에 내원하였다. 문진 및 병력 채취, 그리고 임상 검사를 통해 치과 영역에서 베체트병을 조기 진단할 수 있었고, 추후 환자는 소아과, 피부과, 소화기내과, 안과와의 협의 진료 하에 베체트병으로 확진되었다. 치과에선 환자의 동통을 완화시키고 섭식을 돕기 위해 도포마취제를 처방하였으며, 추후 베체트병의 확진 하에 그에 따른 적절한 의과적 치료를 시행할 수 있었기에 보고하는 바이다.

• Archives of Plastic Surgery
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• 제39권1호
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• pp.18-24
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• 2012

Background : Infection caused by rapidly growing mycobacteria (RGM) is not uncommon, and the prevalence of RGM infection has been increasing. Clinical diagnosis is difficult because there are no characteristic clinical features. There is also no standard antibiotic regimen for treating RGM infection. A small series of patients with RGM infections was studied to examine their treatments and outcomes. Methods : A total of 5 patients who had developed postoperative infections from January 2009 to December 2010 were retrospectively reviewed. Patients were initially screened using a mycobacteria rapid screening test (polymerase chain reaction [PCR]-reverse blot hybridization assay). To confirm mycobacterial infection, specimens were cultured for nontuberculous mycobacteria and analyzed by 16 S ribosomal RNA and rpoB gene PCR. Results : The patients were treated with intravenous antibiotics during hospitalization, and oral antibiotics were administered after discharge. The mean duration of follow-up was 9 months, and all patients were completely cured of infection with a regimen of a combination of antibiotics plus surgical treatment. Although none of the patients developed recurrence, there were complications at the site of infection, including hypertrophic scarring, pigmentation, and disfigurement. Conclusions : Combination antibiotic therapy plus drainage of surgical abscesses appeared to be effective for the RGM infections seen in our patients. Although neither the exact dosage nor a standardized regimen has been firmly established, we propose that our treatment can provide an option for the management of rapidly growing mycobacterial infection.

• 대한예방한의학회지
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• 제7권1호
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• pp.123-132
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• 2003

It is considered to be important to create aesthetically beautiful style through the change of external shape, however for the hair stylists, whose beauty expression is through hair, the role of hair doctor is becoming even more important with focus to improve the hair healthiness. Hair clinic is management of hair and scalp. It is the management process of preventing damages, while improving and cultivating healthy and shiny hair. The current concept in hair management is moving from simple hair styling to emphasis at hair management. As far as hair management is concerned, it usually includes treatment tools such as shampoo, conditioner, hair treatment and scalp scaling system, which is used for diagnosis of hair condition in order to treat the scalp. As the interest of hair healthiness becoming more wide spread, so does the breadth of clinic menu. The wide choice is to fulfill the profound desire of people, whose demands are simply to have variety in their choice. This is resulting in faucets of new value-added and differentiated products. The values that make-up the hair styles consist of mainly design (trend, preference), function(styling, management convenience) and clinic(hair quality improvement, damage repair). Shampoo and conditioner have gone beyond their original function of cleansing to providing combinational functions of treatment, to care and remedy, and advanced massage effectiveness. These are, to name a few that seem to go beyond their original function to satisfy the mental healthiness in people, the King Kong shampoo of shampooings in forward-backward manner, 5-minute shampoo massage that applies sports and relaxation massage, scalp acupunctural message and aural(ear) massage. More and more people are complaining about the damaged hair and hair loss problems due to perms, dyeing and bleaching of hair, in addition to natural scalp and hair damaging factors. Such complaints have stimulated many beauty products and various hair treatment systems being introduced with focus to provide nutrition and prevent damages to scalp and hair. As the living standards improve and the desire of people is to pursue differentiated lives, their demand also increases in hair styling products to fulfill the needs of healthy and aesthetical aspects of their lives.

• Journal of Preventive Medicine and Public Health
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• 제9권1호
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• pp.109-116
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• 1976

Reorganization of myun health care service is one of the main issues in health care delivery in rural Korea. The fundamenta, concept of the role and function of the myun health subcenter is that it is the basic unit of rural health care service and is to provide comprehensive health care service through the integration of curative and preventive services. The aim of this study is to analyze the patterns of curative activities in the myun health subcenter in terms of the most prevalent types of diseases, necessary diagnostic methods and required equipment, types of treatment, necessary drugs and materials, and finally the cost of curative services. The population on which this study was done was the 1596 patients who visited the two myun health subcenters (Sunwon Myun and Naega Myun) in Kang Wha County, the area of the Yonsei University Community Health Teaching Project, during period from May 1, 1975 to June 10, 1976. For the patient's record in the clinic, problem oriented medical records were used. Decisions regarding the disease classification, the diagnostic methods used and selection of the most appropriate and adequate medical treatment were made by a group of three experienced physicians after reviewing the medical records which had been written by public physicians who were treating patients in the study area. The records were reviewed by resident staff members of the Department of Preventive Medicine, of Yonsei University College of Medicine. A brief summary of results of the study is as follow: 1. 29.9% of the patients who visited the clinics were ages between 0-4. No sex difference was observed among patients less than 20 years of age. However, among patients over 20 years old, females predominated. Thus it is evident that the majority of patients were either children or mothers and grandmothers. 2. The distance from the individual villages to the myun health subcenter was one of important factors in determining the ratio of clinic visits. However, other factors such as the activities of the health workers also affected the rates substantially. 3. The most common 25 diseases comprised 90.2% of all the diseases recorded. Acute respiratory infection (25.5%), Skin (12.7%) , diarrheal diseases (6.8%), neuralgia and back pain (4.9%) and. all other injuries (3.9%) were the five most common diseases. 4. Of all the diseases diagnosed and treated, 9.2% required simple laboratory tests for diagnosis, 6.5% required X-ray examination, and altogether 13.6% required either laboratory test or X-ray examination. 5. Treatment and management of 42.0% of the cases could be accomplished with simple, inexpensive drugs, 12.8% required the use of more expensive drugs (mostly antibiotics) and injections were required in 19.7% of the cases. Minor surgery and referral were necessary in 5% of the cases. 6. The cost for diagnosis and treatment was estimated with a standard which was set by general concensus. The average cost of diagnosis was 144 per case and the cost of treatment was 726 per case, The Total average cost per visit was 870.