• Clinical Endoscopy
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• 제56권4호
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• pp.391-408
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• 2023

With an aging population, the number of patients with difficulty in swallowing due to medical conditions is gradually increasing. In such cases, enteral nutrition is administered through a temporary nasogastric tube. However, the long-term use of a nasogastric tube leads to various complications and a decreased quality of life. Percutaneous endoscopic gastrostomy (PEG) is the percutaneous placement of a tube into the stomach that is aided endoscopically and may be an alternative to a nasogastric tube when enteral nutritional is required for four weeks or more. This paper is the first Korean clinical guideline for PEG developed jointly by the Korean College of Helicobacter and Upper Gastrointestinal Research and led by the Korean Society of Gastrointestinal Endoscopy. These guidelines aimed to provide physicians, including endoscopists, with the indications, use of prophylactic antibiotics, timing of enteric nutrition, tube placement methods, complications, replacement, and tube removal for PEG based on the currently available clinical evidence.

• Journal of Korean Dental Science
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• 제16권1호
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• pp.9-22
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• 2023

Xerostomia is defined as the subjective complaint of dry mouth with or without hyposalivation, which is insufficient salivary secretion from salivary gland. Xerostomia can lead to multiple oral symptoms such as dental caries, halitosis, burning mouth syndrome, and oral candidiasis, which can significantly impact the well-being of patients, especially in geriatric patients who may already have compromised health. Clinical findings of xerostomia include decreased salivary flow and alterations in salivary composition. These changes can lead to various oral health problems such as dental caries, periodontitis, swallowing and speaking difficulties, taste disturbances, halitosis, mucosal diseases, and burning mouth syndrome. Recognizing these clinical manifestations is essential for early diagnosis and appropriate management. Although several reasons and risk factors have been suggested for xerostomia such as aging, chemo-radiation therapy, systemic disease, and Sjögren's syndrome, the polypharmacy is recently highlighted especially in elderly patients. Understanding the etiology and risk factors associated with xerostomia is crucial for effective management. To manage xerostomia patients, a multidisciplinary guideline should be established beyond dental care. Through this literature review, we summarized consideration for diagnostic, therapeutic, nursing essentials for the clinical guideline. By addressing the underlying causes and implementing appropriate treatment strategies, healthcare professionals can improve the quality of life for individuals suffering from xerostomia.

• 한국치위생학회지
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• 제12권4호
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• pp.801-815
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• 2012

Objectives : To obtain necessary fundamental data for the development of oral health improvement programs for senior citizens in the manner of investigating the Status of their oral health. Methods : Data were collected from 346 senior citizens aged 65 years or older who had lived in Seoul and Gyeonggido province, Republic of Korea. This study was conducted for 3 months from April 2011 to June 2011. Excluding those obtained from 34 respondents who gave inadequate responses to given questions, the data from 312 respondents were analyzed. Results : 1. The number of senior citizens who chose 'Sometimes' to as an answer to the question about the self-perception of their own oral conditions such as mastication, swallowing, gingiva hemorrhage, dry mouth, and/or oral malodor was the largest. As an answer to the question about the presence of interpersonal avoidance, 'No' accounted for the largest proportion. The number of respondents choosing gingiva treatment regarding the perception of the necessity for medical interventions was the largest. 2. In regard to the knowledge of oral health care, the percentage of correct answers was the highest for 'I brush my tooth before each meal' ($0.69{\pm}0.156$), while the lowest percentage of correct answers was seen for 'Gingival diseases can be improved by medications' ($0.33{\pm}0.472$). Conclusions : Based upon the above mentioned results, the author conclude that developing relevant national programs and support policies at a national level as well as implementing proactive and systematic home-visiting oral health programs at the levels of local autonomous entities or communities will lead to significant improvements in senior citizens' oral health and QoL (quality of life).

• 한국의학물리학회지:의학물리
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• 제34권1호
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• pp.10-13
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• 2023

Patients with breast cancer can be positioned with their head turned to the contra lateral side or with their head straight during the radiation therapy treatment set-up. In our hospital, patients with locally advanced breast cancer who were receiving radiation therapy have experienced swallowing difficulty after 2 weeks of irradiation. In this pilot study, the impact of head position on reducing dysphagia occurrence was dosimetrically evaluated. Patients were divided into two groups viz., HT (head turned to the contra lateral side of the breast) and HS (head straight) with 10 members in each. Treatment planning was performed, and the dosimetric parameters such as Dmin, Dmax, Dmean, V₅, V₁₀, V₂₀, V₃₀, V₄₀, and V₅₀ of both groups were extracted from the dose volume histogram (DVH) of esophagus. The target coverage in the supraclavicular fossa (SCF) region was analyzed using D₉₅ and D₉₈; moreover, the dose heterogeneity was assessed with D₂ from the DVHs. The average values of the dose volume parameters were 27.6%, 58.6%, 35.4%, 19%, 13.8%, 14.1%, 11.8%, 8.4%, and 8.1% higher in the HT group compared with those in the HS group. Furthermore, for the SCF, the mean values of D₉₈, D₉₅, and D₂ were 42.4, 47.5, and 54 Gy, respectively, in the HS group and 38.9, 45.35, and 55.5 Gy, respectively, in the HT group. This pilot study attempts to give a solution for the poor quality of life of patients after breast radiotherapy due to dysphagia. The findings confirm that the head position could play a significant role in alleviating esophageal toxicity without compromising tumor control.

• 한국치위생학회지
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• 제24권3호
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• pp.229-242
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• 2024

Objectives: The purpose of this study was to explore and analyze experiences with home-visiting oral health education in vulnerable populations and to provide foundational data necessary for the development of preventive strategies for oral health promotion among these patients. Methods: Using a phenomenological research, in-depth interviews were conducted between August 29 and October 31, 2023 with 20 vulnerable individuals participating in the Home Visit Oral Health Education Program under the Gwangju+ Gwangsan Integrated Care Service project spearheaded by the Gwangju Medical Welfare Cooperative. Results: After analyzing the contents of the participants' experiences, 130 meaningful words and 14 subcategories were identified and categorized into five major themes. Participants expressed discomfort when chewing or swallowing food and felt burdened by visits to the dentist. Although they experienced considerable loneliness because they spent a significant amount of time alone, they enjoyed communicating through visitation care and expressed gratitude for receiving oral health education. Conclusions: Oral health education through home visits cam increase awareness of oral health management among vulnerable populations and serve as an important means of improving their quality of life.

• Archives of Plastic Surgery
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• 제37권5호
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• pp.607-612
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• 2010

Purpose: Maxillectomy for malignant tumor resection often leads to functional and aesthetic sequalae. Reconstruction following maxillectomy has been a challenging problem in the field of head and neck cancer surgery. In this article, we described three dimensional midface reconstructions using free flaps and their functional and aesthetic outcomes. Methods: We reconstructed 35 cases of maxillectomy defects using 9 radial forearm free flaps, 7 lattisimus dorsi musculocutaneous free flaps, 6 rectus abdominis musculocutaneous free flaps, 4 fibular osteocutaneous free flaps, and 9 anterolateral thigh free flaps, respectively. We classified post-maxillectomy defects by Brown's classification. 1 Articulation clarity was measured with picture consonant articulation test. Swallowing function was evaluated with the University of Washington quality-of-life Head and Neck questionnaire by 4 steps.2 Aesthetic outcomes were checked to compare preoperative with postoperative full face photographs by 5 medical doctors who did not involve in our operation. Results: The average articulation clarity was 92.4% (100-41.9%). 27 (81.9%) patients were able to eat an unrestricted diet. Aesthetic results were considered excellent in 18 patients (51.4%). Functional results were best in the group reconstructed with fibular osteocutaneous free flap. Considering the range of wide excision, aesthetic results is best in the group reconstructed with anterolateral thigh free flap. Conclusion: The free flap is a useful technique for the reconstruction of the midface leading to good results, both functionally and aesthetically. Especially, because osteocutaneous flap such as fibular osteocutaneous free flap offered bone source for osteointegrated implant, It produces the best functional results. And perforator flap like as anterolateral thigh free flap reliably provides the best aesthetic results, because it provides sufficient volume and has no postoperative volume diminution.

• 치위생과학회지
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• 제24권1호
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• pp.1-8
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• 2024

Background: Oral frailty is defined as the functional decline of the oral function due to aging, and it is associated with frailty and chronic disease. Most of the frailty intervention is for adults aged 65 years and older. However, early intervention for preventive disorder is most important. The objective of this study was to identify the age at which oral frailty surpass the "normal" range. Methods: This cross-sectional study included 719 adults (aged 30~89 years) residing in Gangwon province in May 2023. Risk of oral frailty was assessed using criteria from The Korean Academy of Geriatric Dentistry including oral function such as swallowing and mastication, and frailty. Frailty was assessed using the Kihon Checklist. To determine when oral frailty surpass the "normal" status, statistical analysis including chi-squared tests and multiple logistic regression analysis were performed using R (ver. 4.3.1). Results: There were 388 (54.0%) individuals who had a "normal" status risk of oral frailty. The risk of oral frailty was higher in the 50~54 age group compared to the 30~34 age group (odds ratio [OR] 0.50, 95% confidence interval [CI] 0.28~0.91), after adjusting for gender, education, income, occupation, and frailty (OR 0.46, 95% CI 0.22~0.94). This means that from 50~54 years old, regardless of gender, education, income, occupation, or frailty condition, there is a distinction from the "normal" status. Conclusion: We found that intervention for oral frailty is needed starting from age 50 years. This is the stage where early indications of oral frailty become apparent. Early intervention for oral frailty can lead to a decrease in the prevalence of diseases and medical expenditure. Therefore, early intervention in middle-aged adults of oral frailty is necessary to improve the quality of life related to oral health.

• Journal of Chest Surgery
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• 제39권12호
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• pp.920-926
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• 2006

배경: 식도-위 문합의 수술기법 향상과 술 후 관리기법의 발전은 문합부 누출, 폐렴 등의 위험한 조기 합병증을 감소시켰지만, 수술 후 환자의 삶의 질에 중요한 영향을 미치는 문합 부위의 협착 또는 위식도 역류에 의한 증상은 상대적으로 간과되고 있는 경향이 있다. 본 연구에서는 점차 중요시되고 있는 식도암 환자의 수술 후의 삶의 질과 관련하여 식도-위 문합부의 협착과 역류를 종합적으로 분석하여, 식도-위 문합술의 질적 평가를 시행하고 관련된 인자들에 대한 분석을 하고자 하였다. 대상 및 방법: 고려대학교 구로병원에서 1995년 1월부터 2004년 12월까지 식도 절제술 후 식도-위 문합술을 시행 받은 환자들 중, 외래 추적 기간 중 내시경을 시행 받은 53명을 대상으로 환자들의 병력, 수술 후 투약내용, 문합 위치, 문합 방법, 내시경 소견상 역류성 식도염의 존재 여부와 문합부 협착 유무 및 시행되어진 중재적 시술에 대해 조사하였다. 결과: 총 53명의 환자 중 남자 환자가 85%(n=45)였고, 수술 당시 연령은 $60.3{\pm}8.87$세($39{\sim}81$세)였다. 평균 추적관찰 기간은 $29{\pm}23.6$개월($5{\sim}111$)이었다. 식도-위 문합을 흡수성 봉합사로 시행한 경우가 23명이었고 EEA를 이용한 경우가 30명이었으며, 문합 방법에 따른 협착이나(p=0.64)이나 역류성 식도염의 빈도 차이는 없었다(p=0.41). 문합 위치가 경부인 경우는 26명, 흉부인 경우는 27명이었으며, 문합 위치에 따른 협착의 빈도는 차이가 없었으나(p=0.44), 역류성 식도염은 경부 문합 26명 중 3명(12%)에서만 발견되어 흉부 문합군(52%)에 비해 통계적으로 유의한 차이를 보였다(p<0.01). 결론: 식도-위 문합 시 경부 문합은 흉부 문합에 비해 문합부 협착의 빈도는 차이가 없고, 역류성 식도염의 빈도는 현저히 적으며, 식도암의 경우 더 여유 있는 절제면을 제공할 수 있는 장점이 있으리라 판단된다. 따라서 식도절제술 및 위-식도 문합 시 특별한 금기증에 해당하지 않는다면 경부 문합을 선호할 수 있을 것으로 생각된다. 문합 방법에 따른 역류성 식도염과 협착의 빈도에서는 유의한 차이를 발견할 수 없었으나, 수술 시간의 단축 등의 몇몇 장점으로 인해 기계 문합을 선호할 수 있을 것으로 생각된다. 향후 식도암의 수술 기법과 술 후 관리의 향상으로 인하여 문합 부위의 역류로 인한 증상과 환자의 일상 생활의 질에 대한 중요성이 지속적으로 강조될 것으로 생각되며, 이에 따른 적극적인 anti-reflux 수술에 대한 고려도 필요할 것으로 생각된다.

• 한국식품저장유통학회지
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• 제9권3호
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• pp.321-326
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• 2002

키토산이 백설기의 품질특성에 미치는 영향을 조사하기 위하여 0~0.5%의 키토산을 첨가한 백설기를 제조한 후 백설기의 저장성, 물성 및 관능적 품질특성을 조사하였다. 백설기의 pH는 대조구가 5.65이었으며 0.05~0.5%의 키토산 첨가군은 pH 7정도였다. 백설기의 색상은 멥쌀 100%인 대조군은 명도(L치) 84.28, 적색도(a치) -1.56, 황색도(b치) 7.68 이었으며, 키토산 첨가에 의해 명도, 적색도, 황색도가 모두 높아지는 경향이었다. Texture 측정결과, 백설기의 강도, 견고성, 검성, 부서짐성은 대조군에 비해 키토산 첨가군이 높았으며, 응집성과 탄성은 대조군이 가장 높았으나 키토산 첨가구와 유의적인 차이는 없었다. 관능검사 결과, 대조군의 기호도가 색상, 쫄깃한 정도, 삼킨 후의 느낌 및 종합평가에서 키토산 첨가구 보다 유의적으로 높았으며, 촉촉한 정도는 키토산 첨가구가 대조구보다 유의적으로 높은 기호도를 나타내었다(p<0.05). 키토산을 첨가하여 제조한 떡의 저장직전의 생균수는 4.2~9.2$\times$$10^2$CFU/g 이었으며 5$^{\circ}C$에 2주간 저장했을 때 대조구는 7.4$\times$$10^{5}$ CFU/g에 도달한 후, 2주동안 약 1 log cycle 감소하였다. 그러나 키토산을 첨가한 경우에는 키토산 첨가농도에 비례하여 세균의 증식이 억제되어 0.3%와 0.5% 첨가군은 저장말기의 생균수는 대조구보다 2 log cycle 낮은 생균수를 나타내었다. 그러나 키토산을 첨가한 백설기를 2$0^{\circ}C$에 1주일간 저장한 경우에는 $10^{8}$ CFU/g으로 증가하였으며 저장 말기에 0.5% 첨가군이 대조구보다 약 1 log cycle 낮은 생균수를 나타내었다. 키토산 첨가에 의한 떡의 저장성 향상은 5$^{\circ}C$에 저장했을 때 더욱 효과적이었다.다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제39권
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• pp.26.1-26.10
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• 2017

Background: The impairment of the appearance is a major problem for patients with carcinomas of the oral cavity. These patients want to recover their preoperative facial appearance. Some do not realize that this is not always possible and hence develop a desire for further cosmetic and reconstructive surgery (CRS) which often causes psychological problems. Method: The desire of patients for CRS (N = 410; 26%) has been acquired in this $D{\ddot{O}}SAK$ rehab study including multiple reasons such as medical, functional, aesthetic and psychosocial aspects. They relate to the parameters of diagnosis, treatment and postoperative rehabilitation. Patients without the wish for CRS (N = 1155; 74%) served as control group. For the surgeons, knowledge of the patient's views is relevant in the wish for CRS. Nevertheless, it has hardly been investigated for patients postoperatively to complete resection of oral cancer. In this retrospective cross-sectional study, questionnaires with 147 variables were completed during control appointments. Thirty-eight departments of Oral and Maxillofacial Surgery took part, and 1652 German patients at least 6 months after complete cancer resection answered the questions. Additionally, a physician's questionnaire (N = 1489) was available. Statistical analysis was performed with SPSS vers. 22. Results: The patient's assessment of their appearance and scarring are the most important criteria resulting in wishes for CRS. Furthermore, functional limitations such as eating/swallowing, pain of the facial muscles, numb regions in the operating field, dealing with the social environment, return to work, tumour size and location, removal and reconstruction are closely related. Conclusion: The wish for CRS depends on diverse functional psychosocial and psychological parameters. Hence, it has to be issued during conversation to improve rehabilitation. A decision on the medical treatment can be of greater satisfaction if the surgeon knows the patients' needs and is able to compare them with the medical capabilities. The informed consent between doctor and patient in regard to these findings is necessary.