• Korean Journal of Social Welfare
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• v.60 no.1
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• pp.53-76
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• 2008

The aim of this study is to understand the ethical struggles of Child Protective Service(CPS) social workers and to indicate some implications for future studies by conducting research focusing on their ethical dilemmas and decision-making. This study used qualitative methods, in particular the phenomenological approach and 14 in-depth semi-structured interviews with CPS social workers, and were conducted and analyzed using the procedures of Colaizzi(1978). This study looks at the following research questions: 1) What kind of ethical dilemmas do CPS social workers encounter? This means what ethical dilemmas do they directly or indirectly encounter because of policy or system inadequacies and huge caseloads. 2) How do the CPS social workers make decisions when they are faced with ethical dilemmas? Making the best decisions with all of their responsibilities and burdens is the focus of this question. This study suggests the following discussions: First, efforts to emphasize 'ethics' at CPS are needed. Second, proper policies and systems based on the Korean situation are needed so that CPS social workers won't have to face 'needless' ethical dilemmas. Third, an index of ethical problems or ethical codes is necessary because principles are important to those social workers who face ethical dilemmas. Fourth, an ethical committee that protects the CPS social workers by supporting their decisions and being responsible for them is needed. Last, a debriefing system that reduces a CPS social worker's psychological trauma caused by ethical dilemmas should be available.

• Journal of Chest Surgery
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• v.31 no.10
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• pp.1004-1008
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• 1998

We report a case of heart-lung transplantation in a 32 year-old female with Eisenmenger syndrome secondary to patent ductus arteriosus. She has been suffered from congestive heart failure since June 1996 and repeatedly treated at Intensive Care Unit with intravenous inotropic support since July 1997. Preoperative echocardiography showed a patent ductus arteriosus with right to left shunt, severe regurgitation of tricuspid valve and estimated right ventricular systolic pressure of 100mmHg. The brain-dead donor was an 18 year-old male with head trauma from traffic accident 3 days ago. Heart-lung block procurement was performed at another general hospital and was transported to the Seoul National University Hospital by ambulance. Total ischemic time of the transplanted heart and lung were 249 minutes and 270 minutes, respectively. The immunosuppressive therapy was commenced preoperatively with cyclosporine and azathioprine. Corticosteroid was not used until postoperative 3 weeks in order to avoid infection and delayed healing at the tracheal anastomotic site. The patient was discharged at 31st postoperative day, and has been regularly followed up at outpatient clinic without specific complication. The follow-up bronchoscopy, performed 2 weeks and 4 months after surgery, revealed no evidence of cellular rejection.

• Neonatal Medicine
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• v.18 no.1
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• pp.14-22
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• 2011

Neonatal bleeding is a common problem encountered in nursery rooms or neonatal intensive care units, especially among premature infants. Furthermore, owing to recent remarkable improvement of neonatology, survival rates of preterm neonates have increased; hence, neonatal bleeding cannot be emphasized enough. Since the total blood volume of neonates is small, bleeding can be one of the causes of morbidities and mortalities. Therefore, rapid diagnosis and immediate therapy is urgently needed. The patient's medical history including a familial history of a bleeding disorder or of a previously affected infant who suffered from bleeding along with maternal and neonatal drugs can provide important diagnostic clues. Presence of bleeding with or without petechiae and ecchymoses in a healthy term or late preterm infant with thrombocytopenia but normal prothrombin time and activated partial thromboplastin time strongly suggests a congenital bleeding disorder. For a sick infant who is bleeding from multiple sites, an acquired disorder such as disseminated intravascular coagulation is suspected. Intracranial hemorrhage in term or late preterm infants without a history of birth trauma is highly suggestive of coagulation disorders. The purpose of this review is to summarize recent advances in diagnostic methods is as well as basic concepts of neonatal hemostatic disorders. First, an outline of background information will be presented followed by a discussion of primary and secondary hemostatic disorders as well as inherited and acquired disorders.

• Journal of Trauma and Injury
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• v.25 no.4
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• pp.196-202
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• 2012

Purpose: This study aimed to recognize the frequency of near-hanging patients with elevated Troponin-I (Tn-I), to obtain information necessary for treatment and prediction of prognosis by analyzing the clinical feature of near-hanging patients, and to evaluate the relevance of elevated Tn-I to abnormal result of other cardiac-related examinations. Methods: A retrospective review for the near-hanging patients, clinical record was conducted at two urban training hospitals between April, 2001 and December, 2011. We divided included patients into two groups, which one with elevated Tn-I level ($Tn-I{\geq}0.1ng/dL$) and one without it, and compared the differences in initial vital signs, cardiac enzyme tests, an electrocardiogram, echocardiography, chest X-ray, and the clinical outcomes. Results: A total of 39 patients were included, out of them, 14 patients showed rise in Tn-I level. The length of hospital stay and ICU hospitalization was more prolonged in the patient group with elevated Tn-I level than non-elevated group. As well as the incidence of endotracheal intubation and abnormal findings in echocardiography or chest X-ray was higher in the Tn-I elevated group, which is statistically significant. Conclusion: The rising of serum Tn-I level in near-hanging patients were not uncommonly observed. We believe that the cardiac-related test including Tn-I is necessary for near-hanging patients, and those who are shown abnormal result in cardiac-related test may need close observation and intensive care.

• Archives of Reconstructive Microsurgery
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• v.13 no.1
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• pp.43-50
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• 2004

One of the major advantages of microsurgical reconstruction for defects of the hand is that these techniques allow for selection of the most ideal tissue to reconstruct a particular defect, thus optimizing the functional and aesthetic outcome. The dorsalis pedis free flap is an excellent reconstructive tool for various hand reconstructions. It has a reliable vasculature with vessels that are relative large on a long pedicle. It provides thin pliable tissue and be innervated by deep peroneal nerve. Coupled with its thinness and pliability, it is ideal for innervated cover of critically sensitive area, especially such as the hand. Thus it can be used as a cutaneotendinous flap, or an osteocutaneous flap. Otherwise, the major criticism with this flap is related to its uncertain vascularity and the donor defect. It is the purpose of this paper to outline our technique of flap elevation and donor site closure and to indicate our current use of this flap in hand reconstruction. We have treated 10 cases (6 burn scar contracture cases, 4 acute hand trauma cases) of hand reconstruction from Dec. 3, 1997 to Mar. 4, 2004 using dorsalis pedis free flap. The key points for sucess in terms of a viable flap and acceptable donor site are the preservation of the critical dorsalis pedis-first dorsal metatarsal vascular axis and the creation of a viable bed for grafting. In addition, we substituted preserved superficial fat skin graft for split thickness skin graft and wet environment was offered for good graft take. Preserved superficial fat skin is defined as composite graft containing epidermis, dermis and superficial fat layer. With sufficient care in flap elevation and donor site closure, a good graft take of preserved superficial fat skin under wet environment can be achieved with no functional disability and minimal cosmetic deformity in donor site. This flap has proved itself to be a best choice for hand reconstruction.

• Journal of the korean academy of Pediatric Dentistry
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• v.38 no.1
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• pp.95-100
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• 2011

Fibrodysplasia ossificans progressiva(FOP) is characterized by episodes of permanent heterotopic ossifications of soft tissues throughout the body. FOP is inherited in an autosomal dominant pattern, but most cases result from new mutations in the ACVR1 gene. Even minimal trauma can cause permanent ossifications of soft tissues and give rise to complications following routine dental care. Dental block anesthesia, severe stretching of the jaw and biopsies are all contraindicated in children with FOP. There is no effective treatment. Since the prevalence of FOP is very low and most patients with FOP are misdiagnosed during childhood, they undergo dangerous and unnecessary treatment that can lead to permanent harm. For patients with FOP, early diagnosis and prevention of complications are most important. This study aims at contemplating the characteristic features and consideration factors for the dental treatment of FOP patients in relation to the case of an eight years-and-one month old boy who was referred to Pediatric Dentistry due to prolonged retention of mandibular right and left deciduous central incisors after being diagnosed with sporadic FOP at Pediatric Orthopaedics, Seoul National University Hospital, and received dental treatment without the exacerbation of the FOP symptoms.

• Journal of the Korean Home Economics Association
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• v.46 no.5
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• pp.97-109
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• 2008

Atopic dermatitis is the fastest growing skin disorder among children from infancy to adolescence in Korea. The side-effects of atopic dermatitis not only include physical discomfort, but also psychological trauma which ultimately affects the developmental growth of children. This study was conducted in order to investigate the behavioral characteristics of an atopic dermatitis sufferer. As part of this research, the relative influence of behavioral problems and, self-perceived competence were analyzed in relation to the social competence of an atopic child. In total, 301 atopic and non-atopic children, between 2 and 6 years of age, and their mothers and teachers participated in the study. From this number, 109 children had atopic dermatitis, while 192 children did not. Mothers were asked to complete a parent-report questionnaire that required information on parental stress, according to the scale parenting methodology of Abbdin(1990) and Cho(1999). Teachers were subjected to teacher-report questionnaires which included topics on social competence, socia-emotional assessment and behavioral problems of an atopic child. Furthermore, children also completed questionnaires on self-perceived competence. According to analysis on K-CBCL, ITSEA, social competence, self-perceived competence and parental stress, children with atopic dermatitis showed higher scores in depression/anxiety and depression/withdrawal, compared to children in the normal control group. In relation to parental stress, daily stress, parental role stress, and stress related disease, mothers with atopic dermatitis children exhibited higher scores. In establishing relationships among the related variables, atopic children who demonstrated more social competence were more likely to suffer less from withdrawal, attention problems, and depression/anxiety. Stress related disease in mothers with atopic children was positively related to attention problems of the child. In terms of relative influences, behavioral problems was the most significant variable, accounting for 23% of variance. Lower behavioral problems was positively related to more social competence. In summation, this study investigated the general characteristics of atopic children. In conclusion, atopic children and their mothers had difficulty in dealing with this disease. It is our belief that an atopic child would not only require physical treatment, but also need appropriate psychological care.

• Korean Journal of Biological Psychiatry
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• v.17 no.2
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• pp.94-102
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• 2010

Objectives : Eye movement desensitization and reprocessing(EMDR) is a novel, time-limited psychotherapy originally developed for treatment of psychological trauma. The effectiveness of this therapy has been validated only for posttraumatic stress disorder ; however, EMDR is often applied to other psychiatric illnesses, including other anxiety disorders and depression. This pilot study tested the efficacy of EMDR added to the routine treatment for individuals with acute stage schizophrenia. Methods : This study was conducted in the acute psychiatric care unit of a university-affiliated training hospital. Inpatients diagnosed with schizophrenia were randomly assigned to either three sessions of EMDR, three sessions of progressive muscle relaxation(PMR) therapy, or only treatment as usual(TAU). All the participants received concurrent typical treatments(TAU), including psychotropic medication, individual supportive psychotherapy and group activities in the psychiatric ward. The Positive and Negative Syndrome Scale(PANSS), the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale were administered by a clinical psychologist who was blinded to the patients' group assignment. Results : Forty-five patients enrolled and forty patients(89%) completed the post-treatment evaluation. There were no between-group differences in the withdrawal rates of patients during the treatment or at the three-month follow-up session. All three groups improved significantly across each of the symptomatic domains including schizophrenia, anxiety, and depressive symptoms. However, a repeated measures ANOVA revealed no significant differences among the groups over time. Effect size for change in total PANSS scores was also similar across treatment conditions, but effect size for negative symptoms was large for EMDR(0.60 for EMDR, 0.39 for PMR and 0.21 for TAU only). Conclusion : These findings supported the use of EMDR in treating the acute stage of schizophrenia but the results failed to confirm the effectiveness of the treatment over the two control conditions in three sessions. Further studies with longer courses of treatment, more focused target dimensions of treatment, and a sample of outpatients are necessary.

• Journal of Navigation and Port Research
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• v.42 no.1
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• pp.31-38
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• 2018

The purpose of this study is to contribute to the study of the prevention of diseases and promotion of health of ocean going vessel crew members, through the medical diagnosis and disease classification efforts of this study. From the second half of 2016 to 2017, the diagnosis and health characteristics of 195 crew members were collected through counseling, treatment, and emergency care for about 1 year and 2 months. As a result, it is noted that the incidence of diseases was in the order of urticaria (5.6%), lumbar sprain (4.1%), acute gastroenteritis (3.1%) and anxiety (3.1%). In categorical review, the incidence of musculo-skeletal disease was the most common (25.1%) which was followed by skin disease (17.9%) and digestive disease (11.3%). In addition, the disease that was noted as was the most common in the under 30 years old category, and the incidence of the disease was high in the crew group. Finally, there was a difference between the pathogenesis (trauma vs disease, etc.) (p <.001) and the type of vessel (merchant ship and fishing vessel) (p <.005) as noted in this case.

• Journal of Trauma and Injury
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• v.21 no.1
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• pp.22-27
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• 2008

Purpose: Treatment and prognosis in patients with pelvic bone fracture depend on the characteristics of the fracture and the stability of the pelvic ring. The purpose of this study is to analyze the characteristics of and the relationships between fracture patterns, injury mechanisms, clinical courses, and prognoses according to the hemodynamic pattern. Methods: Between January 2004 and September 2006, 89 patients under diagnosis of pelvic bone fracture were retrospectively analyzed on the basis of medical records and radiologic examinations. Patients with confirmed hemorragic shock with a systolic pressure of less than 90 mmHg were defined as the shock group. Young's classification was used to characterize fracture patterns. Factors relating to the clinical manifestation and to treatments such as transfusion and surgery were analytically compared. Results: The mean age of the patients was $48.8{\pm}18.7$, among which 49 (55.1%) were male. The numbers of shock and non-shock patients were 35 (39.3%) and 54 (60.7%) respectively. Eighteen (51.4%) of the shock patient had injuries resulting from pedestrian accidents (p=0.008). According to Young's classification, lateral impact fractures amounted to 20 and 33, front-rear impact fractures to 9 and 20, and multiple fractures to 6 and 1 among the shock and non-shock patients, respectively (p=0.027). Thirty-nine (39) cases in non-shock injuries were conservatively managed while 18 cases in shock injuries were surgically treated. In the shock group, the liver and the kidney were often damaged, as well. Among the shock patients, the average admission period was $7.5{\pm}8.7days$ in intensive care and $55.1{\pm}47.9days$ in total, which were longer than the corresponding numbers of days for the non-shock patients (p<0.05). No deaths occurred in the non-shock group while 5 deaths (14.2%) occurred in the shock group (p=0.007). Conclusion: The factors affecting hemodynamic instability in patients with pelvic bone fracture are injury mechanism, classification of fracture, and associated injuries.