• Archives of Plastic Surgery
• /
• 제47권6호
• /
• pp.613-618
• /
• 2020

The surgical treatment of extensive urethral strictures remains a controversial topic; although techniques have evolved, there is still no definite method of choice. Since 1968, when Orandi presented an original technique for one-stage urethroplasty using a penile skin flap, the Orandi technique has become the most prevalently used one-stage procedure for anterior urethral strictures. We present a 20-year follow-up experience with one-stage reconstruction of long urethral strictures using a longitudinal ventral tubed flap of penile skin, with some important technical changes to Orandi's original technique to overcome the deficient vascularity caused by periurethral scar tissue. In 1997, a 55-year-old male patient complained of severe voiding difficulty and a weak urinary stream because of transurethral resection of the prostate due to benign prostatic hyperplasia. Another 47-year-old male patient had the same problem due to self-removal of a Foley catheter in 2002. In both patients, a urethrogram demonstrated extensive strictures involving the long segment of the anterior urethra. A rectangular skin flap on the ventral surface of the penis was used considering the appropriate length, diameter, and depth of the neourethra. The modified Orandi flap provided a pedicled strip of penile skin measuring an average of 8 cm. The mean duration of follow-up was 20.5 years. A long-term evaluation revealed stable performance characteristics without any complications.

• 대한통합의학회지
• /
• 제11권2호
• /
• pp.37-47
• /
• 2023

Purpose : This study aimed to identify factors that influence selection of occupational therapy as a college major by freshmen. Methods : A survey was conducted on 308 freshmen majoring in occupational therapy from March 2022 to September 2022. The questionnaire consisted of five items about general characteristics, two about the choice of college and major, three about the timing of major selection, three about information acquisition, and one about the university application process. Results : While choosing a university, 37% of the students primarily considered the available choice of majors, whereas 41% considered the college application period. Employment rate was another important factor that was considered when choosing a department. Most students learned about occupational therapy through research on physical therapy and primarily gathered information by searching on "Naver and blogs." Among the descriptions of occupational therapy, the most interesting keyword was "hospital" (54 %). Conclusion : This study investigated the factors that influenced the college major selection by new students in the department of occupational therapy. This study provides meaningful basic data that can be referred to when promoting the department of occupational therapy. A limitation of this study is that a high percentage of students from Gyeongnam were included, and hence, further research that investigates according to region is needed. Moreover, detailed investigations on factors related to university applications in each region are required. It is also necessary to investigate the relationship between the characteristics of freshmen and the determining factors of the department and the admission process.

• 서비스연구
• /
• 제11권2호
• /
• pp.106-117
• /
• 2021

본 연구는 의료경영계열 대학생의 직업가치와 직업선택의도에 대해 알아보기 위하여 자가 보고식 설문 조사법을 이용한 서술적 조사 연구이다. 본 연구는 부산광역시에 소재하고 있는 4년제 대학교 3곳의 의료경영계열 대학생을 대상으로 조사하였다. 총 139부의 유효설문지를 통계분석 자료로 이용하였고, 본 연구에서 수집된 자료는 IBM SPSS statistics version 25.0 for windows를 이용하여 분석하였다. 분석결과, 직업가치가 병원 원무·행정직으로의 직업선택에 있어 사회헌신과 안정추구가 유의하게 나타났고, 직업가치가 의무기록사로의 직업선택에 있어 사회헌신과 안정추구가 유의하게 나타났다. 직업가치가 국제의료관광코디네이터로의 직업선택에 있어 인간관계중심과 체면유지, 안정추구가 유의하게 나타났다. 직업가치가 보건교육사로의 직업선택에 있어 사회헌신만 유의하게 나타났다. 일반적 특성에 따른 직업가치를 비교한 결과, 성별의 경우 지식추구와 사회헌신에서 차이가 있는 것으로 나타났다. 학년의 경우 사회헌신, 안정추구에서 차이가 있는 것으로 나타났다. 종교 유·무의 경우 유의한 차이가 없는 것으로 나타났다. 경제적 수준의 경우 경제우선만이 차이가 있는 것으로 나타났다. 의료경영계열 대학생을 대상으로 한 직업가치에 관한 연구가 많이 이루어지지 않았기 때문에 본 연구를 통해서 전문 의료경영인으로서 직업사회로의 첫발을 내딛기 위해 준비하는 의료경영계열 대학생들이 직업가치 인식의 필요성을 인식하고 직업선택에 있어 좀 더 나은 방향으로 갈 수 있도록 기초자료를 제시하고자 한다.

• Journal of Korean Neurosurgical Society
• /
• 제64권1호
• /
• pp.88-99
• /
• 2021

Objective : The treatment of choice for spinal epidural abscess (SEA) generally is urgent surgery in combination with intravenous antibiotic treatment. However, the optimal duration of antibiotic treatment has not been established to date, although 4-8 weeks is generally advised. Moreover, some researchers have reported that bacteremia is a risk factor for failure of antibiotic treatment in SEA. In this study, we investigated the clinical characteristics of SEA accompanied by bacteremia and also determined whether the conventional 4-8 weeks of antibiotic treatment is sufficient. Methods : We retrospectively reviewed the medical records and radiological data of 23 patients with bacterial SEA who underwent open surgery from March 2010 to April 2020. All patients had bacteremia preoperatively and underwent weeks of perioperative antibiotic treatments based on their identified organisms until all symptoms of infection disappeared. All patients underwent microbiological studies of peripheral blood, specimens from SEA and concomitant infections. The mean follow-up duration was 35.2 months, excluding three patients who died. Results : The male : female ratio was 15 : 8, and the mean age was 68.9 years. The SEA most commonly involved the lumbar spinal segment (73.9%), and the mean size was 2.9 vertebral body lengths. Mean time periods of 8.4 days and 16.6 days were required from admission to diagnosis and from admission to surgery, respectively. Concomitant infections more frequently resulted in delayed diagnosis (p=0.032), masking the symptoms of SEA. Methicillin-sensitive Staphylococcus aureus was the most commonly identified pathogen in both blood and surgical specimens. Seventeen patients (73.9%) showed no deficits at the final follow-up. The overall antibiotic treatment duration was a mean of 66.6 days, excluding three patients who died. This duration was longer than the conventionally advised 4-8 weeks (p=0.010), and psoas or paraspinal abscess required prolonged duration of antibiotic treatment (p=0.038). Conclusion : SEA accompanied by bacteremia required a longer duration (>8 weeks) of antibiotic treatment. In addition, the diagnosis was more frequently delayed in patients with concomitant infections. The duration of antibiotic treatment should be extended for SEA with bacteremia, and a high index of suspicion is mandatory for early diagnosis, especially in patients with concomitant infections.

• 대한임상독성학회지
• /
• 제3권1호
• /
• pp.27-32
• /
• 2005

Purpose: The frequency of carbon monoxide poisoning has been decreased in the interior of the Korea. But occasionally it is occurred and the risk of exposure is high in working place so far. Because of the characteristics of gas, the detection of exposure and poisoning could be delayed and fatality is high. We should apprehend of carbon monoxide poisoning. So we would report analysis of patients with carbon monoxide poisoning. Methods: A retrospective review of CO poisoned patients visited emergency department from January 2000 to December 2004 was conducted. Results: 24 patients were enrolled. Their average of age was $37.6\pm20.9$ years old and COHb was $19.4\pm13.32\%$. The blood level of initial COHb and mental status on arrival were not correlated each other. The blood level of initial COHb and loss of consciousness were not correlated, too. Initial electrocardiography (EKG) was not correlated with cardiac enzymes such as CK-MB and troponin I. But base excess was correlated with mental status on arrival and complication such as rhabdomyolysis. Hyperbaric oxygen therapy was correlated with base excess and mental status on arrival. Conclusion: The clinical features of carbon monoxide poisoning are nonspecific. For proper diagnosis, it is important that we should consider patient's environment and take patient's history carefully. The blood level of initial COHb does not reflect severity of poisoning accurately. So We should determine the treatment of choice depending on patient's status.

• Asian Pacific Journal of Cancer Prevention
• /
• 제13권5호
• /
• pp.2129-2132
• /
• 2012

Objective: To explore improved treatment by retrospectively comparing survival time of gemcitabine-based concurrent chemoradiotherapy (GemRT) versus chemotherapy (Gem) alone in patients with locally advanced pancreatic cancer (LAPC). Methods: From January 2005 to June 2010, 56 patients with LAPC from Subei People's Hospital were treated either with Gem (n=21) or GemRT (n=35). Gem consisted of 4-6 cycles gemcitabine alone (1000 mg/m2 on Days 1, 8, 15, 28-day a cycle). GemRT consisted of 50.4Gy/28F radiotherapy with concurrent 2 cycles of gemcitabine (1000 $mg/m^2$ on days of radiation 1, 8, 15, 21-day a cycle). Radiation was delivered to the gross tumor volume plus 1-1.5 cm by use of a three-dimensional conformal technique. The follow-up time was calculated from the time of diagnosis to the date of death or last contact. Kaplan-Meier methodology wes used to evaluate survival. Results: Patient characteristics were not significantly different between treatment groups. The disease control rate and the objective response rate of GemRT versus Gem was 97.1% vs 71.4%, 74.3% vs 38.1%. The overall survival (OS) was significantly better for GemRT compared to Gem (median 13 months versus 8 months; 51.4% versus 14.3% at 1 year, respectively). Conclusion: Radiation therapy at 50.4Gy with 2 concurrent cycles of gemcitabine results in favorable rates of OS. Concurrent chemoradiotherapy should be the first choice for patients with LAPC.

• Asian Pacific Journal of Cancer Prevention
• /
• 제15권5호
• /
• pp.2205-2210
• /
• 2014

Objective: To retrospectively review the clinical characteristics and analyze the prognostic factors of Chinese patients with pulmonary neuroendocrine tumors. Materials and Methods: The clinical data of 176 patients with pulmonary neuroendocrine tumors in Chinese PLA General Hospital from Mar., 2000 to Oct., 2012 were retrospectively analyzed. The parameters were evaluated by univariate and multivariate analysis, including the gender, age, smoking history, family history, TNM staging, localization (central or peripheral), tumor size, nodal status, histological subtype and treatment (operation or non-operation). Results: There were 23 patients with typical carcinoids (TC) (13.1%), 41 with atypical carcinoids (AC) (23.3%), 10 with large cell neuroendocrine carcinoma (LCNEC) (5.7%) and 102 with small cell lung cancer (SCLC) (57.9%). The median follow-up time was 64.5 months for AC, 38 months for LCNEC and 27 months for SCLC. The typical carcinoid censored data was 18 (more than 50% of the patients), so the median follow-up time was not obtained, and actuarial 5-year survivals for TC, AC, LCNEC and SCLC were 75.1%, 51.7%, 26.7% and 38.8%, respectively. COX univariate analysis revealed that the age (P=0.001), histological subtype (P=0.005), nodal status (P=0.000), treatment (P=0.000) and TNM staging (P=0.000) were the prognostic factors of the patients with pulmonary neuroendocrine tumors, whereas its multivariate analysis showed that only the age(P=0.001), TNM staging (P=0.002) and treatment (P=0.000) were independent prognostic factors. Conclusions: Radical surgery remains the treatment of choice, and is the only curative option. The age, TNM staging and treatment are confirmed to be the independent prognostic factors in multivariable models for pulmonary neuroendocrine tumors.

• 대한후두음성언어의학회지
• /
• 제32권2호
• /
• pp.51-55
• /
• 2021

There are several lasers available for office-based or suspension microlaryngoscopy laser procedures in the treatment of laryngeal diseases. Each has advantages and disadvantages given the depth of penetration per unit of power, absorption in water, spectral absorption characteristics, mode of delivery, safety, and cost. It is important to note that while the proper selection of indication of treatment based on a laser wavelength is critical, of equal importance is selecting the appropriate power setting, focal length (or spot size), and time of exposure. The photoangiolytic lasers precisely target hemoglobin within the microcirculation of the highly vascularized tissue and may have better hemostatic effects and preservation of surrounding normal tissue than the CO₂ laser. Although the choice of laser is purely theoretical and cannot be accurately concluded which parameters of laser (wattage and pulse width) were best to use, photoangiolytic laser surgery is safe and effective for specific laryngeal lesions. In this review, indications for photoangiolytic laser procedures for various laryngeal diseases, laser settings and surgical techniques for specific laryngeal lesions including sulcus vocalis, laryngeal dysplasia, and recurrent respiratory papillomatosis will be introduced. Pros and cons of in-office laser surgery using photoangiolytic laser and flexible CO₂ laser will also be addressed.

• 한국병원경영학회지
• /
• 제12권4호
• /
• pp.1-21
• /
• 2007

The relaxation of the regulation in selection of medical institution allows patients to use their own judgement in choosing proper institution for their diseases. Since the change of the regulation, there should have been many changes in medical institution selection behavior. The analysis of the change in disease specific selection pattern is critical because there be an optimal selection criteria that ensure the efficient and effective utilization of medical resources. This study analysis the institution selection factors by comparing the choice among the cases of acute diseases, the cases of chronic diseases, inpatient services, outpatient services, and emergency medical service. The comparisons performed in terms of size, class and other characteristics of medical institutions. For the study the nationally surveyed database was used and the data were analyzed using logistic regression procedure. The results indicates that the primary care facilities were not properly utilized. This study speculates that the reason for the undesirable pattern of utilization is that the roles of primary care facilities in the healthcare delivery system was not clearly defined. Based on the results, the medical policy implications are discussed.

• 대한족부족관절학회지
• /
• 제24권2호
• /
• pp.48-54
• /
• 2020

Osteochondral lesion of the talus (OLT) is a broad term used to describe an injury or abnormality of the talar articular cartilage and adjacent bone. Various terms are used to describe this clinical entity, including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. Several treatment options are available; the choice of treatment is based on the type and size of the defect and the treating clinician's preference. Arthroscopic microfracture (a bone marrow stimulation technique) is a common and effective surgical strategy in patients with small lesions or in those in whom non-operative treatment has failed. This study had the following aims: 1) to review the historical background, etiology, and classification systems of OLT; 2) to describe a systematic approach to arthroscopic bone marrow stimulation for OLT; and 3) to determine the characteristics that are useful for assessing osteochondral lesions, including age, size, type (chondral, subchondral, cystic), stability, displacement, location, and containment of the lesion.