• Journal of Preventive Medicine and Public Health
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• 제26권3호
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• pp.400-411
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• 1993

The aim of this study is to analyze the variations among hospitals and hospital groups in resource use and procedures of diagnostic and therapeutic process, such as laboratory tests, radiologic examinations, tissue diagnosis, timing of surgery after admission, the time required for operation. The study was performed for five procedures including cesarean section (C/S), appendectomy, cholecystectomy, cataract extraction, and pediatric pneumonia. The 2,316 subjects were selected from medical insurance claims list, and from this list 413 cases were sampled for medical record review. The patterns of resource utilization and process of treatment were described according to hospitals and characteristics of hospital groups. The major results were as follows : 1. The numbers of laboratory and radiologic tests showed significant difference among hospitals and hospital groups. In case of hospital groups, we could find tendencies of more tests with increasing hospital bed size. 2. In general, the proportion of operative cases evaluated by tissue diagnosis postoperatively among all operations ranged from 28.3% to 100%. The proportion varied among hospital groups, of which general hospital A group(more than 15 specialty) showed the highest proportion. 3. Post-admission delay until operation and the time required for operative procedure were not invariable among hospitals and hospital groups. The duration of operation in tertiary hospitals was slightly shorter than general hospitals, with varying statistical significance. We could find that probably there were differences of quality among hospitals in some components of procedures, which suggested that the implementation of quality assurance activities would be mandatory. In this study, we simply described the patterns of resource utilization and some features of clinical process, with institution of the need for advanced studies with in-depth analyses for each component of diagnosis and treatment procedures.

• 생명과학회지
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• 제21권6호
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• pp.893-900
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• 2011

Prostatic acid phosphatase (PAP)는 전립선 암의 진단에 널리 사용되는 표지자로서 1935년 처음으로 동정되었고 인체 전립선에 가장 많이 존재하는 탈 인산화효소이다. PAP는 prostate epithelial cells에서 합성되는 전립선 특이적인 효소로서, 산성 환경에서 효소활성을 띠는 acid phosphatase 그룹에 속한다. PAP는 전립선액에 풍부히 존재하여 수정, 정자부족증, 만성통증의 감소에 관여한다. 그러나 가장 눈에 띄는 기능은 ERK1/2와 MAPK 경로에 관계된 HER-2와 PI3P의 탈 인산화를 유도하여 세포 성장 신호를 억제하고 전립선 암의 억제자로 작용하는 것이다. 최근 PAP DNA 백신을 이용하는 임상시험이 현재 진행 중이고, PAP를 이용한 immunotherapy를 통해 전립선 암을 치료하는 방법이 FDA의 승인을 받아 시행되고 있다. 이러한 PAP의 임상적 중요성에도 불구하고 현재까지 PAP의 분자적 조절기작에 대한 이해는 제한적이라 PAP에 대한 많은 연구가 필요한 실정이다. PAP는 NF-${\kappa}B$, TNF-${\alpha}$, IL-1 및 androgen과 androgen receptor에 의하여 promoter region이 조절된다고 알려졌다. 본 총설에서는 현재까지 밝혀진 PAP 유전자 및 단백질의 특징들과 더불어 전립선 암에서의 PAP의 기능, 발현 조절, 역할들을 종합하였다.

• 대한후두음성언어의학회지
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• 제23권1호
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• pp.48-51
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• 2012

Background and Objectives : Vocal fold cyst is generally treated by surgical resection, it has a difference with vocal fold polyp, treated by conservative management first. Decrease in mucosal waves is known as main diagnostic criteria of vocal fold cyst. Sometimes there is a difficulty for diffrential diagnosis between cyst and polyp only by endoscopic examination. The purpose of the study is to identify the objective features of vocal cyst and polyp on the basis of voice analysis for the proper differential diagnosis, especially at high pitched phonation. Materials and Method : The voice analysis was done in 15 focal fold cyst patients and 42 vocal fold polyp. Parameters of perceptual assessment, acoustic and aerodynamic measure, and voice range profile were compared between two groups. Results : Vocal fold cyst patients showed significantly reduced MPT by acoustic and aerodynamic analysis, narrowed frequency-range and low maximun frequency by voice range profile analysis compared with vocal fold polyp patient. Maximun frequency 381 Hz is established for cut off value, differential diagnosis between cyst and polyp (ROC analysis, sensitivity 60%, specificity 68%). Conclusion : Voice analysis is helpful for differential diagnosis between vocal fold cyst and polyp, especially there is a difficulty for distinguish cyst from polyp at clinical situation by endoscopic examination. The result of decreased maximum frequncy at vocal fold cyst supports incomplete high-pitched phonation and falsetto regester at vocal fold cyst patients due to decreased mucosal wave, compared with vocal fold polyp patients.

• Pediatric Infection and Vaccine
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• 제9권2호
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• pp.201-207
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• 2002

목 적 : 집단 생활을 하는 영유아에서 흔히 이환될 수 있는 세기관지염, 폐렴 등의 급성 하기도 감염증의 원인 바이러스를 규명하고 그 임상상을 분석하여 환자 진료에 도움을 주고자 하기 위함이다. 방 법 : 2001년 4월말에서 5월초에 걸쳐 모 해외 입양 기관에서 집단 생활을 하면서 호흡기 감염 증상을 보였던 영유아 30명 중 세기관지염 및 폐렴으로 입원 치료한 13명의 비인두 분비물을 채취한 후 서울대학교병원 바이러스 연구소에 의뢰하여 respiratory syncytial virus(이하 RSV), adenovirus, parainfluenza virus에 대한 배양 검사를 시행하였다. 결 과 : 1) 검사한 13명 중 4명에서 바이러스가 검출되어 바이러스 검출율은 30.7%였다. 이 중 RSV 단독 감염은 2명(15.4%), adenovirus 단독 감염 1명(7.7 %), RSV와 adenovirus 중복 감염이 1명(7.7%)였으며 parainfluenza virus는 없었다. 2) 원인 바이러스가 밝혀진 환아 4명은 모두 폐렴으로 진단되었다. 3) 환아의 연령 분포는 0~3개월이 9명, 4~12개월이 1명, 13~24개월이 2명이었으며, 25개월 이상이 1명이었다. 4) 입원 당시 주 증상은 발열(69%), 기침(100%), 빈 호흡(54%), 흉곽 함몰(69%), 수포음(85%), 천명음(15%)이었다. 5) 백혈구 수는 3명(23%), C-반응 단백은 6명(46 %)에서 10 이상으로 증가되었으며, 흉부 방사선 소견상 9명(69%)에서 폐 침윤을 보였다. 결 론 : 비록 대상 환아 중 30.7%에서만 호흡기 바이러스가 검출되었지만, 집단 생활을 하는 영유아에서 바이러스성 하기도 감염의 유행이 있었던 것으로 생각되며, 효율적인 치료법이 없는 현 시점에서는 병의 전염경로를 차단하는 격리 등의 예방 조치가 필요하다고 사료된다.

• Pediatric Infection and Vaccine
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• 제25권2호
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• pp.91-100
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• 2018

목적: 본 연구는 30일 이상 90일 미만의 발열이 있는 영아에서 경험적 항생제 사용에 미치는 요소를 조사하였다. 방법: 2010년 1월부터 2016년 12월까지 부산대학교 어린이병원에 발열이 있는 이전에 건강했던 영아를 대상으로 임상양상, 검사소견, 항생제 사용에 대해 의무기록을 후향적으로 분석하였다. 호흡기 바이러스는 다중 역전사 중합 연쇄반응검사로 검출하여 1-3일 후 보고되었고, enterovirus는 중합 연쇄반응검사로 검출하여 수시간 만에 보고되었다. 결과: 366명의 대상자 중 129명은 경험적 항생제를 사용하였고 237명은 경험적 항생제를 사용하지 않았다. 입원 전 발열기간이 긴 경우와 호흡기 증상이 있을 때, 아파보일 때, CRP 상승 시 경험적 항생제 사용이 많았다. 경험적 항생제를 사용하지 않은 환자의 재입원율이 낮았다. Enterovirus polymerase chain reaction (PCR)이 검출된 대부분의 환자는 경험적 항생제를 사용하지 않았다. Respiratory virus multiplex reverse transcriptase (RT)-PCR 결과는 경험적 항생제 사용에 차이를 보이지 않았다. 결론: 본 연구에서 respiratory virus multiplex RT-PCR은 항생제 처방에 영향을 주지 않았고 enterovirus PCR은 항생제 처방에 영향을 주었다. Respiratory virus multiplex RT-PCR 결과가 신속하게 보고된다면 항생제 사용에 영향을 줄 것이다.

• Journal of Trauma and Injury
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• 제23권2호
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• pp.163-169
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• 2010

Purpose: Spinal epidural hematoma (EDH) is a rare condition requiring an urgent diagnosis and management. We describe here the clinical features, magnetic resonance image (MRI) findings, and outcomes of surgery in six patients with spinal EDH. Methods: We retrospectively analyzed six patients who underwent surgery for spinal EDH between April 2004 and May 2010. Preoperative MRI findings within 48 hours of symptom occurrence were analyzed for cord compression, extent of EDH, and presence of vascular abnormalities. Pre- and postoperative neurological status was also assessed comparatively. Results: Our six patients consisted of three men and three women, with a mean age of 70 years (range: 54-88 years), who presented with the back pain or motor weakness. The mean follow-up period was 34 months (range: 2-72 months). Two patients had cardiovascular disease and were taking warfarin, but the others had no history of medical comorbidity. Those two patients taking warfarin had a history of trauma, another one experienced symptoms during a strenuous effort, and the others developed spontaneously. Before surgery, motor power was grade III in three patients, grade 0 in two patients, and normal in one patient. Preoperative MRI showed no vascular abnormalities except for the EDH in any patient. At the last follow-up, all those five patients with motor weakness showed neurological improvement compared to their preoperative status. There were no complications related to surgery. All six patients were able to ambulate with or without an assistive device. Conclusion: Spinal EDH can occur in patients without trauma, bleeding diathesis, or combined vascular pathology. The surgical outcomes of spinal EDH seem to be satisfactory, even in quadriplegic patients.

• 대한유전성대사질환학회지
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• 제2권1호
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• pp.77-79
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• 2002

The urea cycle, consisting of a series of six enzymatic reactions, plays key roles to prevent the accumulation of toxic nitrogenous compound and synthesize arginine de novo. Five well characterized diseases have been described, resulting from an enzymatic defect in the biosynthesis of one of the normally expressed enzyme. This presentation will focus on two representative diseases; ornithine transcarbamylase(OTC) deficiency and citrullinemia(argininosuccinate synthetase deficiency). OTC deficiency is one of the most common inborn error of urea cycle, which is inherited in X-linked manner. We identified 17 different mutations in 20 unrelated Korean patients with OTC deficiency; L9X, R26P, R26X, T44I, R92X, G100R, R141Q, G195R, M205T, H214Y, D249G, R277W, F281S, 853 del C, R320X, V323M and 10 bp del at nt. 796-805. These mutations occur at well conserved nucleotide sequences across species or CpG hot spot. The L9X and R26X lead to the disruption of leader sequences, required for directing mitochondrial localization of the OTC precursor. Their phenotypes are severe, and neonatal onset. The G100R, R277W and V323M mutations were uniquely identified in patients with late onset OTC deficiency. The other genotypes are associated with neonatal onset. Out of 20 patients with OTC deficiency, only 6 patients are alive; two were liver transplanted, and normal in growth and development at 2, 4 years after transplantation respectively. Citrullinemia is an autosomal recessive disease, caused by the mutations in the argininosuccinate synthetase(ASS) gene. We identified in 3 major mutations in 11 unrelated Korean patients with citrullinemia; G324S, $IVS6^{-2}$ A to G, and 67 bp ins at nt 1125-1126. Among these, the 67 base pair insertion mutation is novel. The allele frequency of each mutation is; G324S(45%), IVS6-2 A to G(32%), and 67 base pair insertion(14%). All patients are diagnosed at neonatal or infantile age. Interestingly, two patients presented with stroke like episode. Out of 11 patients, 5 patients died. Among 6 patients alive, one patient was successfully liver transplanted.

• 대한유전성대사질환학회지
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• 제15권1호
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• pp.49-54
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• 2015

다발성 골단이형성증은 비교적 흔한 골이형성증으로 소아기에 관절통과 관절 강직, 뒤뚱거리면 걸어가는 보행 및 일부에서 경한 저신장을 특징으로 하며 영상의학적 검사에서는 여러 관절에서 골단의 불규칙한 소견과 골화 지연을 보인다. 본 증례 환자는 임상적, 영상의학적으로 다발성 골단이형성증을 진단 할 수 있었으며 환자의 넓적다리 관절 영상 검사는 MATN3 유전자 변이를, 무릎 관절 영상 검사는 COMP 유전자 변이를 시사하였기에 MATN3과 COMP 유전자 변이에 대해 시퀀싱(sequencing)을 하였으나, 변이는 발견되지 않았다. 이후 엑솜시퀀싱(exomesequencing)을 시행하였으나, 기존에 다발성 골단이형성증과 관련이 있는 것으로 알려진 유전자에 대한 변이가 발견되지 않았다. 본 증례와 같이 임상적, 영상의학적으로 다발성 골단이형성증으로 진단가능 하였으나 분자유전학적으로 기존에 알려진 변이 유전자가 발견되지 않은 환자들을 위해 추가적인 연구가 필요할 것으로 보인다.

• 대한두경부종양학회지
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• 제14권2호
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• pp.220-227
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• 1998

The clinical and pathological features of 35 cases of anaplastic thyroid cancer were studied. These tumors occurred in 12 men and 23 women ranging in age from 19 to 83 years(mean age; 61.7 years). A rapidly enlarging thyroid mass was the most common presentation. The duration of the presence of mass varied from 20 days to 12 months with an average of 2.7 months. Systemic metastasis at the time of initial examination was found in 14 patients(40.0%) and the lung was the most common site of involvement. The overall rate of distant metastasis was about 65.7%. The tumors were subdivided morphologically into giant cell type of 10 cases, spindle cell type of 7 cases, epidermoid cell type of 1 cases, and mixed giant cell and spindle cell type of 5 cases. The mean survival period of 6 among 35 patients who had biopsy alone was 1.4 months. The 22 patients underwent the incomplete combined treatment modalities (palliative surgery with or without chemotherpy or radiation therapy) survived for a mean period of 3.0 months, among them, 7 patients who had surgery combined with chemotherapy and radiation therapy showed mean survival period of 3.7 months. The mean survival of 7 patients who had complete combined treatment modality(curative surgery combined with chemotherapy and hyperfractionated radiation therapy) was 6.6 months, only one patient survived for 21 months and one patient has been alive for 1 month after operation, and the others survived for a mean period of 4.8 months. So far, as of July 31, 1998, 34 patients among 35 were died(one has been survived for 1 month) despite the various treatment modalities, and the main cause of death were failure of local control and systemic metastasis. None of the various treatment modalities gave consistently favourable results. However, a combination of surgery, radiation therapy and chemotherapy seemed to have a slight positive effect on survival. Furthermore, the aggressive treatment modalities will be indicated only in the early diagnosed and minimal cases.

• 대한두경부종양학회지
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• 제19권2호
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• pp.127-132
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• 2003

Objectives: The best treatment for the malignant parotid tumor still remains to be defined, and a better knowledge about the tumor features that predict the treatment result is needed. The aim of this study is to evaluate the treatment outcomes and to suggest the optimal treatment modality for the parotid cancer. Materials and Methods: The clinicopathologic characteristics of 113 patients who were treated for parotid cancer from January 1990 to December 2002 were retrospectively analysed. Univalate analyses were performed to establish the prognostic influence of pateint age, gender, tumor size, histologic grade and lymph node metastasis. Results: The mean age was 46.4 years old (15-81 years) and. The male to female ratio was 1 : 1.1. The chief complaint was a palpable mass in 85%, pain was in 12.4% and facial nerve palsy was accompanied with 2.7%. The mean tumor size was 3.5cm in diameter. The most common malignant tumor was mucoepidermoid carcinoma (33.6%), followed by acinic cell carcinoma (15%), adenoid cystic carcinoma (11%), carcinoma expleomorhpic adenoma (11%), basal cell carcinoma (7%). The most common operative procedure was total parotidectomy (47.8%) and various types of cervical lymph node dissection were added in 69.9%. Postoperative radiotherapy was done in 61.1 %. Postoperative complications developed in 54 cases (47.8%), including 46 cases (40.7%) of facial nerve palsy and 9 cases (8%) of Frey's syndrome. Recurrences developed in 21 cases (18.6%) and deaths in 15 (13.3%). Cumulative survival at 5 year was 75.4%. Univariate analysis of clinical factors showed that histologic grade and positive cervical lymph node significantly influenced survival (p<0.05). Conclusion: These results suggests that the radical resection with lymph node dissection and postopertaive XRT would be necessary to improve the survival of the patients with high grade cancer or positive lymphnode metastasis.