• Journal of Chest Surgery
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• 제55권6호
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• pp.470-477
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• 2022

Background: Upfront surgery followed by systemic treatment is recommended to treat clinical stage I-IIA small cell lung cancer (SCLC), but data on the clinical outcomes are sparse. Thus, this study evaluated the stage migration and long-term prognosis of surgically treated clinical stage I-IIA SCLC. Methods: We retrospectively reviewed 49 patients with clinical stage I-IIA SCLC who underwent upfront surgery between 2000 and 2020. Additionally, we re-evaluated the TNM (tumor-node-metastasis) staging according to the eighth edition of the American Joint Committee on Cancer staging system for lung cancer. Results: The clinical stages of SCLC were cIA in 75.5%, cIB in 18.4%, and cIIA in 6.1% of patients. A preoperative histologic diagnosis was made in 65.3% of patients. Lobectomy and systematic lymph node dissection were performed in 77.6% and 83.7% of patients, respectively. The pathological stages were pI in 67.3%, pII in 24.5%, pIII in 4.1%, and pIV in 4.1% of patients. The concordance rate between clinical and pathological stages was 44.9%, and the upstaging rate was 49.0%. The 5-year overall survival (OS) rate was 67.8%. No significant difference in OS was found between stages pI and pII. However, the OS for stages pIII/IV was significantly worse than for stages pI/II (p<0.001). Conclusion: In clinical stage I-IIA SCLC, approximately half of the patients were pathologically upstaged, and OS was favorable after upfront surgery, particularly in pI/II patients. The poor prognosis of pIII/IV patients indicates the necessity of intensive preoperative pathologic mediastinal staging.

• 대한통합의학회지
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• 제10권1호
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• pp.27-38
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• 2022

Purpose : This study is aimed to develop and validate the clinical practice education program and clinical competence scale of occupational therapy student. Methods : The development of the clinical practice education program used the delphi technique method, which had a total of five steps. Based on the occupational therapist's job analysis, the first stage assessed the importance of 21 experts, and the second stage examined the importance of 19 new specialists to derive constitutive factors. In the third stage, in-depth interviews were conducted with three experts based on the derived factors, and in the fourth stage, the final clinical practice education program was derived. In the final stage, the details of the clinical training program were drawn up based on the themes and were reviewed by two experts. Structured and unstructured interviews were conducted with 43 job experts. Results : The expert survey through the delphi technique was conducted three times, and content analysis and descriptive statistics were conducted to examine the distribution of responses. The final 11 educational program topics and contents were derived. Topics are confirmation of client information, evaluation and intervention, cognitive therapy, spinal cord injury, brain injury, musculoskeletal disorders, pediatric occupational therapy, interventions in activities of daily living, driving rehabilitation, vocational rehabilitation, occupational therapy assessment tool, safety training and management. Conclusion : The clinical practice education program reduce the difference between school education and clinical education of occupational therapy student. Occupational therapy helps college student understand occupational therapy practices and improve the quality of clinical education. Through more research and supplementation of clinical practice education programs in the future, it is suggested that clinical practice education be successfully operated in various practice institutions and used as basic data for designing and evaluating useful educational models.

• 대한한의학회지
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• 제17권1호
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• pp.266-279
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• 1996

To complement and develop the Orient Medical Bian Zheng treatmemt(韓方辨證施治), I have observed and analysed 68 persons who have recieved medical treatment because of the epigastric pain. Considering and analysed the Clinical Diagnosis(臨床診斷) and Clinical Bian Zheng(臨床辨證), Clinical Diagnosis(臨床診斷) and Gastroscopic Bian Zheng(微觀辨證), Clinical Bian Zheng(臨床辨證) and Gastroscopic Bian Zheng(微觀辨證), case history, age and sex, I have obtained the conclusion as follows. 1. The frequency of epigastric pain according to the classfication of Clinical Bian Zheng(臨床辨證) most occured in Gi Che Zheng(氣滯證), then in Huh Han Zheng(虛寒證). and least in Wi Youl Zheng. 2. There is no clear connection between the Clinical Bian Zheng(臨床辨證) and Clinical Diagnosis(臨床診斷). 3. The frequency of the epigastric pain according to Gastroscopic Bian Zheng(微觀辨證), mainly occurred in Wi youl Type(胃熱型), Wi Rac Jac Sang Type(胃絡灼傷滯型)and then occurred in Wi Han Type(胃寒型), and least occurred in Wi Rac A Che Type(胃絡瘀滯型) 4. Having observed the relation between the Gastroscopicin Bian Zheng(微觀辨證), and Clinical Diagnosis(臨床診斷) as pathological process, I have obtained the result that Wi Youl type(胃熱型) and Wi Rac Jac Sang Type(胃絡灼傷型) mainly occurred in Erosive Gastritis and Superficial Gastritis at the early stage, and Wi Rac A Che Type(胃絡瘀滯型) occurred in the whole stage among the Wuperficial Gastritis, Atro pic Gastritis, and Erosive Gastritis, Gastric Cancer, and the Wi Han Type(胃寒型) mainly occurred in Atropic Gastritis at the later stage. 5. The relation between Clinical Bian Zheng(臨床辨證) and Gastroscopic Bian Zheng(微觀辨證) do not coincide. 6. Observing the relation between the Clinical Bian Zheng(臨床辨證) and case history, Gi Che Zheng(氣滯證), Huh Han Zheng(虛寒證), Wi Youl Zheng(胃熱證) were commonly seen in the early stage of the case history, and Eum Huh Zheng(陰虛證) and Houl A Zheng(血瘀證) were seen in every stage. 7. Observing the relation between the Clinical Bian Zheng(臨床辨證) and age, Gi Che Type(氣滯型) was mostly seen in the thirties and other Bian Zheng(辨證) was seen after the middle 8. Observing the relation between the Clinical Bian Zheng(臨床辨證) and sex, Gi Che Type(氣滯型) was seen at high ratio in both sexes. 9. Observing the relation between the Gastroscopic Bian Zheng(微觀辨證) and case history Wi Han Type(胃寒證), Wi Youl Type(胃熱型), Wi Rac Jac Sang Type(胃絡灼傷型) were seen in the early stage of the case history Wi Rac A Che Type(胃絡瘀滯型) was mostly seen in the later stage. 10. There was no clear connection between the Gastroscopic Bian Zheng(微觀辨證) and age, sex. Although the examples were not sufficient, recipe regarding the partial variation state of stomach mucos together with Orient Medical Bian Zheng(韓方辨證) treatment seems to be useful in the effective treatment of Bi wi(脾胃) disease besides the epigastric pain.

• Clinical and Experimental Pediatrics
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• 제56권8호
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• pp.323-326
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• 2013

Quality of life in addition to various medical problems in children with end-stage renal disease (ESRD) should be objectively assessed to accomplish normal growth and development during childhood. However, unfortunately, studies of quality of life (QoL) in children with ESRD have been not popular yet and there are only fewer suitable assessment tools compared with adults. Recently, disease-specific modules to evaluate QoL in children with chronic disease such as ESRD have been developed. This review was made to introduce these QoL instruments for children and help the clinical application of them.

• 대한한의학회지
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• 제22권3호
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• pp.42-50
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• 2001

Objectives : Dysphagia is common and severe problems of acute stroke determining the prognosis of stroke only second to mental change, and results in secondary fatal complications such as aspiration pneumonia, malnutrition, dehydration, etc. Therefore, we were to investigate the clinical characteristics of dysphagia accompanied by acute ischemic stroke. Methods : We selected subjects through clinical notes retrospectively, whose main problems included dysphagia resulted from acute stroke within 72 hours from onset who were admitted to the Internal Medicine Department of Wonkwang Oriental Medicine Hospital from Jan. 2000 to Apr. 2001. We assessed the severity of dysphagia from admission to discharge using a staging method : stage 0 is normal without dysphagia, stage 1 is nearly normal except for intermittent dysphagia, stage 2 is compensated abnormal swallowing requiring adjusted diets or delayed feeding time, stage 3 is uncompensated abnormal swallowing resulted in weight loss down to 10% of initial and daily aspiration, coughing, and vomiting, stage 4 is uncompensated abnormal swallowing resulting in weight loss beyond 10% and recommended for non-oral feeding, and stage 5 is 100% non-oral feeding by L-tube, or gastrostomy or NPO state. Results : Dysphagia was improved statistically significantly from the mean stage of $3.6{\pm}0.29$ on admission to $1.88{\pm}0.32$ on discharge (P<0.05). On average $7.1{\pm}1.48$ days were required for improving more than one stage level. As patients were older and the stage of dysphagia was worse on admission, severity of dysphagia was more difficult to improve (correlation coefficiency was 0.55 and 0.77 respectively, P<0.05). Aspiration pneumonia was complicated in 13 patients of the total 25 at mean dysphagia stage of $3.36{\pm}0.37$. However, any specific values such as lesion size, lesion site, sex, age, past history and NIH Stroke Scale on admission did not affect it (P>0.05). Conclusion : Clinical course of dysphagia was determined about I week from the onset. Aspiration pneumonia was mainly complicated during oral feeding periods. If there were no improvement of dysphagia over 2-3 weeks, then non-oral feeding such as Levin tube or gastrostomy must be considered.

• IMMUNE NETWORK
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• 제2권4호
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• pp.202-207
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• 2002

Background: Kawasaki disease is an acute febrile illness with systemic vasculitis which primarily affects children, We examined the production of leptin in plasma and gene expressions of CXC chemokines in peripheral blood mononuclear cells from patients with Kawasaki disease. Methods: Consecutive 39 samples from 13 patients according to the different clinical stages (acute, subacute, convalescent) of Kawasaki disease were collected. The plasma leptin levels according to clinical stages of Kawasaki disease were examined by ELISA and the expression of IP-10, Mig and IL-8 mRNAs in 39 samples (13 samples of each stage) from 13 cases were examined by RT-PCR. Results: There were not significant changes of plasma leptin levels according to the clinical stages of Kawasaki disease. The mean values of plasma leptin concentrations during each of the stages (n=13, p>0.05, pg/ml) were $335.8{\pm}549.0$ in acute, $358{\pm}347.6$ in subacute, and $443.6{\pm}645.9$ in convalescent stage. The mRNAs of IP-10, Mig, and IL-8 were expressed in 13/13 (100%), 2/13 (15%), 9/13 (69%) during acute stage, 13/13 (100%), 6/13 (46%), 13/13 (100%) during subacute stage, and 13/13 (100%), 4/13 (31%), 10/13 (77%) during the convalescent stage, respectively. In three patients, the production of leptin and expression of IP-10 mRNA were dramatically decreased according to the process of the clinical stages. In five patients with prominent cervical lymphadenopathy, the expression of IL-8 mRNA during the subacute stage was more elevated than the acute and convalescent stages. Conclusion: This data suggests that the production of leptin and the gene expressions of IP-10, Mig and IL-8 seem to have no significant correlation to the clinical stages of Kawasaki disease. However, expression patterns of IP-10, Mig and IL-8 mRNA may be related to the specific clinical manifestations, and the expression of IP-10 may also be correlated to leptin levels with pericardial involvement.

• 대한임상검사과학회지
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• 제39권3호
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• pp.264-270
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• 2007

Obstructive sleep apnea syndrome (OSAS) is defined by sleep apnea with decreased oxygen saturation, excessive snoring with daytime sleepiness, and frequent awakening during the night time sleep. The present study was performed to investigate how apnea-hypopnea, that possibly causes breathing disturbance during sleep, can affect sleep pattern in patients with OSAS. We included 115 patients (92 men, 23 women) who underwent a polysomnography from January 2006 to May 2007. As the frequency of sleep apnea-hypopnea increases, the proportion of non-rapid eye movement (REM) sleep (p<0.001), and stage I sleep (p<0.001) increased, while that of stage II sleep (p<0.001), stage III and IV sleep (p<0.01), and REM sleep (p<0.05) decreased. Furthermore, sleep apnea-hypopnea was closely correlated with REM sleep (r=0.314, p<0.001), stage I sleep (r=0.719, p<0.001), stage II sleep (p=-0.342, p<0.05), stage III and IV sleep (r=-0.414, p<0.001), and REM sleep (r=-0.342, p<0.05). Stage I sleep could account for the 51% of the variance of apnea-hyponea. Our study shows sleep apnea-hypopnea affects sleep pattern in pattern with OSAS significantly, and the change of stage I sleep is the most important factor in estimating the disturbance of sleep pattern.

• Journal of Chest Surgery
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• 제23권4호
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• pp.715-719
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• 1990

Thymoma is defined as a neoplasm of the epithelialreticular framework cells of the thymus. The treatment of choice and the prognosis for patients with thymoma are still controversial subjects due to lack of a uniform histological classification and standardized criteria for typing thymic tumors. Between June 1985 and May 1989, eight patients underwent thymomectomy at the Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center. A clinical analysis was performed and the following result was obtained. In histologic cell type, epithelial type was 2 cases, lymphocytic type 3 cases, and mixed type was 3 cases. The clinical stage was classified by Masaoka’s classification that Stage I was 4 cases, Stage II; 2 cases, Stage III; 2 cases and Stage IV was none. Myasthenia Gravis was associated with thymoma in 5 patients. In 8 patients, thymomectomy were performed. Adjuvant radiotherapy was performed in one patient with Stage I due to suspicious tumor remnant and in Stage II, III patients routinely. Combined chemotherapy was performed in one patient with Stage III due to local recurrence. We concluded that the most important prognostic factor of thymoma is extent of tumor invasion. And the presence of Myasthenia Gravis is no more prognostic factor. Surgical resection of thymoma is treatment of choice, If local invasion or distant dissemination is present, postoperative radiotherapy and /or combined chemotherapy is recommended.

• Journal of Chest Surgery
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• 제26권6호
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• pp.463-469
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• 1993

From May 1986 to May 1992, 72 patients were diagnosed and operated for primary lung cancer, among them 65 patients were clinically evaluated at the department of Thoracic & Cardiovascular Surgery, Masan Koryo General Hospital. 1. There were 52 males 13 females[M:F=4:1], and 5th, 6th decade of life[72%] was peak incidence. 2. The preoperative diagnosis and its positive rate were sputum cytology 35%, bronchoscopy 47%, pleural effusion cytology 80%, and pleural biopsy 50%. 3. The classification histologic types were squamous cell cancer 71%, adenocarcinoma 17%, undifferentiated cell carcinoma 4.6%, and staging classification were Stage I 31%, Stage II 22%, Stage IIIa 26%, and Stage IIIb 20%. 4. The operative methods were lobectomy 52%, pneumonectomy 36%, and open biopsy 12%, and operability was 89%, resectability was 88%. 5. The postoperative complications developed 13 patients[22%], and operative mortality was 5%. 6. The overall actuarial survival rate was 1year 70%, 2year 42%, 3year 32%, 4year 26%, and 5year 22%, according to Stage 5year survival rate was Stage I 37%, Stage II 22%, Stage IIIa 3year 12%, Stage IIIb 2year 23%. And according to operative method lobectomy 23%, pneumonectomy 19%.

• 한국응용과학기술학회지
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• 제38권4호
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• pp.1020-1028
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• 2021

본 연구는 종합병원에서 근무하는 초보간호사의 임상수행능력에 영향을 주는 요인을 알아보고자 실시하였다. 초보간호사 155명을 대상으로 2020년 9월 11일부터 9월 30일까지 설문조사 하였으며, 수집된 자료는 SPSS 프로그램을 이용하여 t-test, ANOVA, Scheffe test, Person's correlation coefficients, 다중회귀분석을 하였다. 월경곤란증은 2.77점, 임상수행능력은 3.44점 이었고 월경곤란증과 임상수행능력은 유의한 음의 상관관계를 보였다(r=-.226, p=.002). 임상수행능력에 유의한 영향을 준 것은 자율신경계 반응이고(𝛽=-.261, p= .001) 설명력은 22.1%였다. 따라서 초보간호사의 임상수행능력을 증진시키기 위해 월경곤란증의 자율신경계 반응 완화를 위한 중재 교육 프로그램이 필요하다.