• Childhood Kidney Diseases
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• v.17 no.2
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• pp.149-153
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• 2013

We report the case of a 14-year-old girl, diagnosed with atypical thrombotic microangiopathy (TMA). The patient presented with persistent fever, nausea, and newly developed peripheral edema. Her laboratory findings indicated chronic anemia with no evidence of hemolysis, thrombocytopenia, or elevated serum creatinine level. A few days after hospitalization, acute renal failure and fever worsened, and proteinuria developed. On day 40 of hospitalization, she experienced a generalized tonic seizure for 5 min, accompanied by renal hypertension. Brain magnetic resonance imaging revealed posterior reversible leukoencephalopathy syndrome. After steroid pulse therapy, a renal biopsy was performed because of delayed recovery from thrombocytopenia. The biopsy findings showed features of thrombotic microangiopathic hemolysis with fibrinoid change restricted. Current diagnostic criteria for TMA have focused on thrombotic thrombocytopenic purpura and hemolytic uremic syndrome, and diagnosis is based on the clinical presentation and etiology, with the consequence that idiopathic and atypical forms of TMA can be overlooked. Developing effective tools to diagnose TMA, such as studying levels of ADAMTS13 or testing for abnormalities in the complement system, will be the first step to improving patient outcomes.

• Journal of Yeungnam Medical Science
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• v.18 no.1
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• pp.51-58
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• 2001

Background: Cholestatic hepatitis is failure of bile to reach the duodenum with hepatocellular damage and no demonstable obstruction of the major bile ducts. The prognosis is usually good with recovery in less than 4 weeks after withdrawal of the offending drug. However, a prolonged course lasting over 3 months is possible and, in rare cases, progression to ductopenia with development of a vanishing bile duct syndrome occurs. A differential diagnosis with other causes of Chronic liver disease is needed. Materials and Methods: From January 1991 through January 2000, 14 patients diagnosed as cholestatic hepatitis by liver biopsy were included. The possible causative drug, clinical features, laboratory findings, and progression of cholestatic hepatitis were evaluated. The semiquantitative study of liver lesions was performed by two independent observers. Results: Causes of cholestatic hepatitis are 5 cases of oriental medicine, 3 cases of anti-tuberculosis medication, 1 case of ticlopidine and antibiotics and 4 cases of unknown causes. The clinical features of cholestatic hepatitis were jaundice, itching, urine color change, and general weakness. During 6 to 30 months, LFT of 5 patients showed prolonged elevation. Elevated total cholesterol ${\geq}$250 mg/dL in 6 patients, pheripheral blood eosinophilia in 5 patients, auto-antibody positive in 6 patients were observed respectively. The biopsies showed intralobular bilirubinostasis with a mixed portal inflammatory infiltration. Conclusion: In cholestatic hepatitis, durations of abnormal LFT are variable regardless of causative drugs. If cholestatic hepatitis progresses toward chronic course, viral hepatitis, primary biliary cirrhosis, and autoimmune hepatitis should be differentially diagnosed and sequential liver biopsies are needed.

• Journal of Korean Theatre Studies Association
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• no.52
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• pp.359-397
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• 2014

This paper describes dramatherapy with a bulmina nervosa patient. She was in her early 20s and has been under the various psychotherapies for cure of deep depression since 2005. We had 24 sessions and 3 persons - the patient, the therapist, and the assist-therapist- participated in dramatherapy. I found there's a big collision between her important roles in the course of initial interview and diagnosis. Those roles are 'a good daughter of mom' and 'an independent adult'. Therefore I defined her bulmina nervosa as 'an symbolic behavior repeats compulsively the failure of separation from her mother.' And I set the general goals, the separation from her mother, the awareness and expression of negative emotions, and the diminuation of overeating and vomiting. To attain these object, we had many different dramatic experiences in dramatherapy. We made a self-portrait, the mask of bulmina nervosa, family sculpture, figure work, the past I and the present I, psychodramatic scene and several stories. In order to objective assessment, I used behavioral observation and 6PSM(6 Pieces Story Making) analysis. First of all the most noticeable change was a rapid decrease in over-eating and vomiting. Before the dramatherapy she had overeaten 30 times per week. At the closure it has fallen off to 1 time per week. Another behavioral changes were shift of outward appearance, not going church, working for living, and having a date with only one. She made 3 stories on 1th session, 13th session, and 23th session. And I comparatively analysed those stories with both qualitative and quantitative method. For qualitative analysis, I classified 5 structures according to the substantial similrarity. On protagonist structure, there's no difference. Three protagonists are dead things. The type of task structure is changed from an escape, a traveling, to metamorphosis. The type of obstruction structure is changed from the protagonist to an outside object. The type of closure structure is changed from an exaggerated happy ending, sad ending to probable happy ending. To quantitify the aspects of transformation, I developed an assesment tool using likert scale. It is composed of 4 sub-categories-reality testing, imagination, ego-strength, optimism problem-solving. In reality testing category, a shift of score was 9-11-15, imagination 2-5-5, ego strength 3-2-2, optimism 6-3-7, and total score 20-21-29. This change of score reflects the growth of problem solving capacity. Viewed in this light, dramatherapy with this girl was successful on the whole. The thing had significant effect on it was psycho-dynamic approach focused on separation from her mother and defence mechanism to avoid negative emotion. And assessment method used in this case will be full of suggestions to researches to come.

• Journal of the Korean GEO-environmental Society
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• v.19 no.12
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• pp.41-46
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• 2018

The wireless sensor network system has the advantage of confirming the behavior of the entire facility by improving the disadvantages of conventional monitoring system. As a result, it is widely proposed as safety diagnosis and measurement of structures, water management systems, and management systems for dam structures. However, there is a lack of research that can evaluate the condition of facilities such as safety at the same time as monitoring. In this study, it is proposed a wireless sensor network system which can evaluate the behavior characteristics of facilities and evaluate the safety status for improving the technical disadvantages on conventional monitoring system. The geotechnical risk factors for the reservoir dam facility were evaluated and the limit values for the risk factors causing the failure of the facility were set. In other words, the system was set up so that the risk factors can be measured and the limit status can be evaluated immediately for each factor. In this study, numerical analysis is carried out for seepage and slope stability analysis using the typical cross section for reservoir dams. The stress-porewater coupling finite difference numerical analysis is performed for establishing the limit displacement for reservoir dam structures. It is developed a system that can estimate the time to reach the critical value by regression analysis using the measured datas.

• Tuberculosis and Respiratory Diseases
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• v.82 no.1
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• pp.81-85
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• 2019

Background: Bronchoscopy is a useful diagnostic and therapeutic tool. However, the clinical use of high-flow nasal cannula (HFNC) in adults with acute respiratory failure for diagnostic and invasive procedures has not been well evaluated. We present our experiences of well-tolerated diagnostic bronchoscopy as well as cases of improved saturation in hypoxaemic patients after a therapeutic bronchoscopic procedure. Methods: We retrospectively reviewed data of hypoxaemic patients who had undergone bronchoscopy for diagnostic or therapeutic purposes from October 2015 to February 2017. Results: Ten patients (44-75 years of age) were enrolled. The clinical purposes of bronchoscopy were for diagnosis in seven patients and for intervention in three patients. For the diagnoses, we performed bronchoalveolar lavage in six patients. One patient underwent endobronchial ultrasonography with transbronchial needle aspiration of a lymph node to investigate tumour involvement. Patients who underwent bronchoscopy for therapeutic interventions had endobronchial mass or blood clot removal with cryotherapy for bleeding control. The mean saturation ($SpO_2$) of pre-bronchoscopy in room air was 84.1%. The lowest and highest mean saturation with HFNC during the procedure was 95% and 99.4, respectively. The mean saturation in room air post-bronchoscopy was 87.4%, which was 3.3% higher than the mean room air $SpO_2$ pre-bronchoscopy. Seven patients with diagnostic bronchoscopy had no hypoxic event. Three patients with interventional bronchoscopy showed improvement in saturation after the procedure. Bronchoscopy was well tolerated in all 10 cases. Conclusion: This study suggests that the use of HFNC in hypoxaemic patients during diagnostic and therapeutic bronchoscopy procedures has clinical effectiveness.

• Journal of The Korean Society of Inherited Metabolic disease
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• v.21 no.1
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• pp.22-27
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• 2021

Propionic acidemia (PA) is an inherited autosomal recessive disorder, due to the deficiency of propionyl-CoA carboxylase (PCC). PCC is the enzyme which catalyzes the conversion of propionyl-CoA to D-methylmalonyl-CoA, and it is critical for the metabolism of amino acids, odd-chain fatty acids, and side chains of cholesterol. The clinical manifestations present mostly at the neonatal period with life-threatening metabolic acidosis and hyperammonemia. Here, we described a case of a 16-year-old Korean boy with late-onset PA who presented with embolic cerebral infarction due to dilated cardiomyopathy (DCMP) with left ventricular noncompaction. And he has family history of sudden cardiac death, so we performed metabolic screening and genetic tests. Elevated levels of 3-hydroxypropionic acid, methylcitric acid and propionylglycerine were detected in urine. Plasma acylcarnitine profile showed elevated propionylcarnitine (C3). Diagnosis of PA was confirmed by genetic analysis, which revealed compound heterozygous mutations, c.[1151T>G] (p.[Phe384Cys]) and c.[1228C>T] (p.[Arg410Trp]) in PCCB gene. His heart function is in improving state and the results of biochemical analysis are stable with heart failure medication and metabolic managements. We present a case of patient without episodes of metabolic decompensation who manifests DCMP as the first symptom of PA.

• Korean Journal of Clinical Laboratory Science
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• v.55 no.3
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• pp.159-166
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• 2023

This study investigates the current situation of medical technologists for blood collection, which is considered the most important step for diagnosis. The survey enrolled 650 medical technologists working in hospitals and medical check centers in Busan, Ulsan, and Gyeongnam. We found that each medical technologist performed blood collection for about 100 patients. There was more than one blood collection failure per day, with more than one case of pain and filing of civil complaints per year. Hence, there was a high work burden on the medical technologists. Cases where a medical technologist was stabbed with a used needle occurred more than once a year, and about 15% of them received infection control and treatment because of stab wounds. Additionally, more than half of the participants suffered from musculoskeletal disorders and mental stress due to blood collection work. Unlike administering intravenous and intramuscular injections using the same needle, no fee is charged for blood collection. Based on the results of this study, it will be possible to improve the safety and rights of medical technologists by calculating the actual fee for blood collection work and assigning a relative value score.

• Tuberculosis and Respiratory Diseases
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• v.86 no.2
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• pp.133-141
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• 2023

Background: The present study evaluated the association between participation in a rehabilitation program during a hospital stay and 1-year survival of patients requiring at least 21 days of mechanical ventilation (prolonged mechanical ventilation [PMV]) with various respiratory diseases as their main diagnoses that led to mechanical ventilation. Methods: Retrospective data of 105 patients (71.4% male, mean age 70.1±11.3 years) who received PMV in the past 5 years were analyzed. Rehabilitation included physiotherapy, physical rehabilitation, and dysphagia treatment program that was individually provided by physiatrists. Results: The main diagnosis leading to mechanical ventilation was pneumonia (n=101, 96.2%) and the 1-year survival rate was 33.3% (n=35). One-year survivors had lower Acute Physiology and Chronic Health Evaluation (APACHE) II score (20.2±5.8 vs. 24.2±7.5, p=0.006) and Sequential Organ Failure Assessment score (6.7±5.6 vs. 8.5±2.7, p=0.001) on the day of intubation than non-survivors. More survivors participated in a rehabilitation program during their hospital stays (88.6% vs. 57.1%, p=0.001). The rehabilitation program was an independent factor for 1-year survival based on the Cox proportional hazard model (hazard ratio, 3.513; 95% confidence interval, 1.785 to 6.930; p<0.001) in patients with APACHE II scores ≤23 (a cutoff value based on Youden's index). Conclusion: Our study showed that participation in a rehabilitation program during hospital stay was associated with an improvement of 1-year survival of PMV patients who had less severe illness on the day of intubation.

• Journal of the Korea institute for structural maintenance and inspection
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• v.28 no.2
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• pp.1-8
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• 2024

The expansion joint is installed to offset the expansion of the superstructure and must ensure sufficient gap during its service life. In detailed guideline of safety inspection and precise safety diagnosis for bridge, damage due to lack or excessive gap is specified, but there are insufficient standards for determining the abnormal behavior of superstructures. In this study, a data-based maintenance was proposed by continuously monitoring the expansion-gap data of the same expansion joint. A total of 2,756 data were collected from 689 expansion joint, taking into account the effects of season. We have developed a method to evaluate changes in the expansion joint-gap that can analyze the thermal movement through four or more data at the same location, and classified the factors that affect the superstructure behavior and analyze the influence of each factor through deep learning and explainable artificial intelligence(AI). Abnormal behavior of the superstructure was classified into narrowing and functional failure through the expansion joint-gap evaluation graph. The influence factor analysis using deep learning and explainable AI is considered to be reliable because the results can be explained by the existing expansion gap calculation formula and bridge design.

• Korean Circulation Journal
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• v.53 no.12
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• pp.813-825
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• 2023

Background and Objectives: The prognostic implications of septic cardiomyopathy have not been clearly demonstrated. We evaluated serial changes in left ventricular (LV) and right ventricular (RV) function in patients with septic shock and their prognostic value on 7-day and in-hospital mortality. Methods: Transthoracic echocardiography was performed within 48 hours of the diagnosis of septic shock and 7 days after the initial evaluation. In addition to traditional echocardiographic parameters, LV and RV function was evaluated using global longitudinal strain (GLS), and tricuspid annular plane systolic excursion (TAPSE). Results: A total of 162 patients (men, 83, 51.5%; 70.7±13.4 years; Acute Physiology and Chronic Health Evaluation [APACHE] II, 30.6±9.2) were enrolled. Initial GLS and TAPSE were -14.9±5.2% and 16.9±5.5 mm, and improved in the follow-up evaluation (GLS, -17.6±4.9%; TAPSE, 19.2±5.4 mm). Seven-day and in-hospital mortality were 24 (14.9%) and 64 (39.8%). Seven-day mortality was significantly associated with initial GLS >-16% (odds ratio [OR], 14.066, 95% confidence interval [CI], 1.178-167.969, p=0.037) and APACHE II score (OR, 1.196, 95% CI, 1.047-1.365, p=0.008). The in-hospital mortality of 7-day survivors was associated with follow-up TAPSE <16 mm (OR, 10.109, 95% CI, 1.640-62.322, p=0.013) and Sequential Organ Failure Assessment score (OR, 1.340, 95% CI, 1.078-1.667, p=0.008). GLS was not associated with in-hospital mortality of 7-day survivors. Conclusions: Fluctuation of both ventricular function was common in septic shock. Seven-day mortality of patients with septic shock was related to GLS, whereas in-hospital mortality of 7-day survivors was related to TAPSE, not to GLS.