• 제목/요약/키워드: injury severity

검색결과 615건 처리시간 0.031초

병상에서 장기간 방치 된 뇌성마비 환자 : 증례보고 (A LONG-TERM NEGLECTED BED PATIENT WITH CEREBRAL PALSY : A CASE REPORT)

  • 김도영;양연미;김재곤;이대우
    • 대한장애인치과학회지
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    • 제13권1호
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    • pp.33-36
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    • 2017
  • 뇌성마비 환자들은 식이자세와 잇솔질에 대해 스스로 행동할 수 없기 때문에 의과적 치과적인 문제에 더 취약할 수 밖에 없다. 낮은 사회경제적 지위와 심각한 운동장애를 가진 뇌성마비 환자들은 특히 치과치료에서 소외되기 쉽다. 의과적 치료와 함께 구강관리는 뇌성마비 환자들의 삶의 질에 매우 중요한 관련이 있다. 그러므로, 장애인들의 삶의 질을 향상시키고 의료혜택으로부터 소외되지 않도록 정기적인 검진과 예방치료를 받기 위해서는 국가차원에서 공공의료서비스 및 시스템이 필요하다.

Surgical indication analysis according to bony defect size in pediatric orbital wall fractures

  • Kim, Seung Hyun;Choi, Jun Ho;Hwang, Jae Ha;Kim, Kwang Seog;Lee, Sam Yong
    • 대한두개안면성형외과학회지
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    • 제21권5호
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    • pp.276-282
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    • 2020
  • Background: Orbital fractures are the most common pediatric facial fractures. Treatment is conservative due to the anatomical differences that make children more resilient to severe displacement or orbital volume change than adults. Although rarely, extensive fractures may result in enophthalmos, causing cosmetic problems. We aimed to establish criteria for extensive fractures that may result in enophthalmos. Methods: We retrospectively reviewed the charts of patients aged 0-15 years diagnosed with orbital fractures in our hospital from January 2010 to February 2019. Computed tomography images were used to classify the fractures into linear, trapdoor, and open-door types, and to estimate the defect size. Data on enophthalmos severity (Hertel exophthalmometry results) and fracture pattern and size at the time of injury were obtained from patients who did not undergo surgery during the follow-up and were used to identify the surgical indications for pediatric orbital fractures. Results: A total of 305 pediatric patients with pure orbital fractures were included-257 males (84.3%), 48 females (15.7%); mean age, 12.01±2.99 years. The defect size (p=0.002) and fracture type (p=0.017) were identified as the variables affecting the enophthalmometric difference between the eyes of non-operated patients. In the linear regression analysis, the variable affecting the fracture size was open-door type fracture (p<0.001). Pearson's correlation analysis demonstrated a positive correlation between the enophthalmometric difference and the bony defect size (p=0.003). Using receiver operating characteristic curve analysis, a cutoff value of 1.81 ㎠ was obtained (sensitivity, 0.543; specificity, 0.724; p=0.002). Conclusion: The incidence of enophthalmos in pediatric pure orbital fractures was found to increase with fracture size, with an even higher incidence when open-door type fracture was a cofactor. In clinical settings, pediatric orbital fractures larger than 1.81 ㎠ may be considered as extensive fractures that can result in enophthalmos and consequent cosmetic problems.

Helicobacter pylori의 in vivo 연구를 위한 ethanol-pretreating animal model의 개발 (Establishment of ethanol-pretreating animal model to study Helicobacter pylori infection)

  • 이진욱;김승희;박탄우;김옥진
    • 대한수의학회지
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    • 제46권4호
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    • pp.327-335
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    • 2006
  • A stable and reliable Helicobacter pylori (H. pylori) infection animal model would be necessary for evaluating vaccine efficacy and helpful for understanding the pathological mechanism of the organism. The aim of the present study is to investigate the effect of ethanol treatment prior to H. pylori inoculation on associated gastric mucosal injury and to establish ethanol-pretreating animal model to study H. pylori infection. Male Mongolian gerbils were used for the study. H. pylori was orally inoculated after 12 h fasting. 3 h prior to H. pylori inoculation, a group of gerbils was orally treated with absolute ethanol, 60% and 40% ethanol respectively. Another group of animals was treated either with H. pylori culture media alone or with different concentrations of ethanol plus culture media. Gerbils were killed 4 or 8 weeks after H. pylori inoculation. The colonization of H. pylori was confirmed by both histological examination and rapid urease test. Mucosal damage was evaluated grossly and histologically according to the criteria. The colonization of H. pylori and pathological changes in gastric mucosa of the animals were also observed. Although no significant change to the gastric mucose was observed in the animals treated either with H. pylori culture media alone or with different concentrations of ethanol plus culture media, persistent H. pylori infection was seen in the mucosa and mucosal leucocyte infiltration and severe epithelial damage was observed in the Helicobacter and ethanol + Helicobacter groups after 4 weeks. The gross and histological scores were higher in the ethanol + Helicobacter than in the Helicobacter alone group. As the results, ethanol-pretreatment with 60% concentration induced severe pathogenic changes by H. pylori infection in 5 weeks-old Mongolian gerbils. These results suggested that ethanol-pretreatment before H. pylori inoculation could increase the severity of gastric mucosal inflammation and enhance the colonization of H. pylori. The established ethanol-pretreating animal model would contribute to screen new drugs against H. pylori and be used as an useful tool for various animal experiments with H. pylori strains.

열다한소탕(熱多寒少湯)이 kainic acid에 의해 유발된 mouse의 해마체 손상에 미치는 영향 (Effects of Yuldahansotang after kainate administration in the mouse hippocampus area)

  • 김일환;김경요
    • 사상체질의학회지
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    • 제11권2호
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    • pp.283-299
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    • 1999
  • 1. 연구목적 kainic acid를 실험동물에 주입할 경우 간질발작을 일으키고 변연계 특히 해마체 부위에서 조직의 손상이 일어나게 되는데 이는 사람에 있어 측두엽성 간질에서 보이는 구조적 변화와 유사한 것이다. 본 실험은 신경독성 물질인 kainic acid로 마우스의 해마체에 손상을 유발하고 이 경우에 열다한소탕이 신경보호효과가 있는지의 여부를 알고자한 것이다. 2. 연구방법 kainic acid를 경구투여하고 열다한소탕을 3주일간 복용시키면서 각각 1, 2, 3일과 1주, 3주에 조직을 관찰하였다. 조직손상은 해마체의 CA1, CA3과 thalamus, amygdala 등에서 c-fos 와 DNA fragmentation의 출현 율로 지표를 삼았으며 광학현미경하에서 육안적 관찰을 병행하였다. 3. 결과 및 결론 kainic acid만을 투여한 대조 군에서는 실험 3주째에도 손상지표인 c-fos 와 DNA fragmentation이 발견되었으나 열다한소탕을 투여한 실험 군에서는 실험 약 3일 째부터 손상지표의 발현이 줄어 7일째에는 나타나지 않음을 알 수 있었다. 또한 현미경 하의 육안적 관찰에서도 실험초기 많은 손상을 보였던 신경세포가 2주일 후 어느 정도 회복되는 것을 볼 수 있었다. 이로써 열다한소탕이 kainic acid로 유발된 실험동물의 해마체손상에 대하여 신경세포 보호 효과 및 손상 억제 효과가 있음을 알 수 있었다.

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도시와 농촌에서 발생한 독사 교상 환자의 임상적 양상과 합병증 비교 연구 (A Comparative Study on the Clinical Features and Complications of Snake Bite Patients in Urban and Rural Areas)

  • 홍성준;이주환;최우익;진상찬;전재천
    • 농촌의학ㆍ지역보건
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    • 제45권3호
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    • pp.154-161
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    • 2020
  • 이 연구는 도시와 농촌에서 발생한 독사 교상환자의 임상적 특징과 합병증 발생의 차이를 비교하고자 시행하였다. 독사 교상으로 응급실에 내원한 18세 이상의 환자를 대상으로 2013년 1월부터 2019년 12월까지 7년간의 의무기록을 이용하여 조사하였다. 환자는 독사 교상이 발생한 지역에 따라 도시지역 그룹과 농촌지역 그룹으로 나누어 임상적 특성과 합병증을 비교하였다. 그 결과 전체 77명의 연구대상 중 44명(57.1%)이 농촌지역 그룹으로 조사되었다. 도시에서 발생한 독사 교상 환자보다 농촌지역 환자에서 평균 연령이 높았고, 중등도도 높았으며, 교상 장소에서 병원까지의 거리가 멀어 항뱀독소 치료를 포함한 응급처치 지연으로 급성 신기능 부전, 횡문근융해증, 혈액 응고 장애와 같은 합병증 발생이 많았다. 독사 교상에서 핵심이 되는 치료는 항뱀독소 치료로 교상 후 가능한 빨리 투여하는 것이 중요하다. 증상이 진행한 후에 항뱀독소를 투여할 경우, 초기투여 시보다 더 많은 양의 항뱀독소 투여가 필요하다. 농촌은 의료 취약 지역으로 의료 접근성이 떨어지고 고령의 비율이 높아 상대적으로 나쁜 예후를 나타낸다. 따라서 이러한 문제 해결을 위해서는 지방의 중소형 병원에서도 항뱀독소 이용이 가능하도록 해야 하며 그러지 못할 때는 빠르게 대형 병원으로의 이송이 필요하다.

천연물 항암제제 임상시험 평가지표 개발연구 (Study on Development of Assessment Guideline and Endpoints for Clinical Trial with Antitumor Natural Products)

  • 남궁미애;장유성;정승기;김진성;윤성우;장기영;유화승;정면우;이성호;김성훈
    • 동의생리병리학회지
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    • 제20권6호
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    • pp.1678-1727
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    • 2006
  • This study was perfromed to develop the assessment guideline and endpoints for clinical trial with anticancer herbal medicine. The botanical products used to humans for long time may be applied to phase 3 clinical trial after submitting the evidences for safety and efficacy of them or completion of basic requirement of phase 1 and phase 2 for safety confirmation and dose determination. Syndrome improvement was chiefly evaluated by Zubrod and karnofsky(%) methods. We suggest the general clinical trial assessment with botanical products, by following assessment points, that is, tumor size for 50 points, survival fate for 10 points, major syndromes for 40 points. It is recommendable that the each symptom of Qi deficiency syndrome, blood deficiency syndrome and Qi stagnation syndrome was allocated by assessment points, Similarly, the each symptom was given the assessment points according to the severity of symptom, for example, slight for 3 points, moderate for 2 points and severe for 1 point in hepatocelluar carcinoma and lung cancer. Then, the efficacy of botanical products was evaluated by the difference between pre-treatment and post-treatment. Asking the neoplastic patients of questionnaire on physical, emotional, cognitive, social and role subjects availability, three more syndromes (Fatigue, Pain and Nausea/Vomit), quality of life(QOL) will be evaluated by GLM statistics. In addition, in case of lung cancer, 13 questions will be asked by the EORTC QLQ-C13 forms. As the assessment of endpoints for efficacy to reduce side effects induced by chemotherapy and radiotherapy, the data of image scanning and hemato-urinalysis can be usefully applied on immune response, weight loss, indigestion, hemopoietic damage and injury of liver and kidney, while the changes of syndromes of side effect can be evaluated by differentiation methods of Qi and blood and five viscera. However, it is still necessary to determine the ratio between scientific analytical method and Oriental differentiation method as well as confirm the Oriental assessment endpoints by clinical trial. In addition, we suggest the continuous development of assessment endpoints on other carcinomas except of hepatocelluar carcinoma and lung cancer in future.

비외상센터에서 외상센터로의 전원이 예후에 미치는 영향 (Impact of interhospital transfer on outcomes for trauma patients: impact of direct versus non-direct transfer)

  • 양욱태;민문기;류지호;이대섭;이강호;신진욱;염석란;한상균
    • 대한응급의학회지
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    • 제29권5호
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    • pp.415-422
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    • 2018
  • Objective: This study compared the prognosis of patients who visited the trauma center directly (direct visit group) with those transferred from the non-trauma center (transferred group). Methods: The patients, who were 18 or older with Injury Severity Score of 15 or more in the trauma center at Busan, were studied from October 2015 to October 2016. To compare the treatment time between the direct visit and transferred group, first treatment time, final treatment time, and time to visit the trauma center were examined. To compare the prognosis, this study compared the 48-hour, 7-day, and in-hospital mortality rate as well as the duration of intensive care unit (ICU) and total hospital stay. To analyze the factors affecting the outcome of transferred group, the physician's level and procedures that had been performed at the non-trauma center were examined. Results: The mortality was similar in the direct visit and transferred group (48-hour 7.6% vs. 4.6%, P=0.111; 7-day 11.1% vs. 7.2%, P=0.89; and in-hospital 14.6% vs. 11.3%, P=0.214). The length of ICU and total hospital stay were similar in the two groups. The mortality was higher in the patients in the transferred group when using intubation, transfusion, and pressure intensifier. The intubated patients showed higher mortality according to logistic regression. Conclusion: The mortality, length of ICU, and hospital stay were similar but the time to visit the trauma center and the final treatment time were longer in transferred group. Stabilizing the patient at the near non-trauma center may be more helpful for some patients.

Multicenter survey of symptoms, work life, economic status, and quality of life of complex regional pain syndrome patients

  • Lee, Jaemoon;Lim, Yun Hee;Hong, Sung Jun;Jeong, Jae Hun;Choi, Hey Ran;Park, Sun Kyung;Kim, Jung Eun;Park, Eun Hi;Kim, Jae Hun
    • The Korean Journal of Pain
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    • 제34권3호
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    • pp.288-303
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    • 2021
  • Background: Complex regional pain syndrome (CRPS) is an intractable pain disease with various symptoms. Here, we investigated the disease status, work life, sleep problems, medical insurance, economic status, psychological problems, and quality of life (QOL) of CRPS patients. Methods: CRPS patients from 37 university hospitals in South Korea were surveyed. The survey questionnaire consisted of 24 questions on the following aspects of CRPS patients: sex, age, occupation, cause of injury, activities of daily living (ADL), pain severity, sleep disturbance, level of education, economic status, therapeutic effect, and suicidal ideation. Additionally, the abbreviated World Health Organization Quality of Life (WHOQOL-BREF) questionnaire, consisting of 26 questions, was used to identify the status of QOL. Results: A total of 251 patients completed the questionnaire. According to the survey, 54.2% patients could not perform ADL on their own. Over the previous week, the mean pain score was 7.15 ± 1.78 (out of a total of 10 points); 92.1% of patients had sleep disorders and 80.5% had suicidal ideation, with most patients suffering from psychological problems. The average for each domain of WHOQOL-BREF was as follows: 21.74 ± 14.77 for physical, 25.22 ± 17.66 for psychological, 32.02 ± 22.36 for social relationship, and 30.69 ± 15.83 for environmental (out of a total of 100 points each). Occupation, ADL, sleep time, therapeutic effect, and suicidal ideation were statistically correlated with multiple domains. Conclusions: Most patients had moderate to severe pain, economic problems, limitations of their ADL, sleep problems, psychological problems, and a low QOL score.

마치현(馬齒莧)의 급성 췌장염 보호 효과 (Protective effects of Portulaca oleracea against cerulein-induced acute pancreatitis)

  • 곽태신;김동구;김주영;배기상;최선복;조일주;신준연;이성곤;김명진;김민준;송호준;박성주
    • 대한본초학회지
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    • 제29권3호
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    • pp.11-17
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    • 2014
  • Objective : Portulaca oleracea (PO) has been used as an important traditional medicine for inflammatory and bacterial diseases in East Asia. However, the protective effects of PO on acute pancreatitis (AP) is not well-known. Therefore, this study was performed to identify the anti-inflammatory and prophylactic effects of PO on cerulein-induced AP. Methods : AP was induced in mice via intraperitoneal injection of supramaximal concentrations of the stable cholecystokinin analogue cerulein ($50{\mu}g/kg$) given every hour for 6 times. Water extracts of PO (100, 300, or 500 mg/kg) was administrated intra-peritoneally 1 h prior to the first injection of cerulein. The mice were killed at 6 h after the final cerulein injection. Pancreas and lung were rapidly removed for morphologic and histochemical examination, myeloperoxidase (MPO) assay. Blood samples were taken to determine serum amylase and lipase activities. Results : Administration of PO significantly inhibited pancreatic weight/body weight ratio, pancreas and lung histological injury. And MPO activity which indicates neutrophil infiltration was inhibited by PO extracts on cerulein-induced pancreatitis. In addition, PO administration inhibited digestive enzymes such as serum amylase and lipase activity on cerulein-induced pancreatitis. Conclusion : Our results could suggest that pre-treatment of PO reduces the severity of cerulein-induced AP, thereby, PO could be used as a protective agent against AP. Also, this study could give a clinical basis that PO could be a drug or agent to prevent AP.

흉요추 압박골절 치료에 대한 한의복합치료 고찰: 후향적 관찰 연구 (A Review of Korean Medicine Treatment for Managing the Thoracolumbar Compression Fractures: A Retrospective Observational Study)

  • 조민진;이지윤;이명종;김호준;한경선
    • 한방재활의학과학회지
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    • 제33권4호
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    • pp.109-124
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    • 2023
  • Objectives This study aims to find out effect of Korean medicine treatment on managing thoracolumbar compression fractures through retrospective observational study. Methods Among hospitalized patients at the Department of Korean Medicine Rehabilitation from January 1st, 2018 to February 28th, 2023, a total of 24 inpatients who were diagnosed with thoracolumbar compression fractures and received Korean medicine treatment were included in this study. Numeric rating scale (NRS) was used for pain assessment and clinical variables such as sex, symptoms, age, thoracolumbar injury classification and severity (TLICS) scores were collected. For subgroup analysis to analyze factors affecting treatment response, we divided patients into responders and non-responders according to NRS change. For statistical analysis, we compared before/after hospitalization and analyzed distinct features between two groups. Results Most of the patients were in their 70s and 83.33% were female. Average hospitalization period was 24.54±11.91 days. All patients had back pain as their chief complaint and only 2 patients received surgeries. In TLICS, only 1 patient got score 6, which represented surgery indication. After Korean medicine treatment, NRS of almost every patient got lower significantly at the time of discharge (3.02±1.93) than admission (5.52±1.95). Comparing two groups, responders had lower NRS at the time of discharge and TLICS score of them were lower than non-responders. Conclusions Our results show that Korean medicine treatment for thoracolumbar compression fractures was effective in reducing pain. There were distinct clinical features such as age, past history, surgeries between those with significant improvement in pain scores and those who did not.