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수술 후 성인 Fallot 4징 환자의 임상적 고찰 (Follow-up in Adult after Total Repair of Tetralogy of Fallot)

  • 장기영;김선영;문주령;허준;강이석;박승우;전태국;박표원;이흥재
    • Clinical and Experimental Pediatrics
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    • 제46권7호
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    • pp.661-667
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    • 2003
  • 목 적 : Fallot 4징 환자에 대한 수술 및 수술 후 집중 치료의 발달로 생존율이 향상되면서 교정 수술을 받은 Fallot 4징 환자의 연령이 점차 증가하였고, 이에 따라 장기 생존에 따른 여러가지 문제점들이 알려지게 되었다. 저자들은 완전 교정 수술을 받은 성인 Fallot 4징 환자에서 나타나는 주요 임상적인 문제점들을 알아보고자 하였다. 방 법 : 1994년 5월부터 2000년 7월까지 삼성서울병원 성인선천성심장병클리닉(GUCH Clinic)에 등록된 Fallot 4징 환자는 30명으로, 내원 당시 자연 생존자는 6명, 수술 후 생존자는 24명이었다, 이들중 본 조사 당시까지 완전 교정 수술을 받은 환자 28명을 대상으로 임상 기록, 심전도, 심장 초음파, 심도자 검사, 수술 기록 등을 후향적으로 조사하여 주요 임상 문제점을 알아보았다. 결 과 : 1) 본 조사 당시 평균 연령은 30.8세(16-53세)였고, 교정 수술시 나이는 15.8세(2-49세)였다. 남녀 비는 1.3 : 1이었다. 2) 완전 교정 수술 후 임상적으로 유의한 문제점들은 부정맥(11례), 폐동맥 역류(8례), 좌폐동맥 협착(6례), 잔존 심실 중격 결손(6례), 승모판막 역류(5례), 삼첨판막 역류(4례), 우심실 유출로 협착(3례), 우심실 유출로 낭성 확장(3례), 대동맥판막 역류(3례), 심내막염(1례) 및 단백 소실 장증(1례) 등이었다. 3) 부정맥이 있었던 환자군(Group I, 11명)과 부정맥이 없었던 군(group II, 17명)으로 나누어 비교하여 보았을 때, 수술 시 연령이 낮을수록 수술 후 부정맥이 적게 관찰되었고(P<0.05), 부정맥 군이 부정맥이 없었던 군에 비해 흉부 방사선 소견상 심.흉 비 0.55 이상의 심비대가 유의하게 많았다(P<0.05). 심전도에서 QRS폭이 넓을수록 심비대가 많았으며(P<0.05), 수술 후 심비대가 있는 군(심/흉 비>0.55)과 심비대가 없는 군으로 나누어 비교해 보았을 때는 심비대가 있는 군에서 QRS폭이 넓었고 (P<0.05), 의미 있는 폐동맥 역류와 삼첨판막 역류가 많이 관찰되었다(P<0.05). 4) 재수술은 총 28례 중 8례에서 시행되었다. 재수술의 원인으로, 잔존 심실 중격 결손만 있었던 경우가 3례, 우심실 유출로 협착이 동반된 잔존 심실 중격 결손이 1례, 우심실 유출로 협착과 폐동맥 역류가 동반된 잔존 심실 중격 결손이 1례, 우심실 유출로 협착, 감염성 심내막염으로 인한 삼첨판막 우종 및 잔존 심실 중격 결손이 1례, 좌폐동맥 협착이 1례, 우폐동맥 협착(추정)이 1례 있었다. 결 론 : Fallot 4징은 교정 수술 후 대부분의 환자가 별 문제없이 정상적인 생활이 가능하지만 본 조사에서처럼 여러 가지 문제점들-부정맥, 폐동맥 역류, 잔존 심실 중격 결손, 우심실 유출로 협착, 폐동맥분지 협착, 감염성 심내막염 등-이 발생할 수 있으므로 장기적인 예후를 좋게 하기 위해서는 정기적이고도 지속적인 관찰과 조기 교정이 필요하다고 생각된다.

시호계지탕(柴胡桂枝湯)으로 치료한 천일홍(千日紅) 과민 환자 1례 보고 (Case report about allergic patient from Gomphrena globosa and treated Sihogyejitang)

  • 왕채하;김동명;이인호;김동환;이종훈
    • 대한한의학방제학회지
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    • 제12권2호
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    • pp.221-224
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    • 2004
  • Gomphrena globosa has not known including allergic substances. In this report, it could induce allergic diseases like itching, redness, edema, dryness all over the body. Allergic patient from Gomphrena globosa gained a complete recovery under the administration of Sihogyejitang.

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엑시머레이저 치료를 경험했던 백반증 환자가 한방복합치료와 엑시머레이저 병행치료로 호전된 치험 4례 (Four cases of vitiligo patients treated by Oriental medical treatment who have experienced Excimer Laser treatment)

  • 이진혁;김세윤
    • 한방안이비인후피부과학회지
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    • 제27권3호
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    • pp.205-212
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    • 2014
  • Purpose: This study aims to prove effects of an oriental medical complex therapy on vitiligo patients who have experienced the Eximer laser therapy. Method: The study conducted its investigation targeting these four patients who have not been observed with any satisfactory reaction to the Eximer laser therapy. The study analyzed the findings through the comparison on the pictures before and after the therapy. Result: After comparing the pictures, the study confirmed positive changes in the conditions of the patients. The oriental medical complex therapy turned out to be effective enough to treat the patients who have gone through the Eximer laser therapy before. Conclusion: Such result leads the study to a conclusion that the oriental medical complex therapy can be an effective way to treat these patients who do not have a satisfactory reaction to the Eximer laser therapy. In addition, the author of the study suggests that more clinical trials should be conducted.

주의력 결핍 및 과잉행동장애(ADHD) 아동의 한의학적 치료에 대한 사례 (A case report of child ADHD treated with oriental medicine)

  • 변기원;손인철
    • Korean Journal of Acupuncture
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    • 제25권1호
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    • pp.99-111
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    • 2008
  • Objective : This study was performed to evaluate oriental medical treatment for ADHD in childhood Methods : We analyzed DSM-4 and ADS scores before and after the treatments, such as acupuncture, decoction of medical ingredients, correction treatment and oriental kinesitherapy, of ADHD in 12 elementary school students who have been visited Byon oriental medical clinic (Dogok-dong Seoul) from March to October, 2007. And all patients were treated 2 times a week for 3 month. Results : In this study, oriental medical treatments, such as acupuncture, decoction of medical ingredients, correction treatment and oriental kinesitherapy, to balance left and right brains, which is based on oriental medicine theory, was not only effective for treating attention deficit and hyperactivity which is the major problem of children in ADHD, but also effective for resistance, sociality, homology and communication. And we concluded that oriental medical treatments, which treats imbalance disorder of brain, were effective for treating ADHD.

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한양대의료원 치과 진정요법 클리닉의 진정요법(I) (Introduction of Sedation Clinic at Department of Dentistry in Hanyang University Medical Center (I))

  • 빙정호;전재윤;박창주;황경균;심광섭
    • 대한치과마취과학회지
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    • 제6권2호
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    • pp.113-120
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    • 2006
  • Recently, sedation in dentistry is gaining more and more interests of dental practitioners. Moreover. 'dental sedation', 'sleep dentistry', or 'pain-free dental treatment' become everyday words familiar to ordinary persons. Sedation clinic in Hanyang University Medical Center was open on Mar 2006 as specialty clinic at department of dentistry. Our aim is performing comfortable and safe dental treatments for patients who have problems for routine dental treatments because of extreme fear and anxiety or for patients who are supposed to have stressful and painful time-consuming treatment, such as sinus elevation and bone graft for implant placement. Our sedation was focused on conscious sedation, especially intravenous sedation using midazolam alone in technique. In two series, the sedation protocol at our Sedation Clinic will be described in details and then, analysis of our cases will be presented to help beginners for sedation in dentistry.

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자연피임법으로서의 배란법의 피임효과 (Preliminary Report of Use-Effectiveness of Ovulation Method in Korea)

  • 배석천;정윤조;나종구;오원섭;김승조
    • Clinical and Experimental Reproductive Medicine
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    • 제3권1호
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    • pp.27-32
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    • 1976
  • In recent years, explosive increase in population has been damaging mankind in terms of deprivation of natural resources and more of economical demands. Therefore, we have thought about problems as to counter-balance the increasing population, and reached a resolution of artificial methods of controlling birth. In the past, though now used in some of contraceptive methods, extravaginal ejaculation, condom were commonly used. But recently, pills, IUD and several kinds of operative procedures are quite popular. Though the recent methods are known to be effective compared with the traditional methods, a certain unwanted side effects as well as limited value of usages now must be discussed. On this aspect, we are trying to research for a ideal methods such as symptom free, more of natural way of family planning and try to zero the failure rate. And also it has been suggested that only if those scientific methods of controlling birth can be base on religious concepts of moral being, it will be enlightened. At the Happy Family Planning Clinic of St. Mary's Hospital, we apply Billing's ovulation method to out-patients who want contraception and usually advise them to use it on a self-care basis. For a retrospective study of the presurvey data analysis and use-effectiveness of the ovulation method from April 1, 1975 to Nov., 30, 1975, we have dealt with a total of 1,383 women (urban areas 465, rural areas 918). The results of preliminary survey were as follows; 1) Among 465 women in Seoul areas, the failure rate was 10.3, which signified unplanned pregnancies of 32 women. 27 of the 32 women were pregnant due to the users own failure and the remaing 5 due to the failure of the method. Therefore, the failure of the method accounted for 1.6. 2) Among 918 women in rural areas, the failure rate was 15.2 signifing unplanned pregnancies in 93 women. The cause of the failure in 81 of the 93 women was attributable to the user's own mistake and that in the remaing 12 to the default of the method. Therefore, the failure attributable to the method accounted for 2.0.

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생명보험 종합검진중 상부위장관 조영술 결과에 대한 임상적 고찰 (Clinical Study of UGI Finding on Patients with Health Screening)

  • 라세철;박민선
    • 보험의학회지
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    • 제17권
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    • pp.63-67
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    • 1998
  • 연구배경 : 상부위장관 조영술결과 유소견을 보인 환자와 그들이 호소하는 증상, 그들의 사회적 환경, 생활특성이 어떠한 관련이 있는가 알아보고자 하였다. 연구대상 : 1995년 1월부터 1997년 12월까지 제일생명(주) 부속의원 종합검진센타에 내원한 8,982명을 대상으로 상부위장관조영술을 시행하고 이와함께 상부위장관 증상에 대한 설문조사를 시행하여 그 결과를 분석하였다. 결과 : 상부위장관 조영검사자 총 8,982명중 유소견자는 598명(6.66%)이며, 그중 남자 420명(70.24%), 여자 178명(29.76%)으로 나타났다. 유소견중에는 십이지장 궤양이 제일 많았으며 그 중 남자 $30{\sim}40$세에서 제일 많이 발견되었다. 증상발현율은 진단결과와 다른 큰 차이가 없었으며 각 증상중에 진단결과와 유의한 관련을 갖는 것은 없었다. 결론 : 상부위장관 증상은 기질적 원인보다 성별, 연령이나 생활환경의 영향을 더 받는 것으로 보여 진단에 있어 호소하는 증상을 고려하기보다 위장관조영술과 더불어 상기요인에 대한 고려가 필요하다.

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사례분석을 통한 『상한론(傷寒論)』 변병진단체계(辨病診斷體系)의 서사의학적 가치의 탐색 (Shanghanlun Diagnostic System : Exploring Value as Narrative Medicine by Analyzing Cases)

  • 김진아;이성준
    • 대한상한금궤의학회지
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    • 제6권1호
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    • pp.1-25
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    • 2014
  • Objective : The purpose of this study is exploring value of Shanghanlun six diagnostic system as Narrative Medicine by analyzing cases. Methods : In the article, we examined the theory of narrative medicine and current studies. And then key elements of narrative medicine was defined. On the basis of these, two medical cases were analyzed by reordering in accordance with time sequences and causality for confirming narrative factors. Results : The narrative approach to analyzing cases shows us that different diseases could be the result of same pathological patterns based on Shanghanlun. This tells us following four aspects. [1] Shanghanlun is the causes-oriented records and the text includes narrative factors. [2] Shanghanlun six diagnostic system is a process of constructing plot of medical case history through the clinical interpretation of contextual meaning of patient's life. [3] In the process of diagnosis, Schemata and script are engaged in assuming and confirming six patterns diseases. [4] The subjective factors of an individual can be applied universally through the provision of Shanghanlun. Conclusions : Narrative factors of Shanghanlun six diagnostic system suggest the possibility and value of Shanghan Medicine as Narrative Medicine in terms of Medical Humanities, essence of medical diagnosis and therapeutic action.