• Journal of Korean Neurosurgical Society
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• v.60 no.6
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• pp.723-729
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• 2017

Objective : Acute subdural hematoma (ASDH) is generally considered a condition that should be managed surgically. However, some patients initially receive conservative treatment, a subset of whom require surgical intervention later. This study aimed to evaluate the predictors of delayed surgical intervention in ASDH patients who are initially managed conservatively. Methods : From January 2007 to December 2015, 842 patients diagnosed with ASDH were treated at our institution. Among them, 158 patients with convexity ASDH were initially treated conservatively. Patients were divided into a delayed surgery group and a conservative group. Demographic characteristics, past medication and medical histories, and radiological and laboratory data were collected by retrospective chart review. Independent risk factors were identified with univariate and multivariate analyses. Results : Twenty-eight patients (17.7%) underwent delayed surgical intervention. Their mean age was 69.0 years, and 82.1% were male. Hypertension, diabetes mellitus, and heart disease prevalence and use of anti-platelet agents did not significantly differ from the conservative group. However, age (p=0.024), previous cerebral infarction history (p=0.026), increased maximal hematoma thickness (p<0.001), midline shifting (p=0.001) and accompanying subarachnoid hemorrhage (p=0.022) on initial brain computed tomography (CT) scan, low hemoglobin level (p<0.001), high leukocyte count (p=0.004), and low glucose level (p=0.002) were significantly associated with delayed surgical intervention. In multivariate analysis, increased maximal hematoma thickness (odds ratio [OR]=1.279, 95% confidence interval [CI] 1.075-1.521; p=0.006), low hemoglobin level (OR=0.673, 95% CI 0.467-0.970; p=0.034), and high leukocyte count (OR=1.142, 95% CI 1.024-1.272; p=0.017) were independent risk factors for delayed surgical intervention. Conclusion : Due to the high likelihood of delayed surgical intervention among minimal ASDH patients with a thicker hematoma on initial brain CT, lower hemoglobin level, and higher leukocyte count, these patients should receive more careful observation.

• Journal of Oral Medicine and Pain
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• v.35 no.1
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• pp.41-47
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• 2010

Burning mouth syndrome(BMS) is a chronic oral pain and a symptom complex disorder usually unaccomplished by mucosal lesion or other clinical and laboratory signs of organic disease. BMS is characterized by a spontaneous burning sensation that mainly affects middle-aged and postmenopausal women. The etiology of BMS is poorly understood even though evidence for a possible neuropathic pathogenesis. BMS cause from various local or systemic factor, including nutritional deficiencies, hormonal change, local infection, dental procedure, dry mouth, medication and systemic disease including diabetes mellitus. Many studies suggest peripheral alteration in sensory of trigeminal nerve system. BMS patients with supertaster indicates pathologies of central and peripheral nerve system induced by an alteration in the taste system at the level of chorda tympani and glossopharyngeal nerve. The author discuss our current understanding of etiology and pathogenesis of BMS that refered chronic oral pain.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.21 no.3
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• pp.174-181
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• 2010

Objectives: To identify the factors affecting long-term adherence to methylphenidate treatment in children with attention-deficit hyperactivity disorder (ADHD). Methods: A retrospective medical record review of 239 ADHD patients (mean age $9.3{\pm}2.6$ years, range 6.0-17.4 years) who had visited the child and adolescent psychiatry clinic at a university hospital, in Seoul, Korea from March 2005 to February 2008. Subjects were diagnosed as ADHD based on the criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders 4th edition, text revision version (DSM-IV-TR) and underwent neuropsychological tests including the continuous performance test (CPT). Treatment discontinuation was defined as the last prescription date when the medication possession rate (MPR) became less than 0.80. Subjects were divided into three groups and labeled as Group I, non-adherence without pharmacotherapy, Group II, non-adherence with short-term pharmacotherapy, and Group III, adherence with long-term pharmacotherapy. Results: Ninety (37.7%) patients were grouped as non-adherent (Groups I+II) and 149 (62.3%) as adherent (Group III). The adherence group exhibited lower intelligence, higher symptom severity, and a higher number of comorbid psychiatric disorders than controls. The use of stimulants was significantly associated with long-term adherence to treatment. Additionally, the duration of interval between the date of the first visit and the date of the first prescription was positively associated with long-term adherence. Conclusion: About two-thirds of patients diagnosed as ADHD adhered to the treatment six months after the first visit. With respect to patient evaluation and the development of treatment strategies, factors affecting early drop-out and longer follow-up must be considered.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.2 no.2
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• pp.199-211
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• 1995

This study analyzed the practical education in fundamentals of nursing, for the 36 nursing schools including 12 4-year nursing schools and 24 junior college nursing schools. This survey was done from september 5th to october 5th in 1995. The results of this study were as follows : 1. Required credit in fundamentals of nursing. 1) The highest incidence of the total required credit was 7 in 4-year nursing school and 9 in junior college. 2) For the lecture course credit, the large number of 4-year nursing school gave 5 credit lessons and 6 credits provided in junior nursing colleges. 3) For the credit of practical education the major portion of 4-year nursing school gave 2 credits instruction, however junior nursing school provided 3 credits. 2. Laboratory practice in fundamentals of nursing. In laboratory practice, the ratio of instructor and student was 1 : 20 in 83.4% of the 4-year nursing school and in 66.7% of the junior nursing school. 3. Contents and hours of fundamental nursing practice. 1) In the area of health assessment and nursing process, the large number of schools allocated following hours : 6 hours for vital signs, 4 hours for nursing process, 2 hours for recording but practice for physical examination and communication was done in few schools. 2) In the area of functional health pattern, the large number of schools allocated practice hours like followings : 2 hours for I/O, 2 hours for gavage feeding, 2 hours for elimination, 6 hours for catheterization, 6 hours for bed making, 2 hours for positioning, 6 hours for personal hygiene, 2 hours for R.O.M, 4 hours for moving turning lifting, 2 hours for inhalation and suction. But C.P.R and terminally ill patient care were taught in smaller number of schools. 3) In the area of special nursing measures, the major portion of nursing schools allocated hours like followings. It consisted of 6 hours for asepsis, 16-18 hours for medication, 2 hours for heat and cold application, 2 hours for wound care. 4) 22.2% of the nursing schools had total review practice time and 36.1% of the nursing schools had the students clinical practice. Based on above mentioned results, 4-year nursing school had faithful practical education of fundamental nursing than junior nursing school. But for the contents and allocated hours for practice education, junior nursing schools were much more contents and hours than 4 year school.

• Journal of muscle and joint health
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• v.5 no.1
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• pp.83-109
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• 1998

This study was carried out to identify the Important modifiable risk factors for reduced bone mass and to construct prediction model which can classify women with either low or high bone mass. Through the literature review, individual characteristics such as age, body weight, height, education level, family history, age of menarche, postmenopausal period, gravity, parity, menopausal status, and breast feeding period were identified and factors of life style such as past milk consumption, past physical activity, present daily activity, present calcium intake, alcohol intake, cigarette smoking, coffee consumption were identified as influencing factors of reduced bone mass in women. Four hundred and eighty women aged between 28 and 76 who had given measurement bone mineral density by dual energy x-ray absortiometry in lumbar vertebrae and femur from July to October, 1997 at 4 general hospitals in Seoul and Pusan were selected for this study. Women were excluded if they had a history of any chronic illness such as rheumatoid arthritis, diabetes mellitus, hyperthroidism, & gastrointestinal disorder and any medication such as calcium supplements, calcitonin, estrogen, thyroxine, antacids, & corticosteroids known affect bone. As a result of these exclusion criteria, four hundred and seventeen women were used for analysis. Multiple logistic regression model was developed for estimating the likelihood of the presence or absence of reduced bone mass. A SAS procedure was used to estimate risk factor coefficient. The results are as follows For lumbar spine, the variables significant were age, body weight, menopause status, daily activity, past milk consumption, and past physical activity(p<0.01), while for femoral Ward's triangle, age, body weight, level of education, past milk consumption, past physical activity(p<0.001). Past physical activity, present daily activity and past milk consumption are the most powerful modifiable predictors in vertebrae and femur among the predictors. When the model performance was evaluated by comparing the observed outcome with predicted outcome, the model correctly identified 74.1% of persons with reduced bone mass and 84.5% of persons with normal bone mass in the lumbar vertebrae and 82.9% of persons with reduced bone mass and 75.0% of persons with normal bone mass in the femoral Ward's triangle. On the basis of these results, a number of recommendations for the management of reduced bone mass may be made : First, those woman who are classified as high risk group of the reduced bone mass in the prediction model should examine the bone mineral density to further examine the usefulness of this model. Second, the optimal amount of milk consumption and a regular weight bearing exercise in childhood, adolescence, and early adult should be ensured.

• The Korean Society of Law and Medicine
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• v.19 no.1
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• pp.207-254
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• 2018

The major court rulings delivered in 2017 include the ruling that separated the legal character of denture production agreement signed together with medical care agreement and found a subcontracting dimension in the former, and the ruling that overcame the limitations of the theory of entire appearance of a fetus as discussed in civil law by using the legal principle of insurance which suggests that unborn child insurance takes effect after the contract is signed and the first installment of the premium is paid in. As more court rulings find the medical specialists responsible for accidents and injuries from drugs, some argue that medication counseling by the druggist who makes and dispenses drugs should be upgraded. And with respect to a court ruling that denied the hospital's responsibility for an infection-involving accident even if there were no records on specific measures taken in infection management, some criticized the court for being too conservative in recognizing responsibilities. And with respect to infectious disease management, some criticized the court for its interpretation and application of the facts in the direction of denying the negligence. In addition, some claimed that it is necessary to establish institutional system for hospital infection control and its aid for victims, and to improve the system including the reversal of the burden of proof given the special nature of hospital infections. A number of rulings on the duty to disclose included the one which stated that the specific matter did not require a doctor's explanation as it was explained or the specific medical service would have been performed even if no explanation had been given. There was a greatly controversial ruling over the scope of indemnification, which accepted the occurrence of multiple scars and deformation as disorders while regarding breast as a thoracic organ. And a Supreme Court ruling over interpreting Medical Service Act was criticized as overstepping the boundary allowed in the law.

• Tuberculosis and Respiratory Diseases
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• v.40 no.5
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• pp.602-609
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• 1993

Lymphocytic interstitial pneumonitis (LIP) is one of parenchymal pulmonary infiltrative diseases first described at 1966 by Carrington and Liebow. In LIP, there is a predominance of mature small lymphocytes in the interstitium of the lung which form germinal centers. The disease process surrounds, but dose not invade lung parenchyme, tracheobronchial tree and vascular structures. The etiology remains still unknown and the clinical features of this disorder have not been clearly defined. Therefore, the therapeutic modality is obscure. Development of LIP association with AIDS is often reported currently and possibility of progress to malignant lymphoma is emphasized. We experienced a case of primary LIP with pnemomediastinum. She was adimitted due to chest and anterior nuchal pain with chronic coughing, and diagnosed as pneumomediastinum with LIP. Medication with steroid was begun and some improvement of symptoms was observed, but an X-ray film of the chest remained same without improvement. We report above case with review of the literatures.

• Journal of Korean Medical classics
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• v.21 no.2
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• pp.21-28
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• 2008

After translating the contents of "Treatise on Bundon Disease in Chapter 8 of the Essence of the Synopsis of the Golden Chamber" and it was compared with the contents of "The Lecture of Synopsis of Prescriptions of the Golden Chamber" and speculated to review the characteristics of the comments of Ui(尤怡) and the following conclusions were made. As the causes of bundon(奔豚) disease, which means gas rushing like a running piggy from the lower abdomen to the throat, they could be categorized into the cases belongs to miscellaneous diseases (雜病) and into the cases of suffering from cold diseases(傷寒). If it was diagnosed as miscellaneous disease, terror and fear(驚恐) could be regarded as its cause and if it was diagnosed as cold disease, insufficiency of heart Gi(心氣) due to the excessive sweating and the invasion of exterior coldness could be regarded as its cause. As the pathogenesis of this disease, the pathogenic factors of liver and kidney could be found. Since the liver and Soyang meridian(少陽經) are subjected to the exterior and interior relation in case of the pathogenic factor of liver, alternate attacks of chills and fever(寒熱往來) could be characteristic for the disease. If this disease was caused by the pathogenic factor of kidney, there are two cases. One is the palpitation under the umbilicus(欲作奔豚: 臍下動悸) developed by the lack of heart Gi(心氣) and the other is gas rushing like a running piggy from the lower abdomen to the throat which could be developed by the exterior cold disease which invade into the interior and reach into the kidney when the heart Gi(心氣) was insufficient. In its treatment, bundon disease caused by the pathogenic factor of liver could be treated with Bundontang(奔豚湯), and the understanding of Ui(尤怡) on Pinellia ternata Breitenbach(半夏) having the effect of perspiration in the prescription is quite unique concept. In case of bundon disease caused by the pathogenic factor of kidney, treatment is focused to treat exterior coldness by applying moxibustion(灸) and Gyejigagyetang(桂技加桂湯), and in case of the palpitation under the umbilicus(欲作奔豚: 臍下動悸), its pathogenic factor of kidney is controlled with Cinnamomum louerii Nees(桂技), Polia cocos Walf and the spleen Gi(脾氣) is cared by using Glycyrrhiza uralensis Fischer et. De Candolle(甘草) and Zizyphus jujuba Mill(大棗). Especially, Ui(尤怡) emphasized Cinnamomum louerii Nees(桂技) as the medication to treat the pathogenic factor of kidney.

• Journal of Acupuncture Research
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• v.32 no.3
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• pp.95-105
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• 2015

Objectives : The purpose of this study is to review the characteristics of patients who visited the emergency room of a Korean medical hospital with musculoskeletal disorders during the last 5 years and to provide a potential basis for future studies and emergency medical practice. Methods : Patient visit records between May 1st, 2010 and February 28th, 2015 were reviewed and patients with musculoskeletal disorders were included in a retrospective analysis. Results : A total of 5,218 patient visit records were initially reviewed and 1,485 patients (28.46 %) were included in the analysis. S code group was the most frequently diagnosed coding group of Korean Standard Classification of Diseases. The male to female ratio was 1.05:1 and patients in their thirties represented the highest age group. When classified by time of visit, the distribution of patients was similar from 10:00 to 22:59. The most frequently visited day and month were Sunday and September. 879 patients (59.19 %) visited the emergency room within 24 hours from onset of symptoms. The most common symptom site was the low back (45.59 %), followed by ankle (13.94 %) and neck (13.80 %). The most frequently used treatment method was acupuncture (92.32 %), followed by infrared (45.45 %), TENS (30.03 %) and herbal medication (29.02 %). The follow-up and admission rates were 30.24 % and 13.00 % respectively. 343 patients (23.10 %) received Western medical treatment within a day before visiting the emergency room of the Korean medical hospital. Conclusions : This analysis provides the latest information on the characteristics of patients who visited the emergency room of a Korean medical hospital with musculoskeletal disorders. The results can provide the basis for further studies and for other attempts to improve the clinical setting of the emergency room.

• Archives of Plastic Surgery
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• v.42 no.6
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• pp.709-715
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• 2015

Background The incidence of vascular anomalies in the head and neck is higher than in the extremities. It is especially common for vascular anomalies to involve the lip. The lips are a functionally and aesthetically important component of the head and neck area. A retrospective analysis of data from our vascular anomaly center was performed in order to understand the characteristics and treatment requirements of vascular anomalies of the lip and to establish which treatments are likely to lead to the best outcomes. Methods A retrospective review was performed of the medical records of patients diagnosed with vascular anomalies of the upper or lower lip from January 2001 to September 2013. Using clinical photographs, radiologic findings, and patient records, the diagnosis of each case and the location of the vascular anomaly were recorded, along with information about treatment and follow-up. Results A total of 1,606 patients were diagnosed with vascular anomalies over this time period, of whom 127 (7.9%) were found to have vascular anomalies in the lip only. Surgical treatment with or without embolization, sclerotherapy, laser therapy, medication only, and observation were the treatment strategies adopted in these cases. Conclusions Vascular anomalies of the lip should be diagnosed accurately. Radiologic diagnosis played a crucial role in treatment planning, and several techniques were used to treat vascular anomalies of the lip. When surgical excision is indicated for the correction of vascular anomalies of the lip, the aesthetic and functional characteristics of the lip should be considered.