• Journal of Yeungnam Medical Science
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• 제3권1호
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• pp.313-318
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• 1986

본 환자는 전신쇠약감 피로감, 고혈압과 혈청 potassium치가 저하되어 있고 혈청 Renin활성도가 감소되어 있으면서 Aldosterone억제 시험에도 억제가 되지 않았음을 볼 때 원발성 Aldosterone증을 의심할 수 있었다. 또 자세변화 시험에서 혈청 Renin활성도가 떨어져 있었고 자세변화에 따라 혈청 Aldosterone이 증가했으며 컴퓨터 단층촬영에서 별다른 병변이 뚜렷이 보이지 않음을 볼때 부신증식성 Aldosterone증으로 의심된다. 따라서 본 환자에게 spironolactone을 투여했고 이후 외래를 통해 추적검사 중이며 혈압 조절이 양호할 뿐 아니라, 불편을 느끼던 증상들도 호전이 되었음을 안 수 있었다. 끝으로 원발성 Aldosterone증에 대한 관심을 더 기울인다면 더 많은 증례가 발견될 것으로 사료되고, 본 저자들은 보다 많은 증례를 찾아 추후 증례보고및 추적검사할 예정이다.

• Journal of Gastric Cancer
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• 제13권3호
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• pp.149-156
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• 2013

Purpose: Clinical stage of gastric cancer is currently assessed by computed tomography. Accurate clinical staging is important for the tailoring of therapy. This study evaluated the accuracy of clinical N staging using stomach protocol computed tomography. Materials and Methods: Between March 2004 and November 2012, 171 patients with gastric cancer underwent preoperative stomach protocol computed tomography (Jeju National University Hospital; Jeju, Korea). Their demographic and clinical characteristics were reviewed retrospectively. Two radiologists evaluated cN staging using axial and coronal computed tomography images, and cN stage was matched with pathologic results. The diagnostic accuracy of stomach protocol computed tomography for clinical N staging and clinical characteristics associated with diagnostic accuracy were evaluated. Results: The overall accuracy of stomach protocol computed tomography for cN staging was 63.2%. Computed tomography images of slice thickness 3.0 mm had a sensitivity of 60.0%; a specificity of 89.6%; an accuracy of 78.4%; and a positive predictive value of 78.0% in detecting lymph node metastases. Underestimation of cN stage was associated with larger tumor size (P<0.001), undifferentiated type (P=0.003), diffuse type (P=0.020), more advanced pathologic stage (P<0.001), and larger numbers of harvested and metastatic lymph nodes (P<0.001 each). Tumor differentiation was an independent factor affecting underestimation by computed tomography (P=0.045). Conclusions: Computed tomography with a size criterion of 8 mm is highly specific but relatively insensitive in detecting nodal metastases. Physicians should keep in mind that computed tomography may not be an appropriate tool to detect nodal metastases for choosing appropriate treatment.

• 대한임상독성학회지
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• 제8권1호
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• pp.16-23
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• 2010

Purpose: Organophosphate insecticide poisoning is common in Korea, but there is no definitive guideline for determining the severity of the poisoning and the predictive factors. Therefore, we evaluated the organophosphate poisoned patients and we divided them into two groups, the survivors and the dead, and the results might be useful for treating organophosphate poisoning patients. Methods: We performed a retrospective analysis of 68 organophosphate poisoned patients who visited the Chosun University Hospital Emergency Medical Center during a 24-month period from January, 2007 to December, 2008. We made a work sheet of the patients' characteristics and the collected data was analyzed and we compared this data between the survivor group and the dead patient group. Results: There were significant differences between the survivor group and the dead patient group for the mean age, the alcohol intake state and the typically expressed signs. The dead patients had lower blood pressure, tachycardia and a lower Glasgo Coma Score (GCS) score than the survivor group. On the arterial blood gas analysis, the dead patients had more severe acidemia and they had lower saturations. Increased serum amylase levels were found in the dead patients. The survivors'initial and follow up serum pseudocholinesterase activity (after 6~8 days) was significantly higher than that of the dead group. The total amount of atropine injected to patient was less in the survivors than that in the dead patients. Conclusion: Old age and expressing the typical intoxication signs, a lower GCS score and blood pressure, showing acidosis on the gas analysis and low serum cholinesterase activity may be useful as poor prognostic indicators for patients with organophosphate poisoning. We suggest that physicians must pay careful attention to the signs and prognostic factors of organophosphate insecticide poisoned patients.

• 대한한의진단학회지
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• 제11권1호
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• pp.105-129
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• 2007

Objectives: The purpose of this research is to obtain basic data about the effects of Constitution-Acupuncture (CA) based on Eight-Constitution Medicine (ECM) by the expert CA Oriental Medical Doctors. Methods: The resources were collected from the internet survey method. 35 samples were collected. The SPSS 13.0 for windows and Answer Tree 3.0 was used for statistical analysis. Results: The results from this research are as follow. 1. The motivation that apply ECM to clinic are 'Because ECM is effective for diagnosis, treatment and prevention against disease' 48.6% and 'Because CA therapy is effective' 25.7%. 2. The advantage that CA therapy compare to the other acupuncture therapy are 'Management and prevention against disease are available by ECM theory to a person who exact constitution is confirmed' 82.9%, 'CA therapy is superior in treatment of hard symptoms to treat by the other acupuncture therapy' 80%, 'Treatment effect is good' 77.1%, 'Needle manipulation of CA is simple comparatively' 57.1%, 'It is definite whether treatment effect is good or not' 54.3% and CA therapy is superior all in diseases of twelve category. 3. When the effects of CA is good, patients expressed much 'Eyesight lightened', 'Took deep sleep at night', 'Fatigue decreased', 'Body is light', 'Feelings became refreshing' as well as 'Symptoms were improved' and also physicians confirmed as those reactions whether treatment is effective. Conclusions: The research suggest that CA is effective therapy in clinic, and so further study is needed for CA therapy.

• 대한핵의학회지
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• 제39권6호
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• pp.456-463
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• 2005

목적: FDG PET에서 위(stomach)에 보이는 다양한 FDG 섭취 양상들이 임상적으로 어떠한 의미가 있는지 알아보고 유의한 병변의 특징적 양상을 밝혀 내어 좀 더 정확한 PET 판독을 유도하여 임상적 처치에 도움이 되고자 하였다. 대상 및 방법: 2003년 6월에서 2004년 8월까지, 15개월 동안 FDG PET과 위 내시경을 모두 시행한 위 절제술을 받지 않은 피검자들 중에서 두 검사간 간격이 1주일 이내인 총 38명을 대상으로 하여 후향적으로 연구하였다. PET 영상의 분석은 섭취 정도의 측면에서 시각적 섭취 정도와 max.SUV를 사용하였고, 섭취 모양의 측면에서 국소적, 미만성, 비대칭성의 섭취 양상을 인자로 분석하였다. 내시경 소견은 악성 병변, 염증성 병변, 비염증성 병변, 정상 소견으로 분류하였고, 염증성 병변은 다시 궤양, 위염(만성위염, 기타위염)으로 분류하였다. 통계적 분석은 t-test와 Mann Whitney test를 이용하였다. 결과: 악성 병변의 경우 시각적 섭취 정도에서 grade 4,5, max.SUV $7.95{\pm}4.38$로 높은 섭취 정도를 보였으며, 섭취 양상은 국소적 섭취 양상이었다. 이러한 기준에 따른 결과는 다른 병변들과 유의한 차이를 보였다. 염증성 병변, 비염증성 병변, 정상 소견에서는 시각적 섭취 정도가 grade$1{\sim}5$까지 다양하게 분포하였으며, 섭취 양상도 국소적, 미만성, 비대칭적인 다양한 양상이었다. 이러한 양성 염증성 병변, 비염증성 병변, 정상 소견 병변들 간에는 섭취 정도와 양상의 인자들 사이에 유의한 차이를 보이지 않았다. 결론: 위의 악성 병변은 양성 병변에 비해 높은 FDG 섭취 정도를 보이고 섭취 양상에 있어서는 대개가 국소적 섭취 양상이었다. 그러나 위의 양성 병변과 정상에서는 다양한 정도의 섭취 정도와 섭취 양상을 보여 주었고, 각 병변들간에 또는 정상의 생리적 섭취와 구별할 수 있는 소견은 제시하기 어려웠다.

• Tuberculosis and Respiratory Diseases
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• 제65권2호
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• pp.147-151
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• 2008

고령의 폐렴 환자들에게 적절한 치료를 하였는데도 방사선 검사상, 호전되지 않고, 병변이 남아있는 '호전되지 않는 폐렴(non-resolving pneumonia)' 환자들을 종종 볼 수 있다. 여러 가지 원인들에 따라 환자들마다 방사선학적 호전을 보이는 기간이 매우 다양하다. 흔하지는 않지만, '호전되지 않는 폐렴'의 원인이 경화성 폐암으로 뒤늦게 진단되는 경우도 있다. 경화성 병변으로 나타나는 세기관지폐포암의 경우 다양한 임상 증상과 영상 소견을 보일 수 있고, 폐렴과 구분이 어려워 주의를 요한다. 경화성 폐암의 경우, 조기진단을 하면 근치적 절제가 가능하기 때문에 신속하고 정확한 검사를 시행하는 것이 중요하다. 따라서, 폐렴 환자들에서 처음 검사에서 악성 세포가 없었다고 하더라도, 경화성 병변이 지속된다면 세기관지폐포암을 염두에 두고 신중하게 추가 검사를 고려해야 한다.

• 기본간호학회지
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• 제6권3호
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• pp.522-531
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• 1999

This research identifies the ingress to egress primary factors that causes a patient to receive delayed emergency medical care. This material was collected between February 1st to 28th, 1998. Research envolved 4,118 people who visited the college emergency medical center in Kyeongido Province, South Korea. Medical records were examined, using the retrospective method. to determine the length of stay and the main cause for waiting. Results are as follows : 1. The age group with the highest admission rate was 10 and under, approximately 1,394 (33.9%). Followed by an even distribution for ages between 11-50 at 10-15% for their respective ranges. The lowest admission rate was 50 years and above. 2. From the 4,118 records examined, 3,489 received outpatient treatment (84.7%); 601 were admitted for inpatient care (14.6%); 25 arrived dead on arrival (0.6%); and 4 people died at the hospital. 3. Between 7PM to 12AM, 42.9% were admitted to the EMC. The hours from 9PM to 11PM recorded the highest admission rate and 5AM to 8AM was the lowest From 8PM to 12AM, the most beds were occupied. 4. For most patients. the average length of stay was approximately 2.2 hours. By medical department, external medicine was the longest for 2.8 hours. Pediatrics was the shortest for 1.6 hours. The average waiting period for inpatient admission was 2.6 hours. Inpatient admission for pediatrics and external medicine was 3.4 hours and 2.2 hours respectively. 5. Theses are primary factors for delay at EMC: 1) pronged medical consultations to decide between inpatient versus outpatient treatment, and delaying to be inpatient, 2) when you call physicians they are delayed to come 3) Understaffing during peak or critical hours, 4) Excessive consulting with different medical departments, 5) some patients require longer monitoring periods, 6) medical records are delayed in transit between departments, 7) repeated laboratory tests make delay the result, 8) overcrowded emergency x-ray place causes delay taking x-ray and portable x-ray, 9) the distance between EMC and registration and cashier offices is too far. 10) hard to control patient's family members. The best way to reduce EMC waiting and staying time is by cooperation between departments, both medical and administrative. Each department must work beyond their job description or duty and help each other to provide the best medical service and satisfy the patient needs. The most important answer to shortened the EMC point from ingress to egress is to see things from a patient point of view and begin from there to find the solution.

• Tuberculosis and Respiratory Diseases
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• 제71권5호
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• pp.328-334
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• 2011

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality throughout the world and is the only major disease that is continuing to increase in both prevalence and mortality. The second Korean National Health and Nutrition Survey revealed that the prevalence of COPD in Korean subjects aged ${\geq}45$ years was 17.2% in 2001. Further surveys on the prevalence of COPD were not available until 2007. Here, we report the prevalence of spirometrically detected COPD in Korea, using data from the fourth Korean National Health and Nutrition Survey (KNHANES IV) which was conducted in 2007~2009. Methods: Based on the Korean Statistical Office census that used nationwide stratified random sampling, 10,523 subjects aged ${\geq}40$ years underwent spirometry. Place of residence, levels of education, income, and smoking status, as well as other results from a COPD survey questionnaire were also assessed. Results: The prevalence of COPD (defined as forced expiratory volume in 1 sec/forced vital capacity <0.7 in subjects aged ${\geq}40$ years) was 12.9% (men, 18.7%; women, 7.5%). In total, 96.5% of patients with COPD had mild-to-moderate disease; only 2.5% had been diagnosed by physicians, and only 1.7% had been treated. The independent risk factors for COPD were smoking, advanced age, and male gender. Conclusion: The prevalence of COPD was 12.9% in the KNHANES IV data. Most patients with COPD were undiagnosed and untreated. Based on these results, a strategy for early COPD intervention is warranted in high risk subjects.

• 농촌의학ㆍ지역보건
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• 제12권1호
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• pp.102-110
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• 1987

One of the familiar medical facility that most people reach easily in Korea is the drug store. In Korea, it is possible to purchase all kinds of common drugs without physician's prescriptions, which caused some problems. In other words, such treatment without professional supervision has led to medical, social and economical problems. In view of the above, this study is aimed at revealing the actual status of long-term use of drugs in some urban residents. Long-term use of drugs is operationally defined as using certain drugs at least once a week for more than 3 months. This survey took the residents of Guro 6-Dong where was one of the target areas for Community Health Development Project managed by Korea University as a target population. A sample of 1,517 residents was selected by the multistage sampling method. The interview was conducted on September 21st and 22nd in 1985. The object of this study was to compare the result with that of the rural area which was obtained by the same method, tools and research team, prior to this study in 1984. The results were as follows; 1) The age-standardization of the study showed that 97 per 1,000 urban residents were actually on long-term drug use. The prevalance of long-term use is high in accordance with aging and low with education level. 2) Out of 1,000 urban samples the most popular item involved in the long-term drug use was antipyretic-analgesic-antiinflammatory drug (26), and next in order was vitamin (23), antibiotics (13), digestives (10) and antacids (7). In the rural samples as for compare, that was antipyretic-analgesic-antiinflammatory drug (100), antacids (36), digestives (23), adrenocortical hormones (12) etc. 3) With antipyrctic-analgesic-antiinflammatory drugs, 50% of the urban samples were taking for more than a year, whereas such were 82.7% of the rural samples. Using such a high percentage of antipyretic-analgesic-antiinflamatory drugs in the rural residents is probably due to the high prevalence rate of musculo-skeletal diseases. 4) The urban long-term drug users of antipyretic-analgesic-antiinflammatory drugs were influenced mostly by the mass media (43.6%), next in order was pharmacist (35.9%) and physician (10.3%). Comparing with the result from the rural areas the role of mass media was much more influencial in the urban areas. 60% of them consulted with pharmacists, 14.3% with physicians and 25.7% had no history of consultation in the urban samples. 5) Considering the incidence of knowing the possible side-effects of each drug, 28.2% of the urban residents had no recognition about side-effects prior to use antipyretic-analgesic-antiinflammatory drugs. In the rural residents, 29.67o had no knowledge about the side-effects before using the drug. 6) For the solution of the above problems, it is necessary to limit the advertisement of some drugs by the parmaceutical company. And therapeutic drugs which may bring on side effects in case of long-term use should not be sold at drug stores without physician's prescription.

• Journal of Trauma and Injury
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• 제21권1호
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• pp.28-35
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• 2008

Purpose: This study was conducted to examine the clinical significance IV-contrasted helical abdomen computed tomography (CT) as a diagnostic screening tool to evaluate hollow viscus injury in blunt abdominal trauma patients. Methods: This is a retrospective study encompassing 108 patients, presenting to Korea University Medical Center (KUMC) Emergency Department (ED) from January 2007 to December 2007, with an initial CT finding suggestive of intra-abdominal injury. An initial non-enhanced abdomen CT was taken, followed by an enhanced CT with intravenous contrast. Patients' demographic data, as well as the mechanisms of injury, were inquired upon and obtained, initial diagnosis, as dictated by specialized radiologists, were added to post-operational (post-OP) findings and to additional CT findings acquired during their hospital stays, and all were combined to arrive at final diagnosis. Initial CT findings were further compared with the final diagnosis, yielding values for sensitivity, specificity, and accuracy, as well as positive and negative predictive values. Patients were further divided into two groups, namely, those that underwent operational intervention and those that did not. The initial CT findings of each group were subsequently compared and analyzed. Results: Initial CT scans revealed abnormal findings in a total of 212 cases - solid organ injuries being the most common finding, as was observed in 97 cases. Free fluid accumulation was evident in another 69 cases. Based on the CT findings, 77 cases (71.3%) were initially diagnosed as having a solid organ injury, 20 cases (18.5%) as having a combined (solid organ + hollow viscus) injury, and 11 cases (10.2%), as having an isolated hollow viscus injury. The final diagnosis however, were somewhat different, with only 67 cases (62.0%) attributed to solid organ injury, 31 cases (28.7%) to combined injury (solid + hollow), and 10 cases (9.3%) to hollow viscus injury. The sensitivity (CI 95%) of the initial helical CT in diagnosing hollow viscus injury was 75.6%, and its specificity was 100%. The accuracy in diagnosing hollow viscus injury was also meaningfully lower compared to that in diagnosis of solid organ injury. Among patients initially diagnosed with solid organ injuries, 10 patients (2 from follow-up CT and 8 from post-OP finding) turned out to have combined injuries. A total of 38 patients underwent an operation, and the proportion of initial CT findings suggesting free air, mesenteric hematoma or bowel wall thickening turned out to be significantly higher in the operation group. Conclusion: Abdominal CT was a meaningful screening test for hollow viscus injury, but the sensitivity of abdominal CT was significantly lower in detecting hollow viscus injury as compared to solid organ injury. This calls for special consideration and careful observation by the ED physicians when dealing with cases of blunt abdominal trauma.