• Journal of Chest Surgery
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• 제54권1호
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• pp.59-64
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• 2021

Background: Diaphragmatic injuries following blunt or penetrating thoraco-abdominal trauma are rare, but can be life-threatening. Rib fractures are the most common associated injury in patients with a traumatic diaphragmatic injury (TDI). We hypothesized that the pattern of rib fracture injuries could dictate the likelihood of acute TDIs. Methods: A retrospective study was carried out between April 2014 and October 2018 to analyze patients with TDIs and rib fractures at a major trauma center in London, United Kingdom. Results: Over the study period, 1,560 patients had rib fractures, of whom 14 had associated diaphragmatic injuries. Left-sided diaphragmatic injuries were found in 8 patients (57%). A significant proportion of the rib fractures were located posterolaterally (44.9%). The highest frequency of fractures was found in ribs 5-10, which accounted for 74% of all the fractures. Ten patients underwent surgery, of whom 7 were diagnosed with a diaphragmatic injury intraoperatively after video-assisted thoracoscopic surgery assessment of the pleural cavity. Two patients died due to severe injuries of other organs and the remaining 2 patients were managed conservatively. Conclusion: Our series of patients demonstrates a relationship between significant rib fractures and diaphragmatic injuries in trauma patients, and the diagnostic difficulties in identifying the condition. We found that the location of the rib fractures and the pattern of injury in patients with TDIs were much lower and posterolateral in the chest wall without a preference for laterality. We suggest using a thoracoscope in patients undergoing chest wall surgery post-trauma to aid in diagnosing this condition.

• Journal of Korean Neurosurgical Society
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• 제64권5호
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• pp.818-826
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• 2021

Objective : The widely accepted treatment option of a traumatic carotid cavernous fistula (TCCF) has been detachable balloon or coils based fistula occlusion. Recently, covered stent implantation has been proving an excellent results. The purpose of this study is to investigate our experiences with first line choice of covered stent implantation for TCCF at level 1 regional trauma center. Methods : From November 2004 to February 2020, 19 covered stents were used for treatment of 19 TCCF patients. Among them, 15 cases were first line treatment using covered stents. Clinical and angiographic data were retrospectively reviewed. Results : Procedures were technically successful in all 15 cases (100%). Immediate angiographic results after procedure were total occlusion in 12 patients (80%). All patients except two expired patients had image follow-up (mean 15 months). Recurred symptomatic three patients underwent additional treatments and achieved complete occlusion. Mean clinical follow-up duration was 32 months and results were modified Rankin Scale 1-2 in five, 3-4 in five, and 5 in three patients. Conclusion : The covered stent could be considered as fist line treatment option for treating TCCF patients especially in unstable vital sign. Larger samples and expanded follow-up are required to further develop their specifications and indications.

• 디지털융복합연구
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• 제16권11호
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• pp.353-361
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• 2018

본 연구의 목적은 학사경고를 받은 대학생이 학업에 대한 내적 자기 동기화가 이루어지는 과정을 파악해 보고자 함이다. 질적 연구방법 중 내러티브 연구방법을 적용하여 내면적 사고의 흐름을 추적해보고자 하였으며, 심층인터뷰를 통해 수집된 자료는 Burke의 내러티브 분서방법을 통해 분석하였다. 학습 환경이 변화되는 시점인 대학입학 전 후를 기점으로 자아의 변화과정을 4가지 주제로 도출하였다: '만들어진 우수한 아이', '우수한 아이 코스프레', '부족한 자아와의 만남', '독립된 실체와의 만남'. 위의 4가지 주제는 학사경고라는 사건을 극복해 가고자 하는 인간내면에 존재하는 강인한 독립적 탄성이 형성되어가는 과정을 단계적으로 제시해주고 있다. 이를 토대로 대학차원의 학습지원 프로그램의 개발에 있어서 내면적 자기 동기화 능력을 강화시켜줄 수 있는 소프트적인 내용과 기존의 학습지원방법이 병행된 프로그램의 개발이 필요하리라 본다.

• 한국심리학회지 : 문화 및 사회문제
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• 제28권3호
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• pp.483-512
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• 2022

본 연구는 잠재프로파일분석을 통해 코로나 팬데믹 초기 한국인의 스트레스-대처 양상을 확인하고, 잠재계층구분에 영향을 미칠 것으로 예상되는 인구사회학적 정보(성별, 연령, 가구형태, 경제수준), 코로나로 인한 비일상성(코로나로 인한 두려움, 코로나로 인한 스트레스, 외출 및 일정제약, 코로나로 인한 수입 감소)을 살펴보고, 잠재계층에 따른 심리적 안녕감(삶의 만족감, 우울, 불안)의 차이를 확인하였다. 본 연구는 세계보건기구(WHO)가 코로나 팬데믹을 선언하고, 국내에서 대구·경북지역이 특별재난지역으로 선정된 시기인 2020년 4월 13일 부터~21일까지 성인 600명을 대상으로 온라인 설문을 실시했다. 대처 양상에 따라 모형을 분류한 결과, 4계층('낮은 대처관여 집단 1', '보통 수준의 적응적 대처집단 2', '높은 수준의 적응적 대처집단 3', '적응-부적응 대처 관여집단 4')의 모형적합도가 가장 양호하였다. 또한 인구사회학적 정보에서는 성별, 연령, 경제수준이 잠재계층을 유의하게 구분하였으며, 코로나로 인한 비일상성에서는 두려움, 스트레스, 외출 및 일정제약과 수입 감소가 잠재계층을 유의하게 구분하였다. 또한 잠재계층 간 심리적 안녕감 차이를 확인한 결과, '높은 수준의 적응적 대처집단 3'이 가장 높은 삶의 만족감을 경험하는 것으로 나타났으며, '적응-부적응 대처 관여집단 4'이 가장 높은 우울, 불안을 경험하는 것으로 나타났다. 이를 토대로 논의 및 시사점이 제시되었다.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제24권3호
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• pp.124-131
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• 2013

South Korea is changing into a multi-cultural society, due to an increase in international marriage, foreign workers and transcultural immigration. In addition, the number of North Korean defectors entering South Korea has increased and now, there are approximately 25000. Therefore, this review have focused on a research that pertains to adaptation and mental health concerns of their children. Children who have immigrated themselves or whose parents have immigrated, might experience language barriers, difficulties in school adjustment, identity confusion and mental health problems. However, their academic performance and developmental status are known to be variable and be affected by socioeconomic status and their parents' educational level. Studies that evaluated the psychological problems of North Korean adolescent refugees' indicated the need for interests in both emotional and behavioral problems. The risk factors of North Korean adolescent refugees' mental health are suggested to be past traumatic experiences, long duration of defection and short period of adaptation. When mental health professionals provide assessment and treatment, they should consider the pre- and post-migration experiences & cultural background that affect the illness behaviors and attitudes toward mental illnesses. Lastly, the majority of children with multi-cultural background are still under an adolescent period and we should follow up with long-term perspectives.

• Journal of Korean Neurosurgical Society
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• 제66권5호
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• pp.543-551
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• 2023

Objective : This study aimed to investigate the current status of intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (sTBI) in Korea and the association between ICP monitoring and prognosis. In addition, a survey was administered to Korean neurosurgeons to investigate the perception of ICP monitoring in patients with sTBI. Methods : This study used data from the second Korea Neurotrauma Databank. Among the enrolled patients with sTBI, the following available clinical data were analyzed in 912 patients : Glasgow coma scale score on admission, ICP monitoring, mortality, and extended Glasgow outcome scale score at 6 months. In addition, we administered a survey, entitled "current status and perception of ICP monitoring in Korean patients with sTBI" to 399 neurosurgeons who were interested in traumatic brain injury. Results : Among the 912 patients, 79 patients (8.7%) underwent ICP monitoring. The mortality and favorable outcome were compared between the groups with and without ICP monitoring, and no statistically significant results were found. Regarding the survey, there were 61 respondents. Among them, 70.4% of neurosurgeons responded negatively to performing ICP monitoring after craniectomy/craniotomy, while 96.7% of neurosurgeons responded negatively to performing ICP monitoring when craniectomy/craniotomy was not conducted. The reasons why ICP monitoring was not performed were investigated, and most respondents answered that there were no actual guidelines or experiences with post-operative ICP monitoring for craniectomy/craniotomy. However, in cases wherein craniectomy/craniotomy was not performed, most respondents answered that ICP monitoring was not helpful, as other signs were comparatively more important. Conclusion : The proportion of performing ICP monitoring in patients with sTBI was low in Korea. The outcome and mortality were compared between the patient groups with and without ICP monitoring, and no statistically significant differences were noted in prognosis between these groups. Further, the survey showed that ICP monitoring in patients with sTBI was somewhat negatively recognized in Korea.

• 한국심리학회지 : 문화 및 사회문제
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• 제23권2호
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• pp.215-237
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• 2017

의료사고 관련 연구들은 의료분쟁 및 피해구제와 관련한 법이론적 연구가 대부분이며 의료사고 환자들의 심리적 경험을 심층적으로 탐구한 연구는 부족한 실정이다. 이에 본 연구는 의료사고를 겪은 환자들의 외상후 스트레스 장애(Post Traumatic Stress Disorder: PTSD) 현황을 알아보고, 의료진의 설명 및 태도와 PTSD 증상의 관계에서 사회적 지지의 조절효과를 검증하였다. 의료사고 단체와 의료사고 관련 온라인 커뮤니티에서 모집된 총 180명의 의료사고 환자의 자료가 분석에 사용되었다. 분석 결과, 연구대상자 중 171명(95%)이 완전 PTSD 증상 수준으로 선별되었으며 다른 외상 경험자들과 비교해도 PTSD 증상의 심각도가 높은 것을 확인하였다. 또한 의료진의 설명 및 태도가 PTSD 증상에 미치는 주효과는 유의미하지 않았지만 의료진의 설명 및 태도와 PTSD 증상의 관계에서 사회적 지지 수준의 조절효과가 유의한 것으로 나타났다. 즉, 사회적 지지 수준이 높을 때는 의료진의 설명 및 태도에 따른 PTSD 증상의 유의미한 변화가 없었으나, 사회적 지지 수준이 낮을 때는 의료진의 설명 및 태도가 미흡할수록 PTSD 증상이 악화되었다. 이러한 연구 결과를 바탕으로 의료사고 환자들의 PTSD 증상을 완화하고 예방하는데 있어 심리적, 사회적, 제도적 방안들을 제언하였다. 마지막으로 본 연구의 제한점과 향후 연구 방향에 대해 논의하였다.

• Journal of Korean Neurosurgical Society
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• 제46권4호
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• pp.417-420
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• 2009

The purpose of this report is to describe our surgical experiences in the treatment of cerebral decompression with in situ floating resin cranioplasty. We included in this retrospective study 7 patients who underwent in situ floating resin cranioplasty for cerebral decompression between December 2006 and March 2008. Of these patients, 3 patients had traumatic brain injury, 3 cerebral infarction, and one subarachnoid hemorrhage due to aneurysmal rupture. In situ floating resin cranioplasty for cerebral decompression can reduce complications related to the absence of a bone flap and allow reconstruction by secondary cranioplasty without difficulty. Furthermore, it provides cerebral protection and selectively eliminates the need for secondary cranioplasty in elderly patients or patients who have experienced unfavorable outcome.

• The Korean Journal of Pain
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• 제7권2호
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• pp.263-269
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• 1994

Causaliga is a syndrome of sustained burning pain, allodynia and hyperpathia after a traumatic nerve lesion, often combined with vasomotor and sudomotor dysfunction and later trophic changes. Various treatments of causalgia contain sympathetic blockade, sympathectomy, transcutaneous electrical nerve stimulation, physical therapy, cryotherapy and psychotherapy. Repeated stellate ganglion blocks with 6ml of 0.25% bupivacaine provided good results for 2 patients. We recommand sympathetic blocks for treatment of causalgia.

• Archives of Plastic Surgery
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• 제32권5호
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• pp.671-673
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• 2005

Difficulties with intraoperative fixation of hair or eyebrow sometimes occur because of displacement or dislodgment of hair during surgery. So we have found that the simple application of a small transparent adhesive disposable dressing, such as $Tegaderm^{(R)}$ or OpSite $Flexigrid^{(R)}$, can prevent this. One of the advantages of this technique, compared with stapler fixation of the hair, is that it does not cause local trauma. An OpSite $Flexigrid^{(R)}$ or $Tegaderm^{(R)}$ is placed such that it covers both the scar and operation site hair. The hair or eyebrow were easily, quickly, and firmly positioned even on the nonshaved scalp. The technique seems to have no drawbacks, and when the $Tegaderm^{(R)}$ or Opsite $Flexigrid^{(R)}$ is removed, patient experiences little discomfort. We have never seen an allergic or direct traumatic cutaneous response following the use of these materials.