• Journal of Korean Neurosurgical Society
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• 제49권4호
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• pp.241-244
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• 2011

Sparganosis is a rare parasitic infection affecting various organs, including the central nervous system, especially the lumbar epidural space. This report describes the identification of disease and different strategies of treatments with preoperative information. A 42-year-old man presented with a 2-year history of urinary incontinence and impotence. He had a history of ingesting raw frogs 40 years ago. Magnetic resonance (MR) imaging showed an intramedullary nodular mass at conus medullaris and severe inflammation in the cauda equina. A 51-year-old woman was admitted with acute pain in the left inguinal area. We observed a lesion which seemed to be a tumor of the lumbar epidural space on MR imaging. She also had a history of ingesting inadequately cooked snakes 10 years ago. In the first patient, mass removal was attempted through laminectomy and parasite infection was identified during intra-operative frozen biopsy. Total removal could not be performed because of severe arachnoiditis and adhesion. We therefore decided to terminate the operation and final histology confirmed dead sparganum infection. We also concluded further surgical trial for total removal of the dead worm and inflammatory grannulation totally. However, after seeing another physician at different hospital, he was operated again which resulted in worsening of pain and neurological deficit. In the second patient, we totally removed dorsal epidural mass. Final histology and enzyme-linked immunosorbent assay (ELISA) confirmed living sparganum infection and her pain disappeared. Although the treatment of choice is surgical resection of living sparganum with inflammation, the attempt to remove dead worm and adhesive granulation tissue may cause unwanted complications to the patients. Therefore, the result of preoperative ELISA, as well as the information from image and history, must be considered as important factors to decide whether a surgery is necessary or not.

• Journal of Korean Neurosurgical Society
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• 제55권6호
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• pp.370-374
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• 2014

To present a case of cauda equina syndrome (CES) caused by chronic inflammatory demyelinating polyneuropathy (CIDP) which seemed clinically similar to Charcot-Marie-Tooth disease type1 (CMT1). CIDP is an immune-mediated polyneuropathy, either progressive or relapsing-remitting. It is a non-hereditary disorder characterized by symmetrical motor and sensory deficits. Rarely, spinal nerve roots can be involved, leading to CES by hypertrophic cauda equina. A 34-year-old man presented with low back pain, radicular pain, bilateral lower-extremity weakness, urinary incontinence, and constipation. He had had musculoskeletal deformities, such as hammertoes and pes cavus, since age 10. Lumbar spine magnetic resonance imaging showed diffuse thickening of the cauda equina. Electrophysiological testing showed increased distal latency, conduction blocks, temporal dispersion, and severe nerve conduction velocity slowing (3 m/s). We were not able to find genetic mutations at the PMP 22, MPZ, PRX, and EGR2 genes. The pathologic findings of the sural nerve biopsy revealed thinly myelinated nerve fibers with Schwann cells proliferation. We performed a decompressive laminectomy, intravenous IgG (IV-IgG) and oral steroid. At 1 week after surgery, most of his symptoms showed marked improvements except foot deformities. There was no relapse or aggravation of disease for 3 years. We diagnosed the case as an early-onset CIDP with cauda equine syndrome, whose initial clinical findings were similar to those of CMT1, and successfully managed with decompressive laminectomy, IV-IgG and oral steroid.

• 간호행정학회지
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• 제14권4호
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• pp.421-431
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• 2008

Purpose: Using comprehensive and valid instrument, MDS-HC 2.0, this study aimed to analyze the functional status and to evaluate the care needs of the community-dwelling disabled with cerebral impairment. Method: With a convenient sample of 88 disabled with cerebral impairment, the data were collected at a community health center located in rural area in Choongchung providence in August 2005. Subject's functional status and care needs were evaluated using Minimum Data Set-Home Care version 2.0. Result: Significant proportion of subjects were totally dependent for locomotion-outdoor (26.1%), personal hygiene (24.1%), bathing (24.1%). For IADLs, over 40% of subjects were totally dependent for ordinary house work, managing finances, or shopping. Top five ranked care needs were preventive health care measures (100%), communication disorders (71.6%), visual function (55.7%), health promotion (52.3%), and pressure ulcers (48.9%). The proportion of triggered clinical assessment protocols were significantly higher in disability level I group for the risk of institutionalization (p=<.001), communication disorders (p=.004), cognitive problems (p=.001), pressure ulcers (p=<.001), skin and foot conditions (p=.010), and urinary incontinence and indwelling catheters (p=<.001). Conclusions: It is necessary to provide community based rehabilitation services that are individualized for their service needs thus enhance optimal level of functioning.

• Journal of the Korean Data and Information Science Society
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• 제26권3호
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• pp.715-727
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• 2015

본 연구는 우리나라 요양병원의 간호인력 확보수준과 간호결과의 관련성을 파악하고 간호에 민감한 환자 결과를 알아봄으로써 요양병원의 적정 간호인력 확보에 대한 근거를 제공하기 위해 시행되었다. 자료는 건강보험심사평가원의 2012년 '요양병원 병원평가정보'를 바탕으로 분석하였다. 연구결과, 간호사 1인당 환자 수가 평균보다 많은 그룹에서 유치도뇨관 비율 (고위험군/저위험군)이 통계적으로 유의하게 높았다. 간호인력 1인당 환자 수가 평균보다 많은 그룹에서 일상생활수행능력이 감퇴한 환자비율 (치매환자군/비치매환자군), 요실금, 욕창이 새로 발생한 환자 (고위험군)비율이 통계적으로 유의하게 더 높았다. 그리고 요양병원의 등급이 향상될수록 입원환자의 간호결과가 더 좋아지는 것으로 나타났다. 이는 간호인력 확보수준이 높을수록 그리고 요양등급이 높을수록 환자의 간호결과에 긍정적인 영향이 나타난다는 결과이다. 따라서 요양병원에서 간호인력 수를 적정화시킬 수 있는 보다 강력한 정책적 접근이 필요하다는 것을 제안하는 바이다.

• 한방재활의학과학회지
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• 제25권3호
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• pp.119-125
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• 2015

A chronic subdural hematoma (CSDH) is an old collection of blood and blood breakdown products between the surface of the brain and its outermost covering. We present two cases with tibia fracture caused by traffic accident progressed to chronic subdural hematoma. A 72-year-old male patient had shown signs of headache, urinary incontinence and mental storm when he has been in the hospital after 3weeks without CSDH diagnosis. And a 78-year-old male patient with mild head injury suffered from right side headache after traffic accident. We took korean medical treatments associate with tibial fracture. And we knew subdural hematoma through Brain CT. It is good report which shows CSDH can can occur from traffic accident. It requires correct diagnosis and closed observation for traffic accident patients.

• 재활복지공학회논문지
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• 제12권1호
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• pp.46-52
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• 2018

본 연구는 65세 이상 도시거주 노인 107명을 대상으로 일반적 특성, 만성질환 상태, 낙상 관련 의학적 변수, 균형 관련 자신감, 신체적 능력, 우울감을 평가하는 도구를 통해 낙상에 영향을 미치는 관련 주 요인을 찾고자 하였다. 또한 유의한 차이가 있는 변수들 간의 상관관계를 파악하며, 이 중 낙상을 유발하는 데 높은 영향력이 있는 변수를 도출하여 예측력을 알아보았다. 연구 결과, 낙상군에서 요실금, 발의 통증, 하지근력약화, 만성 질환수 및 복용 약물수 빈도수가 비낙상군에 비해 통계적으로 유의하게 높았다. 또한 ABC (Activities-specific Balance Confidence) 총점, BBS (Berg Balance Scale) 총점, SGDS (Short Geriatric Depression Scale) 총점, FRT(Functional Reach Test) 값에서 통계학적으로 유의한 차이가 있었다. 낙상에 영향을 주는 주요인은 ABC 총점으로 점수가 낮을수록 낙상 위험이 높아짐으로써 균형능력에 대한 자기 확신감이 낮을수록 낙상의 가능성이 높아지는 것으로 나타났으며, ABC, SDGS, BBS 척도가 결합하여 적용될 경우 낙상군과 비낙상군을 구분하는 예측력은 70.1%로 높게 나타났다.

• 대한한의학방제학회지
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• 제11권1호
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• pp.45-55
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• 2003

From the study of the symptom, pathology in prescription of Ha-Tong from The Bangyakhapeun. I have reserched 163 prescription. It can be concluded as follows. 1. Prescription about Fecal disease which was the most as 11.66% of the whole, following order Internal disease(6.75%), Uterus Disease(5.52%) Sick-by-Cold Disease(5.52%), Eye Disease(4.91%), Blood Disease(4.91%), Unbalanced humoral status Disease(4.91%), Gynecologic Disease(4.91%). 2. The Fecal Disease divide diarrhea and dysentery; The Internal Disease divides with Sik-sang(食傷) Chu-sang(酒傷), Sik-juck-yu-sang-han(食積類傷寒), Carbonic acid, Vomiting acid; The Uterus Disease divides with Urinnary Disadvantage, Urinary retention, Incontinence; The Sick-by-Cold Disease divides with yang-myung-byung(陽明病), sang-han-goi-jng(傷寒壞證), sang-han-bun-gal(傷寒煩渴), sang-han-sum-ou, sang-han-hyul-jng(傷寒血證), sang-han-ja-ri(傷寒自利), sang-han-bun-jo-jng(傷寒煩燥證). 3. The Diarrhea and Dysentery many used o-ryung-san, hwng-gum-jak-yak-tang(黃芩芍藥湯) hyang-ryun-hwan(香連丸) etc, and The Internal Disease many used pyung-we-san(平胃散) as a basic prescripton. 4. The organ problem use the Sil-yuol(實熱) of the liver, stomach, lung, uterus, small intestine; six natural factors problem used the Sil-jng(實證) of the wind, fire, heat, cold, dampness; And used Unbalanced humoral status, lntrnal hurt, qi and blood, seven extream feeling.

• 대한간호학회지
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• 제43권2호
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• pp.145-153
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• 2013

Purpose: The purpose of this manuscript is to discuss the need for use of evidence based practice (EBP) in LTC, the current use of evidence in long term care facilities and what we know about adoption of the use of EBP in LTC. Methods: Literature review and reporting of findings from the M-TRAIN study that was a quasi-experimental design to test the effectiveness of an intervention to increase the use of EBPs for urinary incontinence and pain in 48 LTC facilities. Results: Barriers to adopting EBPs include lack of available time, lack of access to current research literature, limited critical appraisal skills, excessive literature to review, non-receptive organizational culture, limited resources, and limited decision-making authority of staff to implement change. Strategies to promote adoption of EBP include the commitment of management; the culture of the home; leadership; staff knowledge, time, and reward; and facility size, complexity, the extent that members are involved outside the facility, NH chain membership, and high level of private pay residents. Findings from the M-TRAIN add, stability of nurse leader and congruency between the leaders perception of their leadership and the staff's perception of the leadership. Conclusion: There is clear evidence of the need and the benefits to residents of LTC and to the health care system yet adoption of EBP continues to be slow and sporadic. There is also evidence for the process of establishing best evidence and many resources to find the available EBPs. The urgent need now is finding ways to best get the EBPs implemented in LTC. There is growing evidence about best methods to do this but continued research is needed. Clearly, residents in LTC deserve the best care possible and EBPs represent an important vehicle by which to do this.

• 센서학회지
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• 제9권4호
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• pp.256-267
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• 2000

본 논문에서는 뇨실금 환자들에 대한 지원 기술의 일환으로 인체에 무해하고 비침습적인 초음파를 이용하여 배뇨시기를 알려주는 뇨의 경보기용 뇨량검출 센서의 개발과 이를 이용한 방광 벽간거리와 뇨량과의 상관관계에 관하여 연구하였다. 개발된 센서의 중심 주파수는 2.25 MHz이며, 이는 인체내로의 침투력이 비교적 좋으면서도 분해능이 높아 오차를 감소시킬 수 있게 설계하였다. 이 센서를 이용하여 방광 전 후벽간의 거리를 검출하여 이로부터 뇨량을 정량적으로 측정하기 위한 기초 실험을 실시하였다. 기초실험은 건강한 성인 남자 3명을 대상으로 초음파 뇨량검출 센서를 이용한 초음파 RF 반사신호 획득장치와 초음파 진단기에 의한 2가지 방법으로 이루어졌고 그 결과 뇨량과 벽간거리와의 사이에는 높은 상관성이 있음을 확인할 수 있었다. 결론적으로, 실험 결과를 토대로 하여 제작된 초음파 뇨량검출용 센서는 뇨실금 환자로 하여금 배뇨시기를 알려주는 뇨의 경보 시스템으로 활용될 수 있으며, 보건 복지적인 측면에서 현대사회에 기여할 공헌도가 매우 클 것이라 생각된다.

• 한국임상수의학회지
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• 제26권2호
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• pp.185-188
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• 2009

6개월령의 보스톤 테리어가 미측 음경 돌출과 불완전 형성된 포피, 이분화된 음낭, 잠복고환과 음경골 이형성을 나타내었다. 신체검사상, 요도구멍은 회음부 표면에 위치하였고 섬유성 띠는 귀두로부터 회음부에 있는 요도구멍까지 연결되어 있었다. 또한, 잘못 위치한 요도구멍을 통한 상행성 감염에 의하여 요도염을 나타내었다. 교정수술은 외부생식기 전체와 잠복고환을 절제하기 위하여 시행되었다. 포피, 음경 그리고 잠복고환은 성공적으로 절제되었다. 수술 후 요도구멍을 주기적으로 세척하고 항생제를 투여한 이후, 재발성 요도염은 사라졌다. 만약, 요도구멍의 위치가 재발성 요도염의 원인과 요실금의 주요 원인이 아니라면, 요도구멍을 재형성할 필요가 없는 이 치료법을 이용할 것을 제안한다.