• 지역사회간호학회지
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• 제9권1호
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• pp.181-199
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• 1998

This study was designed to examine Home Nursing Care in Hospital-based and Community-based programs. This study investigates actual conditions of nursing needs and demands of clients and their family and the state of home nursing services. We hope that this study will improve upon the current home nursing care system. In Korea Home-Nursing Care programs are still developing and only now becoming a part of the health care delivery system. The data was collected by a questionaire the clients developed and modified through literature review by this writer and through 10 nurses who are members of 4 hospital and 3 community- based agencies. In this study 173 clients were selected. The study lasted from Oct. 1997 to March of 1998. The results show that the average age was 64.3, years older than most women clients (63.0%), the average age of a caregiver was 50.9 years old and most were female(77%). Two types of agency clients with a significant difference between social conditions [25.7%] used some form of insurance; 54.3% had the spouse pay expenses; pay 58.5% son and daughters of Hospital-based agencies: patients of social workers were 24.0%, the highest in the community agency. The condition of patients was 63.2% of the foley and nelaton catheter insertion at hospital based agencies. The range of nursing services offered is one of the highest among the 34 kinds of servies including nasogastric tube management basic nursing, ROM exercise, bladder irrigation, wound and sore dressing. For an effective care service factors that disturb each program such as a non-cooperatative family as well as patients themselves need to be lessened. Further more, the following must be emphasized, supportive counsel 27.0%, steady care for patient, 13.3%maintain a sense of security(11.7%), dressing sores and nutrition(10.0%). Although there were a large number of home nursing care services in the community, policy changes have gathered momentum. Fortunately, the scope and level at legal support will be increased in the future. The program should intergrate and link the district or community together. A project to develop a community based home nursing system as soon as possible should be developed. In conclusion, home nursing care nurses training curriculum should be strengthened.

• 대한소아치과학회지
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• 제35권3호
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• pp.532-538
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• 2008

Lesch-Nyhan 증후군은 드물게 나타나는 X 염색체 열성 유전 질환으로 purine의 대사 장애를 보이는 질환이다. Purine의 대사 장애는 대사에 관여하는 효소인 hypoxanthine guanine phosphoribosyl transferase의 결손 또는 활성 감소로 인하여 나타나며, 요산의 과다 생산에 의한 요산과다혈증, 요산과다뇨증 등의 신장계 증상과 정신지체, 무도증 등의 신경학적 장애를 보이고, 구강이나 손가락에 대한 자해를 나타낸다. 이 중 자해 행위는 입술과 혀, 손가락을 깨무는 경우가 흔하고, 심하면 혀와 손가락이 완전히 절단될 수도 있다. 이 경우 자해로 인한 통증뿐 아니라, 연조직 결손으로 인한 심미적인 문제와 상처 부위로의 2차 감염이 발생할 수 있다. 이러한 Lesch-Nyhan 증후군 환자에서 자해를 막기 위해 여러 방법이 사용되고 있는데, 이 중 치과적으로 접근하는 방법으로는 마우스 가드나 lip bumper 등의 장치를 이용하는 방법과 해당 치아들을 모두 발거하는 방법, 악교정 수술을 통해 개방 교합을 형성해 주는 방법 등이 있다. 본 증례는 13세 9개월의 Lesch-Nyhan 증후군 환아로서 자해에 의해 혀에 심각한 외상을 가한 경우로 마우스 가드를 이용한 보존적인 방법을 사용하였으나 계속적으로 혀에 외상을 가해 하악 전치 뿐 아니라 구치까지 발거하여 치료하였다.

• Asian Pacific Journal of Cancer Prevention
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• 제17권9호
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• pp.4381-4389
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• 2016

Background: Surgery is the corner stone for the management of rectal cancer. The purpose of this study was to demonstrate the optimal time of surgical resection after the completion of neoadjuvant chemo-radiotherapy (CRT) in treatment of locally advanced rectal cancer. Materials and Methods: This study compared 2 groups of patients with locally advanced rectal cancer, treated with neoadjuvant CRT followed by surgical resection either 6-8 weeks or 9-14 weeks after the completion of chemo-radiotherapy. The impact of delaying surgery was tested in comparison to early surgical resection after completion of chemo-radiotherapy. Results: The total significant response rate that could result in functional preservation was estimated to be 3.85% in group I and 15.4% in group II. Some 9.62% of our patients had residual malignant cells at one cm surgical margin. All those patients with positive margins at one cm were in group I (19.23%). There was less operative time in group II, but the difference between both groups was statistically insignificant (P=0.845). The difference between both groups regarding operative blood loss and intra operative blood transfusion was significantly less in group II (P=0.044). There was no statistically significant difference between both groups regarding the intra operative complications (P=0.609). The current study showed significantly less post-operative hospital stay period, and less post-operative wound infection in group II (P=0.012 and 0.017). The current study showed more tumor regression and necrosis in group II with a highly significant main effect of time F=61.7 (P<0.001). Pathological TN stage indicated better pathological tumor response in group II (P=0.04). The current study showed recurrence free survival for all cases at 18 months of 84.2%. In group I, survival rate at the same duration was 73.8%, however none of group II cases had local recurrence (censored) (P=0.031). Disease free survival (DFS) during the same duration (18 months) was 69.4 % for patients in group I and 82.3% for group II (P=0.429). Conclusions: Surgical resection delay up to 9-14 weeks after chemo-radiation was associated with better outcome and better recurrence free survival.

• Archives of Plastic Surgery
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• 제39권5호
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• pp.483-488
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• 2012

Background Pediatric hand burns are a difficult problem because they lead to serious hand deformities with functional impairment due to rapid growth during childhood. Therefore, adequate management is required beginning in the acute stage. Our study aims to establish surgical guidelines for a primary full-thickness skin graft (FTSG) in pediatric hand burns, based on long-term observation periods and existing studies. Methods From January 2000 to May 2011, 210 patients underwent primary FTSG. We retrospectively studied the clinical course and treatment outcomes based on the patients' medical records. The patients' demographics, age, sex, injury site of the fingers, presence of web space involvement, the incidence of postoperative late deformities, and the duration of revision were critically analyzed. Results The mean age of the patients was 24.4 months (range, 8 to 94 months), consisting of 141 males and 69 females. The overall observation period was 6.9 years (range, 1 to 11 years) on average. At the time of the burn, 56 cases were to a single finger, 73 to two fingers, 45 to three fingers, and 22 to more than three. Among these cases, 70 were burns that included a web space (33.3%). During the observation, 25 cases underwent corrective operations with an average period of 40.6 months. Conclusions In the volar area, primary full-thickness skin grafting can be a good indication for an isolated injured finger, excluding the web spaces, and injuries of less than three fingers including the web spaces. Also, in the dorsal area, full-thickness skin grafting can be a good indication. However, if the donor site is insufficient and the wound is large, split-thickness skin grafting can be considered.

• Archives of Plastic Surgery
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• 제41권4호
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• pp.387-393
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• 2014

Background Reconstruction of ischial pressure sore defects is challenging due to extensive bursas and high recurrence rates. In this study, we simultaneously applied a muscle flap that covered the exposed ischium and large bursa with sufficient muscular volume and a profunda femoris artery perforator fasciocutaneous flap for the management of ischial pressure sores. Methods We retrospectively analyzed data from 14 patients (16 ischial sores) whose ischial defects had been reconstructed using both a profunda femoris artery perforator flap and a muscle flap between January 2006 and February 2014. We compared patient characteristics, operative procedure, and clinical course. Results All flaps survived the entire follow-up period. Seven patients (50%) had a history of surgery at the site of the ischial pressure sore. The mean age of the patients included was 52.8 years (range, 18-85 years). The mean follow-up period was 27.9 months (range, 3-57 months). In two patients, a biceps femoris muscle flap was used, while a gracilis muscle flap was used in the remaining patients. In four cases (25%), wound dehiscence occurred, but healed without further complication after resuturing. Additionally, congestion occurred in one case (6%), but resolved with conservative treatment. Among 16 cases, there was only one (6%) recurrence at 34 months. Conclusions The combination of a profunda femoris artery perforator fasciocutaneous flap and muscle flap for the treatment of ischial pressure sores provided pliability, adequate bulkiness and few long-term complications. Therefore, this may be used as an alternative treatment method for ischial pressure sores.

• Journal of Trauma and Injury
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• 제22권1호
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• pp.5-11
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• 2009

Purpose: The mortality and the amputation rates due to vascular trauma remain high despite advanced vascular surgical techniques and supportive management. The clinical features of patients with vascular trauma have not been well studied in the Korean population. The aim of this study was to analyze the clinical characteristics of patients with vascular trauma and to develop a database and guidelines for improving the outcomes of treatment. Methods: The medical records of 37 patients with traumatic vascular injuries who had visited in an emergency center between January 2002 and December 2006 were retrospectively reviewed and statistically analyzed. Results: The mean age was 37.8 years, and the male-to-female ratio was 5.2 : 1. The mechanism of vascular trauma was penetrating in 18 patients and blunt in 19 patients. Upper extremities were most frequently injured (39.4%). The treatment methods were primary repair in 21 patients, exploratory laparotomies in 7, radiological interventions in 3, resections and graft interpositions of the pseudoaneurysm in 3, observations in 3 and a bypass graft in 1. Four out of the 37 patients died, and three of these who died had injuried abdominal vessels. Twenty-five of the patients recovered completely, four expired, seven had neuropathy in the course of treatement, one had his limb amputated, and one experienced wound necrosis. Conclusion: Peripheral vessel injuries are commonly accompanied by nerve, muscle, or tendon injuries. Patients without associated fractures or compartment syndrome had good prognosis. Although the time intervals from hospital arrival to definite treatment were the shortest among patients with blunt abdominal vascular injuries, three expired. Therefore, we offer a 'ritical pathway'to improve the outcomes of patients with blunt abdominal vascular injury.

• 대한간호학회지
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• 제26권3호
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• pp.591-604
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• 1996

The surgical hand scrub (SHS) is the single most important procedure in the prevention of post-operative wound infections and yet it remains the most violated of all infection control procedures. The purpose of this study was to gain an overview of SHS habits in operative th atre personnel and to determine knowledge and attitudes to identify whether there is a need for improvement. The subjects for this study included 79 doctors and 94 nurses working in the operative th atres of four hospitals in Incheon City and Kyungki Province. Related data were collected from July 25 to August 10, 1995 by the author. The data were analyzed using descriptive stat-istics and Chi-squre test. The results of the study are summarized as follows : 1. Nurses felt that they conducted SHS for a longer period of time than doctors did(X=20.1, P=.005). 2. Nurses and doctors had some knowledge of slip-ping rings off fingers and the length of nails, but they lacked knowledge on the duration of SHS, handwashing after an operation and on manicure. 3. There were many reasons given for insufficient SHS included : 1) because they were so busy (38%). 2) brushes were too harsh(19.7%). 3) operations were very simple(18.7%). 4) surgical latex gloves provide functional barrier(11.6%). 5) SHSs were troublesome(7.4%) 6) there were no clocks near the sinks(2.5%) and 7) the operative patients were administered antibiotics after operartion(2.1%). 4. Most of nurses and doctors considered SHS to be important in prevention against post operative infections. 5. Nurses were found to do a thorough SHS, but residents were found to neglect SHS. 6. Considering prevention against postoperative infections, most nurses and doctors considered aseptic techniques, environment-sanitary management and SHS more important than the use of antibiotics, the resistance of patients or the method of operation. 7. Half of the nurses and doctors(54.3%) considered surgical latex gloves to function well as a barrier. 8. Half of the nurses (56.4%) and doctors(51.9%) learned SHS as part of the curriculum in their school education and the rest(nurses : 95.7%, doctors : 74.7%) learned SHS as part of their In Service Education. In conclusion, these findings suggest a need to develop an educational program on surgical hand scrub and hospital infection control for surgical personnels, to install clocks near the hand scrub sinks, to consider a violation report for negligent surgical hand scrubs, and to develop a soft brush for hand scrubs in order to increase performance of the surgical hand scrub.

• 대한기관식도과학회:학술대회논문집
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• 대한기관식도과학회 1977년도 제11차 학술대회연제 순서 및 초록
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• pp.9.1-10
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• 1977

문명의 발달로 나날히 복잡해지는 사회 환경속에서 우리는 생명을 위협하는 수 많은 사고를 당하게 되며, 이럭 경우에 상기도를 유지하기 위한 기관절재술을 많이 시행하게 되는데, 때로는 기관협착등 이에 따른 여러가지 합병증을 유발하게 되는 경우가 있으며, 임상가들에게도 곤란한 문제를 갖어다 주고있다. 그러나 이러한 합병증은 수술방법의 개선과 항생제의 출현등으로 그 빈도가 많이 감소되기는 하였으나, 1969년 Lindholm은 술후성 기관협착증의 빈도를 1.5%내지 10%라고 했으며, 1969년 Donnelly, Mulder와 Rubush, 그리고 1971년 Andrew와 Pearson 등은 이들 원인의 대부분이 cuff 가 있는 기관삽입관이나, 기관케뉼(tracheal canula)의 부적합한 사용이나, 또는 감염에 의한 압박괴사(pressure necrosis)로 형성된다고 하였고, 협착부위로서 1972년 Bryce는 절개공(stoma)주위가 가장 많으며, 응급기관절개술시에 의사의 부정요법(mal-practice)도 원인이 될 수 있다고도 주의한 바 있다. 기관협착증의 치료로서 협착이 경미한 경우에는 일차적으로 세심한 관찰을 실시하면서 실리콘관(silicon tube)이나 스텐트(stent)를 사용하거나, 비강을 통한 삽관법(naso tracheal intubation)으로 기계적인 확장을 시도하며 (Schmiegelow, 1929, Montgomery, 1965), 육아조직이 형성되었을 경우에는 기관경검사하에서 이를 제거한 후에 steroid를 병용하는 편이 좋은데(Birck, 1970) 그밖에도 기관개찰술(Fenestration method, 백·홍 1974)이나 재수술(Revision)을 하기도 한다. 이러한 방법으로서도 치료가 불가능한 경우에는 그 협착 부분을 절제한 후에 단단문합술(End-to-End Anasto-mosis)을 시행하는 수도 있다. 저자들은 1967년 10월부터 1977년 3월까지 10연년간 세브란스병원에서 기관절개술을 받았던 1514례를 대상으로 일련의 조사를 실시하여 이들 중에서 기관협착증을 유발한 23례를 치료하였으며, 여기서 몇가지 지견을 얻었기에 보고하는 바이다.

• Archives of Plastic Surgery
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• 제38권5호
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• pp.699-702
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• 2011

Purpose: Venous stasis ulcer is the most severe form of chronic venous insufficiency and this commonly appears in the lower limb. Pharmacological therapy, reconstruction of the venous system, surgical management, cellular therapy and compression therapy are known as the treatments of venous stasis ulcer, but relapses are common, which make it a typical chronic wound. We report here on a case of recurrent venous stasis ulcer that healed with compression therapy without any other treatment. Methods: A 35-year-old man with a 13 years history of venous stasis had developed an ulcer on the distal third portion of the lower left limb which was developed 12-year before enrollment in this study. He had been treated with vacuum assist closure, 2 times of cell therapy and 3 times of skin graft for 8 years, but the lesion recurred. From November, 2008 compression therapy was done with the 3M $Coban^{TM}$ 2 Layer Compression System (3M, St. Paul, USA). The ulcer at that time was oval shaped and $3{\times}4$ cm in size. A comfort layer bandage was applied from the proximal phalanx of the great toe to the knee. A compression layer bandage was applied on the previous layer with it being overlapped one half the width of the comfort layer bandage. The dressing was changed every 4 days and the change was recorded with photography. Results: A total of 12 $Coban^{TM}$ 2 Layer Compression Systems were used. The size of the ulcer decreased to $2.5{\times}2.5$ cm in one month, to $2{\times}2$ cm in 2 months, it was $1{\times}1.8$ cm in size at 3 months and it completely healed in 4 months. Conclusion: The venous stasis ulcer was completely healed using the 3M $Coban^{TM}$ 2 Layer Compression System. This method was easy to apply, made the patient comfortable and it provided an excellent compression effect. As in the previous studies, this compression therapy has been proven to play an important role for the treatment and prevention of venous stasis ulcer.

• Journal of Chest Surgery
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• 제40권9호
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• pp.617-623
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• 2007

배경: 침습성 폐아스페르길루스증은 면역체계가 낮은 환자들에게 흔한 진균감염으로, 특히 백혈병으로 항암제 치료를 받고 있는 환자들에서는 항진균제 치료에 반응이 적은 것으로 알려져 있다. 저자들은 백혈병의 치료 중 합병된 폐아스페르길루스증에 대하여 모두 폐절제술을 시행하였으며, 그의 효과 등을 알아보고자 하였다. 대상 및 방법: 1998년 2월부터 2007년 4월까지 혈액암 질환의 진단과 함께 침습성 폐아스페르길루스증 진단을 받은 환자 14명을 대상으로 후향적인 검토를 하였다. 환자의 의무기록을 통해 혈액암(기저질환)의 종류와 그에 따른 치료, 침습성 폐아스페르길루스증의 진단방법, 수술 전 혈액학적 상태와 처치, 수술방법, 수술 후 합병증과 사망여부, 수술 후 폐아스페르길루스증의 재발현율 및 골수이식 여부 등을 조사하였다. 결과: 침습성 폐아스페르길루스증이 합병된 혈액암 환자 14명에서 모두 폐엽절제술이 시행되었다. 수술 후 1명의 환자에서 기관지흉막루가 발생되었으나, 기타 창상감염, 출혈 등의 위중한 합병증이나 수술 후 사망한 환자는 없었으며, 모두 백혈병치료를 지속할 수 있었다. 결론: 침습성 폐아스페르길루스증은 혈액암에 대한 치료 도중 종종 발생되는 위중한 질환이나, 폐엽절제술은 안전하며 효과적으로 혈액암의 치료를 유지시켜 줄 수 있는 치료법으로 생각한다.