Tympanometry and CT Measurement of Middle Ear Volumes in Patients with Unilateral Chronic Otitis Media

안재윤,박홍주,박가현,정용수,곽희붕,이여진,신정은,문원진 대한이비인후과학회 2008 Clinical and Experimental Otorhinolaryngology Vol.1 No.3

Objectives. The goals of the study were to compare the middle ear (ME) volumes from both normal and lesioned ears, and these ME volumes were measured by a digital image processing computed tomography (CT) program in patients with unilateral chronic otitis media, and we wanted to compare the ME volumes of the lesioned ears by comparing the ME volumes obtained by tympanometry with those ME volumes measured by the digital image processing CT program. Methods. Forty-four patients who had unilateral chronic otitis media (COM) and contralateral normal tympanic membranes (TM) and 100 subjects with normal TMs were included in the study. The normal volumes of the external auditory canal (EAC) were measured in the normal group. The tympanometric ME volumes in the ears with a perforated TM were calculated as the difference of the tympanometric volumes measured from the both ears in patients with unilateral COM. The CT ME volumes were measured by a digital image processing program. Results. The tympanometric volumes of the EACs in the ears with normal TMs were 1.4±0.3 mL. There were no significant differences according to gender, age and the side of the face the ear was on. The tympanometric volumes of the EAC in the normal-side ear of the patients with unilateral COM showed no significant differences when compared with those from the normal group. The ME volumes of the intact ears, as measured by CT, showed significantly higher values than those ME volumes of the lesioned ears. The ME volumes of the lesioned ears, as measured by tympanometry, showed a strong, significant linear correlation with those ME volumes calculated by CT; however, the ME volumes of the lesioned ears, as measured by tympanometry (1.5±1.4 mL), were significantly larger than those ME volumes measured by CT (1.1±0.8 mL). Conclusion. Our results show that chronic otitis media causes reduced ME volumes compared to those ME volumes of the contralateral normal ears. Tympanometry can provide a valuable estimation of the ME volumes in chronic ears, although it tends to overestimate the ME volumes, and especially for the ears with a larger ME volume. Objectives. The goals of the study were to compare the middle ear (ME) volumes from both normal and lesioned ears, and these ME volumes were measured by a digital image processing computed tomography (CT) program in patients with unilateral chronic otitis media, and we wanted to compare the ME volumes of the lesioned ears by comparing the ME volumes obtained by tympanometry with those ME volumes measured by the digital image processing CT program. Methods. Forty-four patients who had unilateral chronic otitis media (COM) and contralateral normal tympanic membranes (TM) and 100 subjects with normal TMs were included in the study. The normal volumes of the external auditory canal (EAC) were measured in the normal group. The tympanometric ME volumes in the ears with a perforated TM were calculated as the difference of the tympanometric volumes measured from the both ears in patients with unilateral COM. The CT ME volumes were measured by a digital image processing program. Results. The tympanometric volumes of the EACs in the ears with normal TMs were 1.4±0.3 mL. There were no significant differences according to gender, age and the side of the face the ear was on. The tympanometric volumes of the EAC in the normal-side ear of the patients with unilateral COM showed no significant differences when compared with those from the normal group. The ME volumes of the intact ears, as measured by CT, showed significantly higher values than those ME volumes of the lesioned ears. The ME volumes of the lesioned ears, as measured by tympanometry, showed a strong, significant linear correlation with those ME volumes calculated by CT; however, the ME volumes of the lesioned ears, as measured by tympanometry (1.5±1.4 mL), were significantly larger than those ME volumes measured by CT (1.1±0.8 mL). Conclusion. Our results show that chronic otitis media causes reduced ME volumes compared to those ME volumes of the contralateral normal ears. Tympanometry can provide a valuable estimation of the ME volumes in chronic ears, although it tends to overestimate the ME volumes, and especially for the ears with a larger ME volume.

사지마비와 식욕부진을 호소하는 길랑바레 증후군 환자의 한방치료 증례보고 1례

안재윤,심상송,정솔,신용진,문병순,윤종민 대한한방내과학회 2020 大韓韓方內科學會誌 Vol.41 No.5

Objective: This case study reports improvement in a case of Guillain-Barre Syndrome by Korean medicine treatment in a patient with quadriplegia and anorexia. Methods: A 79-year-old woman diagnosed with Guillain-Barre Syndrome was treated with acupuncture, electroacupuncture, Bojungikgi-tang-gami, cupping, moxibustion, and rehabilitation. Her clinical symptoms were measured with the Manual Muscle Test (MMT), Modified Barthel Index (MBI), Functional Independence Measurement (FIM), and the EuroQol five-dimensional descriptive system (EQ-5D-5L). Results: After treatment, improvements in the MMT, MBI, FIM, and EQ-5D-5L were observed and her anorexia decreased. Conclusion: Korean medicine treatment appeared to be effective in the treatment of a patient with Guillain-Barre Syndrome with quadriplegia and anorexia.

임상 전 의학전문대학원생을 대상으로 한 기본심폐소생술 교육 후 지식 및 술기 수행능력의 6개월 전후 비교

안재윤,박정배,서강석,정제명,류현욱,강성원,최규일,김윤정 대한응급의학회 2009 대한응급의학회지 Vol.20 No.5

Purpose: The following study was performed to compare basic life support (BLS) skills and knowledge over a 6 months interval in preclinical medical students. Methods: Upon initial instruction, 112 first-year medical students at a teaching hospital were given instructions in BLS, their knowledge performance was evaluated by written test and skills test via checklist designed by instructors and PC SkillReporting System (Laerdal, Norway). Their performance was re-evaluated 6 months after initial BLS training in an identical fashion. Evaluation was performed on 103 out of 112 students who had taken initial BLS training. Results: The results of written test showed that the students evaluated right after taking initial BLS training have better knowledge of BLS compared to students evaluated 6 months after taking initial BLS training (p<0.001). Results of skills test evaluated by checklist showed decrease in adequate performance of students evaluated 6 months after BLS education in 12 out of 18 items compared to students who have just received initial BLS training. The decreases were statistically significant in 6 items. Total scores after 6 months were also lower compared with initial scores (p<.0.001). The results of the skills test using PC Skill Reporting System demonstrated that the percentage of adequate ventilation volume, compression rate, hands-off time, and hand position were each 18.4%, 46.6%, 47.6%, 84.2% initially and 5.8%, 32.0%, 32.0%, 76.1% at 6 months after initial training. Students performed significantly worse 6 months post training in 4 out of 7 items (p<0.05). Conclusion: Knowledge and skills of preclinical medical students decreased significantly after a 6 month period compared to knowledge and skills after initial training. Therefore, retraining of BLS is required within 6 months, but more study is required to determine appropriate intervals and methods of retraining.

New Intervention Model of Regional Transfer Network System to Alleviate Crowding of Regional Emergency Medical Center

안재윤,류현욱,박정배,김종건,이미진,김종연,신상도,차원철,서준석,김영애 대한의학회 2016 Journal of Korean medical science Vol.31 No.5

Emergency department (ED) crowding is a serious problem in most tertiary hospitals in Korea. Although several intervention models have been established to alleviate ED crowding, they are limited to a single hospital-based approach. This study was conducted to determine whether the new regional intervention model could alleviate ED crowding in a regional emergency medical center. This study was designed as a “before and after study” and included patients who visited the tertiary hospital ED from November 2011 to October 2013. One tertiary hospital and 32 secondary hospitals were included in the study. A transfer coordinator conducted inter-hospital transfers from a tertiary hospital to a secondary hospital for suitable patients. A total of 1,607 and 2,591 patients transferred from a tertiary hospital before and after the study, respectively (P < 0.001). We found that the median ED length of stay (LOS) decreased significantly from 3.68 hours (interquartile range [IQR], 1.85 to 9.73) to 3.20 hours (IQR, 1.62 to 8.33) in the patient group after implementation of the Regional Transfer Network System (RTNS) (P < 0.001). The results of multivariate analysis showed a negative association between implementation of the RTNS and ED LOS (beta coefficient -0.743; 95% confidence interval -0.914 to -0.572; P < 0.001). In conclusion, the ED LOS in the tertiary hospital decreased after implementation of the RTNS.

응급실에서 자의 퇴원을 요구하는 환자에 대한 최선의 진료 지침

안재윤,류현욱,최한주,김형일,정진우,배현아 대한응급의학회 2021 대한응급의학회지 Vol.32 No.1

Discharge against medical advice remains a problematic issue worldwide because it may not only lead to adverse medical outcomes for the patients but also medicolegal problems for emergency physicians. Recently, there have been cases in Korea in which a patient in the emergency room, who had been discharged from hospital without following medical instructions, filed a lawsuit against the hospital and emergency medical staff for their responsibility for their worsening disease since discharge. The court acknowledged the responsibility of the medical staff. To minimize the legal risk and reach the optimal ethical standard for these patients, this paper suggests the best practice guideline for the emergency physicians for patients who request discharge against medical advice from the emergency department in Korea.

Epidemiological and Survival Trends of Pediatric Cardiac Arrests in Emergency Departments in Korea: A Cross-sectional, Nationwide Report

안재윤,이미진,김현,윤한덕,장혜영 대한의학회 2015 Journal of Korean medical science Vol.30 No.9

Cardiac arrest (CA) in children is associated with high mortality rates. In Korea, cohort studies regarding the outcomes of pediatric CAs are lacking, especially in emergency departments (EDs) or in-hospital settings. This study was conducted to examine the trends in epidemiology and survival outcomes in children with resuscitation-attempted CAs using data from a cross-sectional, national, ED-based clinical registry. We extracted cases in which cardiopulmonary resuscitation and/or manual defibrillation were performed according to treatment codes using the National Emergency Department Information System (NEDIS) from 2008 to 2012. The total number of ED visits registered in the NEDIS during the 5-yr evaluation period was 20,424,530; among these, there were 2,970 resuscitation-attempted CAs in children. The annual rates of pediatric CAs per 1,000 ED visits showed an upward trend from 2.81 in 2009 to 3.62 in 2012 (P for trend = 0.045). The median number of estimated pediatric CAs at each ED was 7.8 (25th to 75th percentile, 4 to 13) per year. The overall rates for admission survival and discharge survival were 35.2% and 12.8%, respectively. The survival outcome of adults increased substantially over the past 5 yr (11.8% in 2008, 11.7% in 2010, and 13.6% in 2012; P for trend = 0.001); however, the results for children did not improve (13.6% in 2008, 11.4% in 2010, and 13.7% in 2012; P for trend = 0.870). Conclusively, we found that the overall incidence of pediatric CAs in EDs increased substantially over the past 5 yr, but without significantly higher survival outcomes.

Impact of the COVID-19 outbreak on adult out-of-hospital cardiac arrest outcomes in Daegu, South Korea: an observational study

안재윤,류현욱,조재완,김정호,이상훈,Tae Chang Jang 대한응급의학회 2021 Clinical and Experimental Emergency Medicine Vol.8 No.2

Objective This study aimed to compare the outcomes of adult out-of-hospital cardiac arrest (OHCA) before and after the coronavirus disease 2019 (COVID-19) outbreak in a large metropolitan city. Methods This before-and-after observational study used a prospective citywide OHCA registry. Adult patients with emergency medical service-treated OHCA, with presumed cardiac etiology, pre- and post-COVID-19 outbreak were enrolled. The study period spanned 2 months, starting from February 18, 2020. The control period was 2 months from February 18, 2019. The primary and secondary outcomes were good neurologic outcome and survival to hospital discharge, respectively. The association between the COVID-19 outbreak and OHCA outcomes was assessed using multivariable logistic regression analysis. Results This study analyzed 297 OHCA patients (control period, 145; study period, 152). The bystander cardiopulmonary resuscitation rates were 64.8% and 60.5% during the control and study periods, respectively. Response and on-scene times increased by 2 minutes, supraglottic airway use increased by 35.6%, and mechanical chest compression device use increased by 13% post-COVID-19 outbreak. Good neurologic outcome was significantly lower during the study period in overall OHCAs (adjusted odds ratio, 0.23; 95% confidence interval, 0.05–0.98) and in witnessed OHCAs (adjusted odds ratio, 0.14; 95% confidence interval, 0.02–0.90). No significant difference was found in the survival to hospital discharge of OHCA patients between the two periods. Conclusion During the COVID-19 pandemic, the response and on-scene times were longer, and good neurologic outcome was significantly lower than that in the control period.

Sustained Release of Stem Cell-Derived Extracellular Vesicles for Skin Rejuvenation by Using Hyaluronic Acid-Based Hydrogel as a Dermal Filler

안재윤,파록루,박재형 한국고분자학회 2022 한국고분자학회 학술대회 연구논문 초록집 Vol.47 No.2

황달을 동반한 알코올성 간질환 환자의 한방치료 치험 1례

안재윤,심상송,정솔,신용진,김강산,문병순,윤종민,Ahn, Jae-yoon,Sim, Sang-song,Jeong, Sol,Shin, Yong-jeen,Kim, Kang-san,Moon, Byung-soon,Yun, Jong-min 대한한방내과학회 2021 大韓韓方內科學會誌 Vol.42 No.5

Objective: This study aimed to report a case of alcoholic liver disease with jaundice that was improved with Korean medicine treatment. Methods: A patient who developed jaundice due to continuous drinking was treated with herbal medicine, acupuncture, moxibustion, and cupping. Blood tests were performed to measure the levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma glutamyl transpeptidase (γ-GTP), total bilirubin, albumin, and total protein; AST/ALT ratio; and mean corpuscular volume (MCV). Jaundice parameters were subjectively recorded at 3-day intervals. Results: After treatment, the AST, ALT, ALP, γ-GTP, and total bilirubin levels; MCV; and jaundice were decreased. Conclusion: Korean medicine treatment appeared to be an effective method for alcoholic liver disease with jaundice.

빗물 재활용을 위한 모래 정화층의 폐색특성을 고려한 비점오염원 제거 예측 모델 연구

안재윤,이동섭,한신인,정영욱,최항석 한국지반공학회 2014 한국지반공학회논문집 Vol.30 No.6

An artificial rainwater reservoir installed in urban areas for recycling rainwater is an eco-friendly facility for reducingstorm water effluence. However, in order to recycle the rainwater directly, the artificial rainwater reservoir requires anauxiliary system that can remove non-point source pollutants included in the initial rainfall of urban area. Therefore,the conventional soil filtration technology is adopted to capture non-point source pollutants in an economical and efficientway in the purification system of artificial rainwater reservoirs. In order to satisfy such a demand, clogging characteristicsof the sand filter layers with different grain-size distributions were studied with real non-point source pollutants. Forthis, a series of lab-scale chamber tests were conducted to make a prediction model for removal of non-point sourcepollutants, based on the clogging theory. The laboratory chamber experiments were carried out by permeating two typesof artificially contaminated water through five different types of sand filter layers with different grain-size distributions. The two artificial contaminated waters were made by fine marine-clay particles and real non-point source pollutantscollected from motorcar roads of Seoul, Korea. In the laboratory chamber experiments, the concentrations of the artificialcontaminated water were measured in terms of TSS (Total Suspended Solids) and COD (Chemical Oxygen Demand)and compared with each other to evaluate the performance of sand filter layers. In addition, the accumulated weightof pollutant particles clogged in the sand filter layers was estimated. This paper suggests a prediction model for removalof non-point source pollutants with theoretical consideration of the physical characteristics such as the grain-sizedistribution and composition, and change in the hydraulic conductivity and porosity of sand filter layers. The lumpedparameter θ related with the clogging property was estimated by comparing the accumulated weight of pollutant particlesobtained from the laboratory chamber experiments and calculated from the prediction model based on the clogging theory. It is found that the lumped parameter θ has a significant influence on the amount of the pollutant particles clogged in the pores of sand filter layers. In conclusion, according to the clogging prediction model, a double-sand-filter layerconsisting of two separate layers: the upper sand-filter layer with the effective particle size of 1.49 mm and the lowersand-filter layer with the effective particle size of 0.93 mm, is proposed as the optimum system for removing non-pointsource pollutants in the field-sized artificial rainwater reservoir.