Cobb

이은우,임정수,손민균,김봉옥 大韓再活醫學會 1998 Annals of Rehabilitation Medicine Vol.22 No.4

백내장 수술환자 진료결과들간의 관계 : 사전 연구를 중심으로 Pilot study

박은철,김한중,홍영재,조우현,손명세,임승정,강형곤,최윤정 한국의료QA학회 1998 한국의료질향상학회지 Vol.5 No.1

Background : This study was done to assess the relationship among multiple patient outcomes of cataract surgery perioperatively, 3-4 months and 12 months after surgery. The patient outcomes include changes in visual acuity(operated eye, better eye), visual function(VF-14), patient satisfaction, subjective satisfaction with vision, and subjective overall health status. Methods : For the assessment of relationship, prospective study was performed with 92 patients who had undergone either one or both eye cataract surgery by 3 ophthalmologists practicing at a university hospital. Patients were interviewed, and clinical data were obtained. Doctors were questioned with self-entered questionnaire forms. Medical record was examined to understand surgery process. The survey was conducted at 4 stages : preoperatively, perioperatively, postoperative 3-4 months, and postoperative 12 months. Results : The correlations within patient outcomes at 4 stages - the visual acuity of operated eye and that of better eye, patient satisfaction and VF-14, subjective overall health status and relative health status as against others - were found to be positively correlated. The change in the visual acuity of operated eye and better eye was correlated with VF-14 as well as with patient satisfaction. The change was also correlated with overall health status. However, the correlations between variables were decreased as the postoperative period got longer. Conclusion : As for the postoperative clinical patient outcomes, VF-14 is acted to linker between visual acuity - clinical outcomes and overall health status - endpoint outcomes. Therefore, VF-14 is the index of patient-sided and disease-specific outcome for cataract surgery.

백내장 수술환자의 진료결과에 미치는 요인 : 사전 연구를 중심으로 Pilot study

박은철,홍영재,임승정,강형곤,최윤정,김한중,조우현,손명세 한국의료QA학회 1998 한국의료질향상학회지 Vol.5 No.1

Backgroud : This study is to identify preoperative patient characteristics associated with a lack of improvement on one or more measures perioperatively, postoperative 3-4 months, and postoperative 12 months. Methods : For the assessment, prospective study was performed with 92 patients who had undergone either one eye or both eye cataract surgery by 3 ophthalmologists practicing at a university hospital. The criteria of improvement were (1) Snellen visual acuity, (2) a cataract-related symptom score(possible range: 0. 0 of 6 symptoms present or bothersome, to 18. all 6 symptoms very bothersome), and (3) VF-14 score - a measure of functional impairment in patient with cataract - (possible range: 0, inability to perform any of the applicable activities, to 100, no difficulty in performing any of the applicable activities). Results : Although 14 patients (15.2%) failed to improve on one or more of the outcome measures assessed, no one failed to improve on all three measures. Both eyes of surgery than one eye, preoperative cataract symptom score of 1-4, 5 or higher than 0 were associated independently with the increased likelihood of improvement (odds ratio 8.95, 7.16, 8.87 respectively). And the preoperative level of Snellen visual acuity was not associated with the likelihood of improvement Conclusion : We conclude that specific preoperative characteristics (both eyes, cataract symptom score) are independent predictors of patient outcome after cataract surgery,

기관지 방선균증의 임상 1례

이은영,장태원,정만홍,옥철호,이규원,손창배,이지숙,신은경,서정아,백종현,김영옥 고신대학교의과대학 2007 고신대학교 의과대학 학술지 Vol.22 No.2

Actinomycosis is a chronic suppurative infection, whitch infiltrates mucosa-associated tissues. Thoracic, pelvic and cervicofacial infections of actinomyces are not uncommon, but endobronchial actinomycosis is rarely reported. We report a case of a 29 year old man who presented with a recurrent pneumonia and chronic cough. Fiberoptic bronchoscopy revealed occlusion of the right. lower medio-basal segment bronchus with exophytic endobronchial mass. The diagnosis was confirmed histologically by demonstration of sulfur granules in the bronchoscopic biopsy of the mass. Intravenous administration of amoxacillin and clindamycin followed by oral amoxacillin and clindamycin therapy resulted in complete recovery.

정신과 폐쇄 병동 환경 평가에 영향을 미치는 임상변인 : 치료의 질적 향성을 위한 예비적 연구 The Preliminary Study for Promoting the Quality of Psychiatric Inpatient Treatment

서정석,류은정,이상미,한미희,최귀순,손인기,남범우 건국대학교 의과학연구소 2003 건국의과학학술지 Vol.13 No.-

Purpose: IS prelminary study was designed to assess the clinical variables influencing on the ward atmosphere in psychiatric closed ward and to promote the quality of psychiatric inpatient treatment. Method: 41 psychiatric inpatients were selected in Chung-ju hospital, Konkuk university. Ward Atmosphere Scale(W AS) was used to evaluate patients' perception of ward milieu. WAS score were compared among subgroups with respect to the clinical variables such as duration of admission, frequency of admission, and diagnosis. Results: Significantly, patients who have hospitalized for 1 month to 2 months reported lower score of WAS and patients who have hospitalized for longer than 2 months reported higher score of WAS. The relationship between educated levels and WAS score was not significant. First admitted patients reported significantly lower score of WAS. Bipolar patients reported significantly higher score of WAS and alcohol related patients reported significantly lower score of WAS. Conclusion: The 1st admitted patients, patients with alcohol problem and educated patients were had less satisfied with psychiatric closed ward. Thus, by considering these factors, more specified therapeutic approach and plan should be conducted.

갑상선 유두암이 병발된 가족성 대장 용종증 1예

백종현,소창배,이은영,이지숙,신은경,박은호,서정아,양재홍,송준영,박선자,박요한,최영식 고신대학교의과대학 2007 고신대학교 의과대학 학술지 Vol.22 No.2

Familial adenomatous polyposis (FAP) is an autosomal dominant syndrome, typically characterized by multiple colorectal adenomas and increased incidence of colorectal carcinomas if it is not treated. Moreover, a variety of extracolonic manifestation are seen. The prevalence of thyroid tumors developing in patients with FAP is about 1∼2%. Generally, papillary thyroid cancer indicates low mortality but ,however, as people get older, the cancer becomes more aggressive. So, the operation is required. Recently we experienced a case of FAP, presenting with papillary thyroid carcinoma, and reported with a brief review of literatures.

Bortezomib과 Dexamthasone으로 치료한 골수외 형질세포종 4예

백종현,이은영,장리라,손창배,신은경,서정아,이지숙,이호섭,이상민,신성훈,김양수 고신대학교의과대학 2007 고신대학교 의과대학 학술지 Vol.22 No.2

Despite the use of aggressive local and systemic treatment including autologous stem cell transplantation in multiple myeloma, extramedullary recurrences are common and the prognosis of these patients is poor. Many novel drugs such as thalidomide, lenalidomide and bortezomib improve the response of treatment of multiple myeloma, but some reports failed to describe thalidomide has effect in extramedullary plasmacytoma. Recent data report on the successful treatment plasmacytomas with bortezomib in patients with advanced multiple myeloma. We treated 4 relapsed or refractory extramedullary plasmacytomas with bortezomib at our institution. We recognized all these extramedullary plasmacytomas decreased and showed more than partial response. This report lends support to the efficacy of bortezomib in the treatment of plasmacytoma and describes the safe use of bortezomib. Responses may, however, be of short duration. Therefore, despite our limited experience, we propose that bortezomib may be considered a therapeutic option for such patients who have risk of radiation therapy

백내장 환자의 시기능지표 : 사전 연구를 중심으로 Pilot study

강형곤,박은철,최윤정,김한중,홍영재,조우현,손명세,임승정 한국의료QA학회 1998 한국의료질향상학회지 Vol.5 No.1

Background : There is increased recognition that rigorous approach to functional assessment will complement the assessment of clinical status. This study is to develop the appropriate visual function index in Korean patients with cataracts by the assessment of the reliability, validity of visual function indexes including VF-14. Methods : An prospective study was performed with 92 patients who had undergone either one eye or both eye cataract surgery by 3 ophthalmologists practicing at a university-hospital. Patients were interviewed, and clinical data were obtained. Doctors were questioned with self-entered questionnaire forms. Medical record was examined to understand surgery-process. The survey was conducted at 1-2 days before cataract surgery. Results : We used following measures : 7 visual function indexes, global measures of patients' trouble and satisfaction with vision, and best-corrected visual acuity (VA) in each eye. 7 visual function indexes showed a high internal consistency reliability (Cronbach's alpha coefficients ≥0.86). The better visual acuity(operated eye. better eye), the higher patient satisfaction with vision, the lower symptom score, the lower patient trouble with vision was correlated with preoperative visual function index scores. Among 7 indexes, VF-12 with the exclusion of 2 items drivings from VF-14 is a high Cronbach's alpha coefficient and correlation coefficient and the highest R². Conclusion : We conclude that VF-12 is reliable and valid in Korea. So we suggest that in Korea, all items of VF-14, the visual function index, which is in use internationally, ought to be surveyed and VF-12 which has been excluded by 2 items of drivings from VF-14 ought to beused for analysis.

소아에서의 급성 파종성 뇌척수염의 임상적 고찰

조수진,박은애,유은선,김혜순,손세정,서정완,이승주,한후재 이화여자대학교 의과대학 2003 EMJ (Ewha medical journal) Vol.26 No.2

목적: 급성 파종성 뇌척수염은 감염이나 예방 접종 후 발생하는 중추 신경계의 급성 자가 면역 염증성 질환으로 탈수초를 일으킨다. 신경학적인 증상으로 발현되고 대부분 환전히 회복되지만 신경학적 후유증을 남기거나 사망 할 수도 있다. 이에 저자들은 본원에서 발생 한 14명을 분석하여 조기 진단과 치료에 도움을 주고자 하였다. 대상과 방법: 1998년 3월부터 2003년 8월까지 이대목동병원에서 급성 파종성 뇌척수염으로 진단 받은 14명의 의무기록을 후향적으로 조사하였다. 결과: 환자들의 평균 발생 연령은 5±7.8개월이였고, 특정계절이나 연도에 집중되어서 나타나지는 않았다. 선행질환은 주로 비특이적인 상기도 감염이 가장 많았고, 초기증상으로는 경련이 가장 많았다. 그 외에 의식저하나 운동장애도 있었다. 뇌척수액 검사에서 백혈구 증가증이 발견된 경우는 있었으나 단백이 증가된 경우는 없었다. 뇌 자기공명 촬영에서 T2 증강시 뇌백질과 기저핵에 고음영의 다발성 병소가 발견되었고 추적 촬영에서 대부분에서 소실되었다. 뇌파 검사가 시행되었던 경우 전반적인 서파가 가장 많았고 국소적인 극파가 나온 경우도 한 명 있었다. 환자들은 정맥 면역 글로블린과 메틸프레드니졸론으로 치료하였고 치료 시작 후 3~7일내 증상이 호전되었다. 모든 환자를 2달 이상 추적 관찰하였고 항경련제가 지속적으로 필요한 정도의 경련성 질환이 두 명, 신경아교증이 남아잇는 경우가 한 명, 외래에서 다발성 경화증이 의심되는 경우가 한 명 있었다. 결론: 급성 파종성 뇌척수염은 침범 부위에 따라서 다양한 임상 상으로 나타나며 면역 글로블린과 메틸프레드니졸론이 치료에 효과적이였다. 본 연구에서는 대상 환자수가 적어 신경학적 후유증의 위험요소는 밝힐 수는 없으나, 예후는 검사소견과 연관되어 있지는 않았고, 대부분에서 양호하여 완전히 회복되었으나, 신경학적 후유증이 남은 경우도 있었다. Objective:Acute disseminated encephalomyelitis(ADEM) is an acute demyelinating autoimmune inflammatory disease of the central nervous system which develops after infection of vaccination. It may be fatal, and produce a permanent residual static disability or fully recover. We retrospec-tively studied 14 cases to investigate the clinical findings and outcome of ADEM. Methods : 14cases of ADEM diagnosed at Ewha Womans University Mokdong Hospital from 1998 to 2003 were retrospectively reviewed. Results : The age of onset was 5years±7.8 months and no seasonal clustering was found. The time of onset of symptoms was between 3 to 30 days. The preceding events were nonspecific upper respiratory infections in 9 cases, aseptic meningitis in 4 cases, and gastroenteritis in one case..The initial symptoms were seizure, altered consciousness, hemiparesis, fever, headache, and vomiting. Brain MRI showed multifocal high signal intensity lesions on T2 weighted image mainly in the cerebral whith matter, basal ganglia and periventricular white matter. EEG was performed in some cases and showed generalized or focal slow waves and only one case showed focal spikes. Patients were treated with IV globulin and methylprednisolone and the symptoms improved within 3-7 days after treatment. All patients were followed up for more than 2 months and most of them fully recovered except two. Conclusion : ADEM presents in various clinical manifestations depending on its involvement of the brain lesions. Most cases recovered fully but in some cases, residual permanent neurologic sequelae remained.

내측 측두엽 간질에서 간질발작 중 언어증상

이장준,이승환,이형,김지언,임정근,손은익,이상도,박영춘 계명대학교 의과학연구소 2000 계명의대학술지 Vol.19 No.1

Background and Objectives : Several speech manifestation are observed in temporal lobe epilepsy(TLE). We studied the frequency of ictal speech manifestations and their localizing and lateralizing value in TLE. Methods : We reviewed 379 seizures recorded on videotape in 135 patients who underwent temporal lobectomy for intractable TLE. We divided patients into group A(n=75) who became seizures free after surgery, and group B(n=60) who were only slightly benefited or unchanged after surgery. Speech manifestations were classified as normal speech, vocalization, or abnormal speech. Abnormal speech was subdivided into speech arrest, dysarthria, dysphasia, or nonidentifiable speech. Results : Speech manifestations occurred in 70(18.5%) seizures of 28 patients. Forty eight seizures of 20 patients were observed in group A, and 22 seizures of 8 patients were observed in group B. In group A, 25 seizures of 11 patients were originating from dominant hemisphere, 23 seizures of 9 patients from nondominant hemisphere. In group B, 13 seizures of 5 patients were originating from dominant hemisphere, and 9 seizures in Lt. side and 6 seizures in Rt. side, respectively) of group A(P>0.05), and eleven seizures of 4 patients(8 seizures from Lt. side and 3 seizure from Rt. side) in group B(P>0.05). Normal speech was observed only seizures from Rt. side in both groups(3 seizures in 1 patient, each group). Dysphasia occurred only in seizures originating from Lt. side. Nonidentifiable speech occurred in 22 seizures of 9 patients(11 seizures from each side) in group A(P<0.01), and 3 seizures of 1 patient occurred only from Lt. side in group B. Conclusion : Ictal speech manifestations were not uncommon(18.5%). All kinds of ictal speech manifestations except normal speech have no reliable lateralizing and localizing value in TLE. Normal speech could be a good indicator of seizure originating from nondominant hemisphere.