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김현숙,서혜수,송인제,손진욱 대한생물치료정신의학회 1997 생물치료정신의학 Vol.3 No.1
만성화된 환자들이 주로 입원하여 있는 대형정신병원에서 수면제의 처방에 영향을 미치는 요소들을 조사해 보고자 하였다. 1996년 10월 2일 국립부곡정신병원에 입원해 있는 환자 402명을 대상으로 병록지조사를 통해 입원시부터 조사당일까지의 수면제 사용을 조사였다. 담당의사의 routine order에 의한 수면제 처방의 여부, 담당의사의 p.r.n. order에 의한 처방 여부, 당직의사에 의한 수면제 처방 여부를 조사하여 환자의 나이, 성별, 진단, 입원횟수, 유병기간, 담당의사의 정신과 근무 연수 등의 변수에 따라 비교해 다음과 같은 결과를 얻었다. 1) 207명(51.5%)이 재원기간동안 최소한 일회 이상 수면제를 복용하였고, 195명(48.5%)은 수면제를 복용한 적이 없었다. 2) 담당의사의 routine order에 의한 수면제 처방의 빈도는 남자에 비해 여자에서 높았다. 3) 담당의사의 routine order에 의한 수면제 처방의 빈도는 전문의가 담당의사인 환자군에서 높았다. 4) 담당의사의 p.r.n. order에 의한 수면제 처방의 빈도는 전공의 1년차가 담당하는 환자나 전문의가 담당하는 환자에서 높았다. 5) 연령, 진단, 유병기간, 입원횟수 등은 수면제 처방의 빈도와 유의한 관계가 없었다. 이상의 결과를 통해 국립부곡정신병원의 입원환자에서 수면제의 처방이 환자의 성별과 담당의사의 정신과 근무 연수와 관계됨을 알 수 있었다. The purpose of this study was to investigate the factors that were associated with the prescription of hypnotics in inpatients of a large mental hospital. The medical records were reviewed in 402 inpatients who were admitting in Bugok National Mental Hospital at October 2, 1996. The results were as follows: 1) Fifty-one percent of the whole group received a hypnotics at least once during hospitalization. 2) The prescription of hypnotics by routine order of doctor in charge was more frequent in female patients than male patients. 3) The prescription of hypnotics by routine order of doctor in change was more frequent in patients whose doctor in charge was a psychiatric specialist than patients whose doctor in charge was a psychiatric resident. 4) The prescription of hypnotics by p.r.n. order of doctor in charge was more frequent in patients whose doctor in charge was a first-year psychiatric resident or a psychiatric specialist than a second, a third, or a forth-year psychiatric resident. 5) Age, duration of illness, frequency of admission, and diagnosis were not significantly associated with frequency of hypnotics prescription. These findings suggest that the prescription of hypnotics in inpatients of Bugok National Mental Hospital was positively associated with patient's sex and duration of service of doctor in charge.
요추부 후방 골유합술시 제4요추 분절동맥의 손상에 의해 발생된 후복막하 혈종의 코일 색전술 치험 1례
이방훈,염진영,최승원,김선환,고현송 대한척추신경외과학회 2004 Neurospine Vol.1 No.1
In spine sugery, iatrogenic vascular injury is unusual, and most common vascular injury is said to be a tear of the left common iliac artery. We report a case of retroperitoneal hematoma from lumbar segmental artery injury after posterior lumbar fusion and pedicle screw fixation. This 60-year-old woman presented with 6 months history of low back pain and radiating pain to the left lower leg. She complained of claudication after 10 meters walking due to spondylolisthesis and spinal stenosis at L2-L5 level. She underwent multiple total laminectomy, posterior lumbar inter-body fusion, and transpedicular screw at L2-L5. During operation there was not evidence of complications such as bleeding. She complained of abdominal pain on post-operation I day and showed tenderness on left upper quadrant. Hemoglobin was 8.4 g/dL on postoperative laboratory examination. Abdominal CT scan revealed retroperitoneal hematoma. We performed angiography for evaluation of hematoma and found extravasation of dye at segmental artery of L4 level. We embolized the bleeding artery with coil successfully. Her postoperative abdominal pain and tenderness were relieved after then and discharged without pain or neurological deficit.
캡슐내시경과 단일풍선 소장내시경으로 진단된 공장의 간질종양 1예
송도경,심기남,태정현,김경진,송명은,송하응,윤혜원,정가영,정정화 이화여자대학교 의과학연구소 2012 EMJ (Ewha medical journal) Vol.35 No.2
Gastrointestinal stromal tumors (GISTs) are common mesenchymal tumors that arise in the wall of the gastrointestinal tract. We report a case of obscure gastrointestinal bleeding due to a GIST of the jejunum successfully documented by videocapsule endoscopy (VCE) and single-balloon enteroscopy (SBE). A 36-year-old man with hematochezia was referred for further evaluation of no evidence of bleeding focus on esophagogastroduodenoscopy and colonoscopy. A VCE showed a suspicious ulcerative hyperemic mass that located in about 1 hour apart from duodenal second portion. SBE revealed a nonbleeding 4×2 cm mass with an ulcer at the proximal jejunum. The patient underwent laparoscopic resection without complication. Histological examination revealed a well circumscribed, dumbbell-shaped firm mass comprised of spindle cells. Immunohistochemical staining for CD 117 was diffusely positive, whereas staining for S-100, CD 34 and MIB-1 was all negative. It was confirmed to be a low-grade GIST at the proximal jejunum.
임상 ; 특발성 혈소판 감소성 자반증으로 진단된 산모의 임신 및 분만에 관한 임상양상
송송아 ( Song Ah Song ),신승주 ( Seung Ju Shin ),최영일 ( Young Il Choi ),김수현 ( Su Hyen Kim ),신지은 ( Ji Eun Shin ),오예은 ( Yei Eun Oh ) 대한주산의학회 2007 Perinatology Vol.18 No.4
목적: 특발성 혈소판 감소성 자반증은 출혈 경향으로 인해 분만이라는 특수한 상황을 겪게되는 산모나 신생아에게 출혈 위험의 가능성이 있으므로 이에 대한 진료지침이 필요하다. 방법: 특발성 혈소판 감소성 자반증 산모 19명에게 분만된 22예의 증례를 의무 기록을 열람하여 후향적으로 분석하였다. 특발성 혈소판 감소성 자반증 산모의 출혈 증상의 유무, 임신 전과 임신 중, 분만 시의 평균 혈소판 수, 치료 방법, 분만 방법, 분만 관련 합병증의 유무를 조사하였으며, 신생아의 혈소판 수와 출혈 합병증 발생 유무를 조사하였다. 결과: 산모는 임신 기간중 부신피질 호르몬 치료, 면역글로불린 정주, 혈소판 수혈 등의 치료를 받았으며 특히 분만에 임박해서는 혈소판 수혈을 통해 혈소판 수치를 50,000/μL 이상으로 유지하려는 경향을 보였다. 분만 방법은 질식 분만이 10예(45%), 제왕 절개가 12예(55%)에서 시행되었다. 분만과 관련된 합병증은 모든 산모에서 발생하지 않았다. 특발성 혈소판 감소성 자반증 산모에서 출생한 17명의 신생아 혈소판 수치의 중앙값은 220,000/μL (범위, 59,000~315,000/μL)이었다. 분만 직후 신생아에서 150,000/μL 이하의 혈소판 감소증을 보인 경우는 4예(23%)에서 관찰되었으나 심각한 출혈 합병증은 한 건도 발생하지 않았다. 결론: 특발성 혈소판 감소성 자반증 환자의 임신과 분만은 출혈 부작용 없이 모두 안전하게 이루어졌으며, 신생아에서도 출혈 부작용은 없었던 점으로 미루어 보아 특발성 혈소판 감소성 자반증 환자에서의 임신과 출산은 산모와 신생아 모두에게 대부분 안전하게 시술될 수 있음을 알 수 있었다. Objective: Idiopathic thrombocytopenic purpura (ITP) frequently occurs in young women. Consequently, clinicians often give medical treatment to pregnant women who are diagnosed with ITP. This study might help to make a clinical guidelines for obstetrical ITP patients and their infants. Methods: We retrospectively investigated the medical charts of 19 cases of deliveries and 22 neonates which from mothers with the diagnosis of ITP during pregnancy from March 1998 to March 2007. Result: Corticosteroid treatment was administrated in 13 cases, high-dose immunoglobulin therapy in 3 cases, and concentrated platelet transfusion in 17 cases during their antenatal care. Ten (45%) vaginal deliveries and twelve (55%) cesarean sections were performed. There were no obstetrical complications associated with their ITP and only four infants with platelet counts below the 150,000/μL were reported after birth. However there were not any signs and symptoms of neonatal complications resulting from their maternal ITP. Conclusion: Our results demonstrate that mothers with ITP can successfully deliver healthy infants in most case. Although maternal and fetal bleeding may occur, such a fatal complication is uncommon.
Computer Tomography as a Tool for Physical Analysis in an Anthropogenic Soil
Hyen Chung Chun,Chan Won Park,Yeon Kyu Sonn,Hyun Joon Cho,Byung Keun Hyun,Kwan Cheol Song,Yong Seon Zhang 한국토양비료학회 2013 한국토양비료학회지 Vol.46 No.6
Human influence on soil formation has dramatically increased as the development of human civilization and industry. Increase of anthropogenic soils induced research of those soils; classification, chemical and physical characteristics and plant growth of anthropogenic soils. However there have been no reports on soil pore properties from the anthropogenic soils so far. Therefore the objectives of this study were to test computer tomography (CT) to characterize physical properties of an anthropogenic paddy field soil and to find differences between natural and anthropogenic paddy field soils. Soil samples of a natural paddy field were taken from Ansung, Gyeonggi-do (Ansung site), and samples of an anthropogenic paddy field were from Gumi in Gyeongsangnam-do (Gasan) where paddy fields were remodeled in 2011-2012. Samples were taken at three different depths and analyzed for routine physical properties and CT scans. CT scan provided 3 dimensional images to calculate pore size, length and tortuosity of soil pores. Fractal analysis was applied to quantify pore structure within soil images. The results of measured physical properties (bulk density, porosity) did not show differences across depths and sites, but hardness and water content had differences. These differences repeated within the results of pore morphology. Top soil samples from both sites had greater pore numbers and sizes than others. Fractal analyses showed that top soils had more heterogeneous pore structures than others. The bottom layer of the Gasan site showed more degradation of pore properties than ploughpan and bottom layers from the Ansung site. These results concluded that anthropogenic soils may have more degraded pore properties as depth increases. The remodeled paddy fields may need more fundamental remediation to improve physical conditions. This study suggests that pore analyses using CT can provide important information of physical conditions from anthropogenic soils.