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      • KCI등재

        A Case of Type B Lactic Acidosis in Acute Leukemia

        이혜승,김현정,최수정,김찬규,이남수,이규택,원종호,박희숙,홍대식 연세대학교의과대학 2010 Yonsei medical journal Vol.51 No.3

        Type B lactic acidosis is a rare condition in patients with solid tumors or hematological malignancies. Although there have been several theories to explain its mechanism, the exact cause of lactic acidosis remains to be discovered. Lactic acidosis is usually related to increased tumor burden in patients with malignancy. We experienced a case of lactic acidosis in a 39-year-old man who visited an emergency room because of dyspnea, and the cause of lactic acidosis turned out to be recurrent acute leukemia. Chemotherapy relieved the degree of lactic acidosis initially, but as the disease progressed, lactic acidosis became aggravated. Type B lactic acidosis can be a clinical presentation of acute exacerbation of acute leukemia.

      • KCI등재

        Effects of Paraquat Ban on Herbicide Poisoning-Related Mortality

        고동률,정성필,유제성,조수형,박용진,전병조,문정미,김현,김용환,김현진,이경우,최상천,박준석,박정수,김승환,서정열,박하영,김수진,강형구,홍대영,홍정화 연세대학교의과대학 2017 Yonsei medical journal Vol.58 No.4

        Purpose: In Korea, registration of paraquat-containing herbicides was canceled in November 2011, and sales thereof were completelybanned in November 2012. We evaluated the effect of the paraquat ban on the epidemiology and mortality of herbicide-inducedpoisoning. Materials and Methods: This retrospective study analyzed patients treated for herbicide poisoning at 17 emergency departments in South Korea between January 2010 and December 2014. The overall and paraquat mortality rates were compared pre- and post-ban. Factors associated with herbicide mortality were evaluated using logistic analysis. To determine if there were any changes in the mortality rates before and after the paraquat sales ban and the time point of any such significant changes in mortality, R software, version 3.0.3 (package, bcp) was used to perform a Bayesian change point analysis. Results: We enrolled 2257 patients treated for herbicide poisoning (paraquat=46.8%). The overall and paraquat poisoning mortalityrates were 40.6% and 73.0%, respectively. The decreased paraquat poisoning mortality rate (before, 75% vs. after, 67%, p=0.014) might be associated with increased intentionality. The multivariable logistic analysis revealed the paraquat ban as an independentpredictor that decreased herbicide poisoning mortality (p=0.035). There were two major change points in herbicide mortality rates, approximately 3 months after the initial paraquat ban and 1 year after complete sales ban. Conclusion: This study suggests that the paraquat ban decreased intentional herbicide ingestion and contributed to lowering herbicide poisoning-associated mortality. The change point analysis suggests a certain timeframe was required for the manifestationof regulatory measures outcomes.

      • KCI등재
      • KCI등재

        Cervical Arthroplasty for Moderate to Severe Disc Degeneration: Clinical and Radiological Assessments after a Minimum Follow-Up of 18 Months -Pfirrmann Grade and Cervical Arthroplasty-

        오창현,윤승환,김도연,지규열,김여주,현동근,김은영,박현선,박형천 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.4

        Purpose: Clinical outcomes and radiologic results after cervical arthroplasty have been reported in many articles, yet relatively few studies after cervical arthroplasty have been conducted in severe degenerative cervical disc disease. Materials and Methods: Sixty patients who underwent cervical arthroplasty (Mobi-C®) between April 2006 and November 2011 with a minimum follow-up of 18 months were enrolled in this study. Patients were divided into two groups according to Pfirrmannclassification on preoperative cervical MR images: group A (Pfirrmann disc grade III, n=38) and group B (Pfirrmann disc grades IV or V, n=22). Visual analoguescale (VAS) scores of neck and arm pain, modified Oswestry Disability Index(mODI) score, and radiological results including cervical range of motion (ROM) were assessed before and after surgery. Results: VAS and mean mODI scores decreased after surgery from 5.1 and 57.6 to 2.7 and 31.5 in group A and from 6.1 and 59.9 to 3.7 and 38.4 in group B, respectively. In both groups, VAS and mODI scores significantly improved postoperatively (p<0.001), although no significant intergroup differences were found. Also, cervical dynamic ROM was preserved or gradually improved up to 18 months after cervical arthroplasty in both groups. Global, segmental and adjacent ROM was similar for both groups during follow-up. No cases of device subsidence or extrusion were recorded. Conclusion:Clinical and radiological results following cervical arthroplasty in patients with severe degenerative cervical disc disease were no different from those in patientswith mild degenerative cervical disc disease after 18 months of follow-up.

      • KCI등재

        Cerebral Oxygenation during Laparoscopic Surgery: Jugular Bulb versus Regional Cerebral Oxygen Saturation

        최승호,김수환,이성진,소사라,오영준 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.1

        Purpose: We hypothesized that regional cerebral oxygen saturation (rSO2) could replace jugular bulb oxygen saturation (SjvO2) in the steep Trendelenburg position under pneumoperitoneum. Therefore, we evaluated the relationship between SjvO2 and rSO2 during laparoscopic surgery. Materials and Methods: After induction of anesthesia, mechanical ventilation was controlled to increase PaCO2 from 35 to 45 mm Hg in the supine position, and the changes in SjvO2 and rSO2 were measured. Then, after establishment of pneumoperitoneum and Trendelenburg position, ventilation was controlled to maintain a PaCO2 at 35 mm Hg and the CO2 step and measurements were repeated. The changes in SjvO2 (rSO2) -CO2 reactivity were compared in the supine position and Trendelenburg-pneumoperitoneum condition, respectively. Results: There was little correlation between SjvO2 and rSO2 in the supine position (concordance correlation coefficient=0.2819). Bland-Altman plots showed a mean bias of 8.4% with a limit of agreement of 21.6% and -4.7%. SjvO2 and rSO2 were not correlated during Trendelenburg-pneumoperitoneum condition (concordance correlation coefficient=0.3657). Bland-Altman plots showed a mean bias of 10.6% with a limit of agreement of 23.6% and -2.4%. The SjvO2-CO2 reactivity was higher than rSO2-CO2 reactivity in the supine position and Trendelenburg-pneumoperitoneum condition, respectively (0.9±1.1 vs. 0.4±1.2% mm Hg-1, p=0.04; 1.7±1.3 vs. 0.5±1.1% mm Hg-1, p<0.001). Conclusion: There is little correlation between SjvO2 and rSO2 in the supine position and Trendelenburg-pneumoperitoneum condition during laparoscopic surgery.

      • KCI등재

        Change in Electromyographic Activity of Wrist Extensor by Cylindrical Brace

        윤정중,배하석 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.1

        Purpose: To verify the effect of a newly-developed cylindrical type forearm brace, which was designed to give focal counterforce perpendicularly on the muscle belly of the wrist extensor. Materials and Methods: The dominant hands of 24 (12 males, 12 females) healthy subjects were tested. Two types of forearm braces (focal cylindrical type and broad pneumatic type) were examined. The braces were applied at the extensor carpi radialis brevis, 5 to 7 cm distal to the lateral epicondyle. Two surface electrodes were attached to the proximal and distal parts of the brace. By quantitative electromyography, the mean amplitudes of voluntary extensor carpi radialis brevis contraction before and after applying each brace were recorded and analyzed. Results: The mean amplitudes of the focal cylindrical brace and broad pneumatic brace were reduced significantly compared to no brace (p<0.05), with a larger reduction for the cylindrical brace than the pneumatic brace (p<0.05). There was no significant difference between the proximal and distal mean amplitudes with each brace. Conclusion: A cylindrical type brace decreased electromyographic activity in the wrist extensor more effectively than did the pneumatic type brace.

      • KCI등재

        Ceramic Head Fracture in Ceramic-on-Polyethylene Total Hip Arthroplasty

        노재휘,박종석,송의섭,김우종,서유성 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.6

        Revision rates of total hip arthroplasty have decreased after introducing total hip arthroplasty (THA) using ceramic component, since ceramic components could reduce components wear and osteolysis. The fracture of a ceramic component is a rare but potentially serious event. Thus, ceramic on polyethylene articulation is gradually spotlighted to reduce ceramic component fracture. There are a few recent reports of ceramic head fracture with polyethylene liner. Herein, we describe a case of a ceramic head component fracture with polyethylene liner. The fractured ceramic head was 28 mm short neck with conventional polyethylene liner. We treated the patient by total revision arthroplasty using 4th generation ceramic on ceramic components.

      • KCI등재

        Central Corneal Thickness and Corneal Endothelial Cell Changes Caused by Contact Lens Use in Diabetic Patients

        임현성,Ki Cheul Shin,이군자,김응권,서경률 연세대학교의과대학 2011 Yonsei medical journal Vol.52 No.2

        Purpose: To analyze the effects of soft contact lenses on central corneal thickness and morphologic characteristics of the corneal endothelium in diabetic patients. Materials and Methods: Ultrasound pachymetry and noncontact specular microscopy were performed on 26 diabetic patients who regularly use soft contact lenses (group 1), 27 diabetic patients who do not use soft contact lenses (group 2) and 30 normal subjects (group 3). We compared the values in each group using the Mann-Whitney test. Results: The central cornea was found to be thicker in diabetic patients,both those who use and do not use contact lenses, than in the normal control group. The central corneal thickness was significantly higher in group 1 (564.73 ± 35.41 μm) and group 2 (555.76 ± 45.96 μm) than in the control group (534.05 ± 27.02 μm), but there was no statistically significant difference between groups 1 and 2. Endothelial cell density was significantly different between the groups, and was smallest in the group of diabetic patients using contact lenses. The coefficient of variation of cell size was significantly higher and the percentage of hexagonal cells was significantly lower in contact lens using diabetic patients than in non-contact lens using diabetic patients and in the control group. Conclusion: Central corneal thickness and endothelial cell density is more affected by diabetes mellitus,and corneal endothelial cell morphology is more affected by contact lens use, when compared with normal subjects.

      • KCI등재

        Evaluation of the Effect of Hemoglobin or Hematocrit Level on Dural Sinus Density Using Unenhanced Computed Tomography

        이승영,차상훈,이성현,신동익 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.1

        Purpose: To identify the relationship between hemoglobin (Hgb) or hematocrit (Hct) level and dural sinus density using unenhanced computed tomography (UECT). Materials and Methods: Patients who were performed UECT and had records of a complete blood count within 24 hours from UECT were included (n=122). We measured the Hounsfield unit (HU) of the dural sinus at the right sigmoid sinus, left sigmoid sinus and 2 points of the superior sagittal sinus. Quantitative measurement of dural sinus density using the circle regions of interest (ROI) method was calculated as average ROI values at 3 or 4 points. Simple regression analysis was used to evaluate the correlation between mean HU and Hgb or mean HU and Hct. Results: The mean densities of the dural sinuses ranged from 24.67 to 53.67 HU (mean, 43.28 HU). There was a strong correlation between mean density and Hgb level (r=0.832) and between mean density and Hct level (r=0.840). Conclusion:Dural sinus density on UECT is closely related to Hgb and Hct levels. Therefore,the Hgb or Hct levels can be used to determine whether the dural sinus density is within the normal range or pathological conditions such as venous thrombosis.

      • KCI등재

        Evaluation of Direct Immunofluorescence Test with PCR for Detection of Novel Influenza A (H1N1) Virus during 2009 Pandemic

        이재훈,신새론,조지현 연세대학교의과대학 2011 Yonsei medical journal Vol.52 No.4

        During the 2009 novel influenza (H1N1) pandemic, the sensitivity of direct immunofluorescence assay (DFA) for H1N1 infection was 62% (266/429) of that of the polymerase chain reaction (PCR) test. The sensitivity of the DFA differed significantly with the age of patients: the sensitivity was the highest (71.8%) for patients aged <10 years and the lowest for patients aged ≥30 years. The sensitivity of DFA in patients aged ≥30 years was 40.7%. Furthermore, the sensitivity (67.3%, 171/254) of DFA was higher for patients who had a high temperature at admission. An increase in the incidence of H1N1 infection did not influence the sensitivity of DFA (62.1% vs. 62%; p=0.984) test, but resulted in a decrease in the negative predictive value, from 92.4% (700/757) to 69.6% (247/355). PCR may be useful as the initial test for diagnosing H1N1 infection in patients aged ≥30 years with a normal temperature at presentation.

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