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목적 및 방법 : 다양한 환경의 변화들은 사람의 건강에 직, 간접적으로 영향을 미쳐, 작업이나 학업의 능률을 저하시킬 수 있다 이러한 관점에서 정신적. 육체적 건강은 매우 중요하며. 이들은 일반적인 좋은 건강과 경제적인 성취를 가능하게 한다. 실내환경은 일 또는 학업의 능률을 증진시키는데 중요한 요인 중의 하나이다. 이와 관련하여 인제대학교 김해캠퍼스와 부산캠퍼스의 남녀 학생들의 의견을 설문조사를 통해 조사하였다. 결과 : 김해캠퍼스 학생의 72.3%는 자신들이 건강하다고 느끼고 있었으며, 반면 이 부산캠퍼스의 학생은 47.3%만이 건강하다고 응답하였다. 부산캠퍼스에서 응답 학생의 86.0%의 학생들은 그들의 학업환경이 열악하다고 답하였으며, 가장 심각한 문제는 소음과 공기오염 등이었다. 결론 : 이러한 학업환경의 차이에 대한 결과는 쾌적한 교내생활 환경을 조성하기 위한 기초자료가 될 것으로 사료된다.
Malaria is a protozoan disease transmitted by Anopheles sinensis and is one of the most common cause of death by infection in the world. Indigenous malaria has been almost eliminated from Korea for recent years. But some cases of malaria except imported malaria experienced in 1980, have been reported in people who had never been abroad since 1993. And they seem to be increasing now. We report the observations about 24 cases of malaria which were experienced in our hospital from 1985 to 1998. The 16 cases of patients had malarias imported from Africa and Southeast Asia but the other recent 8 cases were indigenous. Incidence of indigenous malaria infection was increasing for patients who showed fever of unknown origin. Therefore we should diagnose malaria infection carefully by history and peripheral blood smear when patient comes to hospital because of fever of unknown origin.
컴퓨터, 네트워크 스토리지 솔루션 그리고 원격 전자통신 기술을 이용한 원격의료의 발전을 통한 의료서비스의 질적 개선은 선진국에서는 이미 상당한 수준으로 진행되고 있다. 의료비용절감, 첨단의료기술의 광범위한 적용, 의료정책 변화에 대한 능동적 대처 그리고 의료사고의 위험성 해소 등 좀 더 나은 의료서비스를 위한 사회경제적 필요성은 어느 때보다 폭 넓은 공감대를 형성하고 있다. 전자의료기록, 디지털 MRI 및 X선, 그리고 환자 전자우편 서비스 등은 최근 발전하고 있는 첨단 애플리케이션의 일부에 불과하다. 원격의료는 복잡한 정보 인프라와 법적 지원을 요구하는 최첨단의 전자통신 시스템의 구축을 바탕으로 한 의료 서비스이다. 이를 통한 환자 및 전체 의료업무에 대한 정보를 통합, 관리 및 공유는 보다 신속하고 높은 수준의 의료서비스를 가능하게 할 것이다. 인제대학교 의과대학 및 부속 병원 사이의 효율적이고 모범적인 원격진료의 모델을 개발하기 위한 기본 단계로서 원격진료의 원리와 앞으로 전망에 대해 알아보고자 한다. Computing, networking, and telecommunications support for health care in industrially developed countries have become essential day-to-day services. This support has begun to have a significant impact on the geographic coverage, methods, economy, and efficiency of care, and is becoming increasingly important, both economically and socially. Applications are increasing with the rapid development of the informatics revolution, e-Health is healthcare service support based on the telecommunication a high-level infrastructure and legal support. This paper discusses some of the principles and prospects of e-health in order to draw a complete picture of a model system, which will help us to understand and plan a network of hospitals and schools.
■ Background 3,175 cardiac surgeries were performed in the Pusan Paik Hospital from Sep. 1985 to April 2002, and recently several kinds of current techniques for open heart surgery were adopted with good results. ■ Method Retrospective analysis of the cases and review of the results of operation and usefulness of current techniques such as OFF-Pump CABG. ARCH-FIRST TECHNIQUE. MICRO-WAVE ABLATION, TRANSPLANTATION and MINIMAL INCISION were done. ■ Results ① Among the total cases (3,179), open heart and non-open heart surgery cases were 1,988 and 218, respectively. ② 188 cases of CABG were done. Among them, 20 cases underwent OFF-PUMP coronary artery bypass surgery. 21 cases underwent complete arterial revascularization, and 14 cases underwent both. ③ 75 cases of aortic aneurysm (ascending or arch aneurysm) were operated undercardiopulmonary bypass. The causes of these aneurysm were dissecting aneurysm (45), annuloaortic ectasia(24), non-dissecting chronic aneurysm(5). In the surgery of arch aneurysm. 7 cases underwent ARCH-FIRST TECHNIQUE with good results. ④ In the treatment of atrial fibrillation coupled with valvular heart disease. MICRO-WAVE ABLATION were performed in 18 cases with 83.3 % sinus rhythm recovery. ⑤ Four cases of heart transplantation were performed, using Shumway method, with 3 survivals and one death. ⑥ Minimally invasive incision (using lower sternal incision) was performed successfully in the cases of tricuspid valve diseases(10) and congenital septal defects (50). ■ Conclusion The over all postoperative hospital mortality with open heart surgery was not so high as 3.5 %, whereas more proper management of the all patients with current techniques must be continued.
허혈성심장질환에 대한 외과적 치료의 흐름을 19세기 이전, 19세기 이후, 최근의 경향으로 나누어 분석하였다. 1513 년에 Leonardo da Vinci가 소의 심장을 관찰하여 관상동맥을 도해한 이후 약 300년이 지난 1809년에 Allen Burns가 처음으로 관상동맥의 혈전성 폐쇄에 의해 심근경색과 협심증이 초래된다는 가설을 세웠다. 1946년 Vineberg가 관상동맥 수술적 치료의 효시라고 할 수 있는 내유동맥의 심근내 함몰(implantation) 술이 이루어 졌는데, 당시에는 체외순환이 개발되기 이전이기 때문에 오늘날 크게 성행하고 있는 체외순환없는 관상동맥우회수술의 효시라고도 할 수 있다. 1954년 인공심폐기가 개발되고 1968년 Favaloro가 대복재정맥을 이용한 관상동맥우회수술의 아이디어를 내어 이후 이 질환에 대한 대표적 치료법이 되었다. 현재 까지도 이 방법은 대부분의 클리닉에서 그대로 적용되거나 병용되고 있다. 1990년대 들어 급속히 발전하게 된 최소침습적 수술은 체외순환 자체의 문제점을 해결할 수 있는 계기가 되어 오늘날의 '심장정지없는 관상동맥우회수술 (Off-pump CABG)'를 낳게 되어 수술 예후를 크게 향상시켰다. 또 정맥대신 여러 가지 자가 동맥편을 이용하는 수술이 보편화되고 있다. 따라서 최근 들어 완전동맥편을 이용한 심정지없는 관산동맥우회수술이 가장 바람직한 수술수기로 정착되고 있으며 인제대학교 부산백병원에서도 2000 년 이후 90% 이상에서 이 수술을 적용하고 있다.
Cirrhosis is common in Korea because of prevalent hepatitis B virus related disease and alcoholic liver disease. Cirrhotic patients present as major complications of cirrhosis ; ascites, spontaneous bacterial peritonitis, hepatorenal syndrome. The survival of cirrhotic patients is affected by these major complications. So, It is crucial to manage the complications which are reversible instead of irreversible fibrotic changes of cirrhosis. The clinicians have to attention to accept the new concept in pathogenetic mechanism of these complication and changing modalities in managment.
The liver controls nutrition, metabolism and excretion of foreign substances in the body that may affect other organs. These extrahepatic and systemic effects are caused by hepatic dysfunction of decreased liver cell mass and by decreased liver blood flow by colltaeral circulation, which make changes slowly over long time. Systemic effects of liver cirrhosis changes dynamically. even without changes in liver function tests. In the early stage, they are almost functional changes without irreversible lesions. Then abnormal findings recover completely as improvement of liver function. But there is no specific diagnostic test. Is is important to understand the cirrhotic patient with comprehensive interpretation of liver itself and systemic effects of disease.
A simple new technique for reducing the portosystemic flow in a patient of TIPS induced hepatic failure by means of IVC filter and coils of a commercially available device is presented. A 76-year-old man with progressive hepatic failure after TIPS creation was treated. An IVC filter(Trap-Ease, Cordis) was placed inside the TIPS through a 6-F introducer and then multiple coils(Nester, Cook) were deployed for reducing the TIPS flow. Immediate increase of portal pressure was achieved, followed by clinical recovery.
There are so many reasons why patient selects orthodontic and orthognathic treatment, but most of them want functional improvement. Sometimes patients are not satisfied though functionally improved. It is apparent that they want esthetic improvement too. Satisfaction and happiness are influenced by on self-evaluation, emotional state, expectation and so on. Clinicians have difficulty in estimating and treating the patients by psychological norm. Therefore, we study the relation between orthognathic surgery and aesthetics.
Obiectives: Recently the therapeutic method for cancer has become developed and the life of malignant patients has become prolongated. Computed tomography(CT) is most frequently used as the follow-up study for these patients, the qualify of CT has become prominently improved and accurate various CT findings for peritoneal carcinomatosis on the terminal stage for thsese patients are useful. Ascites is most frequent finding of peritoneal carcinomatosis. Malignant seeding of peritoneum is usualy general accoring to the fluid-flow in peritoneal cavity with genral peritoneal change occurred. Until recently may researchers have described CT findings for peritoneal carcinomatosis in the view point of focal findings of peritoneum, mesentery and omentum The purpose of this study was to find general change of peritoneum(visceral and parietal)-related structure such as peritoneal cavity including paracolic gutter and, cㄴl-de-sac and mesentery, omentum and bowel on 86 clinically and pathologically proven cases of peritoneal carcinomatosis. Materials and Method: In reviewing the medical records of patients of peritoneal carcinomatosis between March 2000 and December 2002, we selected for analysis 86 patients who showed ascites in more than one positive except extreme minute amount on CT scan. The 86 patients were between 22 and 77 years old(mean 55 yerase old) : 46 were men and 40 were women. The diagnosis was established by patholgic analysis obtained from laparatomy, laparascope and aspiration biopy(n=28) and, clinical and CT findings with known primary malignancy. Tumor origins were stomach in 56 patients, ovary in 9, liver in 7, pancreas in 4, colorectal in 4, bile duct in 2, and uterus in 1; three were of undetermined origin. CT was performed on commercially available equipment(Toshiba SAL 9003, japan, or Somatom Volume Zoom, Erland, Germany) using 10 or 5 ㎜ interval from the dome of the diaphragm to the symphysis pubis or to the anus. The patinets routinely received oral and Ⅳ contrast materials, Ⅳ contrast medium, Iopromide(Ultravist 300, Sobering, Germany) was administered with automatic injector in 3㏄/sec. The amount of ascites in patients was devided in +, ++, and +++. + means minimal amount of ascites in perihepatic space, paracolic gutter and in pelvis with minimal inner displacement of bowel loops from parietal peritoneal surface. ++ means moderate amount of ascites in all spaces of peritoneal cavity with definite centralization of bowel loops. +++ means ascites with def mite abdominal distension. The slides of omental and peritoneal biopsy specimen were reviewed, whose show prominent adhesive changes of mesentery, omentum and bowel. The peritoneal involvement were devided in three groups ; 1) peritoneal(parietal and visceral peritoneum) sclcerotic and adhesive change. 2) parietal peritoneal seeding and 3) omental and mesenteric involvement. Peritoneal sclerotic and adhesive changes show the CT finding as as follows ; the mesentery, omentum and bowel show round conglomeration, adhesion and tethered-bowel sign, and the peritoneal cavity show round contraction, multilocuation, obliteration of paracolic gutter and obliteration of cul-de-sac. Multiloculation means that fluid-filled peritoneal space are separated by septum-like enhanced structures on several slices. Parietal peritoneal seeding show even, irregular and nodular, and mat-like enhanced thickening. Omental and mesenteric involvement show permeative, irregular and nodular infiltration and, cake-like pattern. Result: Ascites is + in 31 patients, ++ in 30, and +++ in 25. The slides of omental and peritoneal biopsy specimen show myxoid changes and collagenosis with prominent desplasia, although cancer cells are scattered in the tissues. Adhesion of mesentery, omentum and bowel is in 35%(29/86). Round conglomeration of mesentry, omentum and bowel is in 15%(13/86). Obliteration of paracolic gutter is in 27%(23/86). Round contraction of peritoneal cavity is 6%(5/86). Multiloculation of peritoneal cavity is 23%(20/86). Obliteration of cul-de-sac is 64%(18/28), however it was evaluated in the 28 patients in whom pelvis was included on CT and they usually show large amount of ascites(more than ++ except two). Parietal peritoneal seedning shows even(16%,14/86), irregular and nodular(6%, 5/86), and mat-like 3%, 3/86) enhanced thickening. Omental infiltration shows permeative(2%, 2/86) irregular and nodular infiltration(8%,7/86) and cake-like pattern(16%, 14/86).