소장에 발생한 위장관간질종양의 임상 특성 : 출혈군과 비출혈군 비교

이상진 가톨릭관동대학교 2015 국내박사

Background/Aims: Gastrointestinal stromal tumors (GIST) in small intestine are rare and can be a cause of small bowel bleeding. The study was undertaken to investigate the clinical characteristics of GIST in small intestine and to determine the factors related to gastrointestinal bleeding. Methods: We retrospectively evaluated the clinical outcomes of 22patients with small bowel GIST who were pathologically diagnosed at Gangneung Asan Hospital between March 1997 and August 2012. Results: The median age was 63.5 (38∼82) years with 9 females and 13 males. Nine patients (40.9%) had gastrointestinal bleeding, five patients (22.7%) had abdominal pain, two patients (9%) had palpable mass and one patient had both abdominal pain and palpable mass. In five patients (22.7%), GIST was detected incidentally during an endoscopic study or on a CT done for another purpose. The site of tumor was the duodenum in 9 cases (40.9%), jejunum in 7 cases (31.8%), and ileum in 6 cases (27.3%). Most patients underwent small bowel resection or wedge resection but three patients underwent pancreatoduodenectomy. Tumor size ranged from 1.6 to 19 cm (median 6.5 cm). The median mitotic rate was 2(050)/50 high power fields (HPF). The number of cases with >5/50HPF were 5 and the number of cases with5/50HPF were 15. The median mitotic rate was 2(0∼50)/50 high power fields. Five patients (25%)showed recurrence. Four patients showed hepatic recurrence and one patients showed recurrence in right inguinal area. Gender, aspirin or warfarin use, size and mitotic index of tumor, hospital stay, recurrence and survival were not significantly different between bleeding and non-bleeding group. Bleeding group showed older age, proximal location in small intestine and mucosal ulceration significantly. Conclusion: Small bowel GISTs presenting bleeding were marked by older age, mucosal ulceration and location of proximal small bowel (duodenum and jejunum) rather than distal small bowel (ileum).

일개 도에서 병원외 심정지 환자의 병원전 자발순환 회복과 관련된 요인들에 대한 고찰

정상구 가톨릭관동대학교 2016 국내박사

Return of spontaneous circulation (ROSC) is closely related to the favorable treatment outcome in out-of-hospital cardiac arrest and is also a reliable treatment target in clinical trials. The aim of this study is the identification of major factors affecting field ROSC by analyzing the updated data encompassing the pre-hospital treatment processes. This is a retrospective review of cardiopulmonary resuscitation (CPR) cases performed by 119 rescuers before hospital arrival from January 2012 to December 2014 in one province. The cases with traumatic cardiac arrest, unnecessary CPR, arrest occurred during transport, under the 14 year old age, and incomplete medical records were excluded. Of 1,832 patients enrolled in the study, ROSC was achieved in 99 cases (5.4%). Among them, 50 (50.5%) had ROSC at event field and others achieved ROSC during transport process respectively. Total cases were divided into two groups based on ROSC before arrival to the hospital. The age, underlying cardiovascular illnesses, the event place, the presence of witness, bystander CPR, automated external defibrillator (AED) application, the initial shockable rhythm, defibrillation, advanced airway, hydration, the arrival time of rescuer CPR, the application time of AED and defibrillation showed the significant statistical differences. In multivariate analysis, age, defibrillation, hydration, bystander CPR, the call-to-rescuer CPR interval appeared to be correlated with field ROSC. For improving the survival rate through field ROSC, the public campaign improving bystander CPR, prompt recognition of cardiac arrest and quick application of pre-hospital treatment and political support of the public institution are mandatory.

Effect of Leg Elevation Height on Reduced Swelling of Patients of Postoperative Acute Ankle Fractures

서동교 Journal of Korean Foot and Ankle Society 2021 국내박사

Purpose: Leg elevation is known as an effective method for reducing leg swelling, and it has been routinely used in medical practice. However, the effect of swelling reduction in relation to the degree of elevation height is not known. This study evaluated the swelling of the leg after acute ankle fracture operations at two different elevation heights and the elevated leg heights were compared. Materials and Methods: A total of 66 patients with postoperative acute ankle fractures were classified into two groups depending on the presence of different leg elevation heights: high-elevated (HE, case) and low-elevated groups (LE, control). We checked leg swelling, pain, subjective satisfaction for the elevation device, and the American Orthopedic Foot and Ankle Society (AOFAS) score, and we retrospectively compared them between both the groups. Results: Leg swelling and pain were reduced in both groups. However, they did not show any significant differences between both the groups (p>0.05). Nineteen patients in the HE group replied with uncomfortable, while no patients in LE group did so. The AOFAS score at 1 year postoperatively did not show any significant differences between both the groups (p=0.46). Conclusion: High elevation of the leg after ankle fractures did not show a significant difference from low elevation in regard to leg swelling, pain, and function. Furthermore, high leg elevation resulted in discomfort during the postoperative period. Thus, low elevation with a pillow is enough for acute ankle fracture patients with little discomfort and satisfactory swelling reduction.

The Trend of Prevalence of Pain in Korea from 2005 to 2016

조상현 가톨릭관동대학교 2021 국내석사

Background The Korean society is afflicted with rapid aging. Aging is a risk factor for pain, and pain can reduce patients’ quality of life. Thus, adequate management and monitoring of changing trends accompanying the demographic shift are highly valuable. However, this study was conducted because no studies have investigated the recent changes in the prevalence of pain. Methods The extent of prevalence of pain was determined by questions related to quality of life based on the data derived from Korea National Health and Nutrition Survey (KNHNS) from 2005 to 2016 in Korea. Data analysis was conducted using SURVEYFREQ (SAS Institute Inc., Cary, NC) Results The prevalence of pain in all populations was 30.6% in 2005 and 18.9% in 2016. The average prevalence from 2005 to 2016 was 21.9%. A declining trend occurred over time with an odds ratio of 0.929 per year (95% CI: 0.921–0.938). The prevalence of severe pain was 2.35% in 2005 and 1.88% in 2016. Likewise, a decrease was observed over time, with an odds ratio of 0.920 per year at 95% CI 0.901–0.939. The decline in age-/sex-stratified analysis also showed a statistically significant trend in all groups. Conclusion The prevalence of pain in Korean society, based on the KNHNS, has declined since 2005. Such a trend was observed in all ages and genders, and was most significant in the elderly.

화훼작업 종사자의 유기인계 및 피레스로이드 살충제 노출에 대한 생물학적 모니터링

권기두 관동대학교 대학원 2014 국내박사

Objective: This study was performed to evaluate the exposure level of organophosphorus and pyrethroid pesticides to floriculture workers and florists. Methods: The urinary dialkylphosphates, metabolites of organophosphorus insecticides, including dimethylphosphate (DMP), diethylphosphate (DEP), dimethylthiophosphate (DMTP), diethylthiophosphate(DETP) and pyrethroids of metabolites, cis/trans DCCA, DBCA, and 3-PBA were analysed to evaluate the exposure of organophosphorus and pyrethroid pesticides to floriculture workers and florists. Results: The concentration of DMP is highest in floriculture workers. but the concentration of DETP is highest in retail florists. The concentration of 3-PBA is highest in floriculture workers. Conclusion: The amount of organophosphorus and pyrethroid pesticide expusure is highest in flower workers, wholesale florists and retail florists are followed. The management for reducing pesticide exposure to floriculture workers and wholesale florists is required. Keywords: dialkylphosphate, GC/MSD, orgnophosphate insecticides, pyrethroids insecticides, urine

3차원 전산화 단층 촬영을 이용한 수근 정렬의 분석

이기원 관동대학교 대학원 2013 국내박사

목적: 3차원 전산화 단층 촬영을 이용하여 정상 한국인에서 수근 정렬의 평균치를 알아보고 계측치의 관찰자간 신뢰성을 알아보고자 하였다. 대상 및 방법: 수근관절 증상의 병력이 없으며 이학적 검사에서 정상 소견을 보인 한국 성인 42명을 대상으로 하였다. 3차원 전산화 단층 촬영은 상완부를 체간에 대해 900 외전, 주관절 900 굴곡, 전완부 중립위치에서 수근 관절을 고정하는 기구를 사용한 후 시행하였다. 수근 정렬은 요골 관절면각, 요월상각, 요주상각, 요유두각, 요골-제3 중수골각, 주상월상각, 월상유두각, 월상-제3중수골각을 3명의 계측자가 측정하여 평가하였다. 결과: 요골의 관절면각의 평균치는 12.80±2.6, 요월상각은 0.90±4.6, 요주상각은 54.40±5.3 요유두각은 1.70±2.1, 요골-제3중수골각은 -1.20±2.5였고 주상월상각은 53.40±7.8, 월상유두각은 0.80±4.7, 월상-제3중수골각은 -2.10±5.0이였다. 모든 계측치에서 우수한 관찰자간 신뢰성을 보였다. 결론: 3차원 전산화 단층 촬영을 이용하여 정상 한국인의 수근 정렬을 측정하여 한국 성인의 평균치를 알 수 있었으며 이는 수근관절 정렬의 평가에 도움이 될 것으로 생각한다. 색인단어: 수근 정렬, 3차원 전산화 단층 촬영 Purpose: The purpose of this study was to analyze carpal alignment and evaluate the interobserver reliability of the several parameters using three-dimensional computed tomography(3D-CT) in normal Koreans. Materials and methods: The study included 42 wrists with no history of wrist pain or abnormality by physical examination. 3D-CT scanning was performed with each patient in zero position; the arm abduction against the trunk; the elbow flexed 900; the forearm in neutral position using the stabilizing device. The three observers measured the carpal alignment parameters including distal radius articular angle, radiolunate angle, radioscaphoid angle, radio capitateangle, radio-3rd metacarpalangle, scapholunate angle, lunocapitate angle, luno-3rd metacarpal angle. Results: The mean distal radius articular angle was12.80 ± 2.6, the mean radio lunate angle was 0.90 ± 4.6, the radio scaphoid angle was 54.40 ± 5.3, the mean radiocapitate angle was 1.70 ± 2.1, the mean radio-3rd metacarpal angle was -1.20 ± 2.5, the mean scapholunate angle was 53.40 ± 7.8, the meanlunocapitate angle was 0.80 ± 4.7 and the mean luno-3rd metacarpal angle was -2.10 ± 5.0. All parameters have excellent interobserver reliability. Conclusion: The normal mean values and ranges for carpal alignment angles were evaluated by using 3D-CT, may be of assistance in the evaluation of carpal alignment to the wrist.

Comparison of surgical outcomes between single versus dual K-wire fixation for unstable distal phalanx fractures

최신우 가톨릭관동대학교 2021 국내석사

Distal phalanx fractures are the most common injuries of the hand, and K-wire fixation is commonly performed for unstable fractures. However, there is no consensus regarding the number of K-wires to use in bone fixation. We aimed to compare the results between single and dual K-wire pinning. This retrospective study enrolled patients who underwent K-wire pinning for unstable distal phalanx fractures, including the shaft and tuft, from June 2016 through April 2020. We divided patients into two groups based on the number of K-wires used for bone fixation (single vs. dual). Clinical and radiographic data were measured and compared between the two groups. Additionally, multivariable logistic analysis was performed to identify the risk factors for nonunion. A total of 80 patients were enrolled. Among them, 27 were managed with a single K-wire and 53 with a dual K-wire. There was no significant difference in the union rate between the single and dual K-wire groups (77.7% vs. 84.9%, respectively), but time to union was significantly longer in the single K-wire group (11.3 vs. 8.4 weeks; p ¼ .003). The presence of a bone gap after fixation was a risk factor for nonunion. Our study showed that the union rate was comparable between single and dual K-wire pinning in distal phalanx fractures. However, dual K-wire pinning shortened the union time.

비케톤성고혈당증 유발발작의 임상양상과 예후

이문규 가톨릭관동대학교 2019 국내박사

Seizure can be triggered by the non-ketotic hyperglycemia (NKH). Recently we analysed 18 cases of NKH induced seizure to identify the causes for NKH, seizure types, prognosis, and the differences of clinical presentation between the patient with chronic brain structural lesion (CBSL) and the patient without. Eighteen patients with NKH induced seizure were selected from the database. Data regarding brain images, clinical symptoms, co-morbid illnesses, blood laboratories, and prognosis were collected. Patients were divided into two groups according to the presence of CBSL. The patients with CBSL showed more generalized tonic-clonic seizure (GTCS) than without. Focal seizures in this group appeared to be originated from the pre-existing lesion in many situations. The poor compliance to anti-diabetic treatment and physical stresses were most common causes for NKH. One year seizure remission without anti-epileptic drug treatment was achieved in 17 of 18 patients. The patients with CBSL might have more GTCS than without. The impairment of inhibitory mechanism surrounding the focal irritative zone might be one of plausible explanation for this phenomenon. The prognosis was favorable. Further large studies are required.

래트의 횡경막근육을 이용한 고체온 조건에서 로큐로니움의 유효 농도 변화와 슈가마덱스 역전 효과의 영향

김진선 가톨릭관동대학교 2021 국내박사

Background: Hyperthermia is relatively rare during general anesthesia; however, a few studies have been conducted on hyperthermia and the neuromuscular blockade (NMB) induced by rocuronium, and the reversal of NMB by sugammadex. We investigated the effect of hyperthermia status on the NMB induced by rocuronium, and its reversal by sugammadex, in isolated phrenic nerve hemidiaphragm (PNHD) preparations of the rat. Methods: Thirty-three male Sprague-Dawley rat PNHD preparations were randomly assigned to three groups at different temperatures (36 °C, 38 °C, and 40 °C; each group, n = 11, in Krebs solution). The train-of-four (TOF) and twitch height responses were checked mechanomyographically. The PNHD were treated with progressively increasing doses of rocuronium and three effective concentrations (ECs), EC50, EC90, and EC95, of rocuronium were analyzed in each group via nonlinear regression analysis. Then, sugammadex was administered in doses equimolar to rocuronium.Thereafter, the T1 height (%), TOFR (%) and the duration index were measured. Results: The EC of rocuronium (EC50, EC90, and EC95) decreased significantly in accordance with increasing temperature. The groups at 36 °C and 40 °C showed clear differences in all areas (all P < 0.001). Moreover, the T1 height (%) and the duration index upon sugammadex administration showed faster recovery results in the 36 °C than the 38 °C and 40 °C groups. Conclusion: A rise of temperature from 38 °C to 40 °C in rat PNHD preparations proportionally enhanced the NMB induced by rocuronium. In addition, equimolar doses of sugammadex to the administered rocuronium showed a slower recovery time as the temperature rises.

주관절 터널 증후군으로 수술 받은 환자들의 임상적, 전기진단학적 분석

구정회 관동대학교 대학원 2013 국내박사

주관절 터널 증후군은 수근관 증후군에 이어 상지에서 두 번째로 흔한 압박성 말초신경병증이다. 주관절 터널 증후군의 병태생리나 치료에 대한 많은 보고들이 있지만 정확한 발생률이나 유병률은 잘 알려져 있지 않은데, 최근의 한 연구에서 연간 발생률은 10만 명당 20.9명으로 추정된다고 보고되었고, 농촌 주민을 대상으로 한 국내 연구에서는 유병률이 6.4%로 보고된 바가 있다. 주관절 터널 증후군의 발생과 관련된다고 알려진 위험 인자들은 남성, 연령, 체질량지수, 외상의 병력 등이 있는데 이는 연구에 따라 서로 다른 결과를 보이고 있다. 또한 이러한 추정되는 위험 인자들과 전기진단 검사의 중증도의 관련성에 대한 연구는 거의 없는 실정이다. 따라서 본 연구에서는 주관절 터널 증후군으로 수술을 시행 받은 환자들을 대상으로 하여 임상적 요소를 분석하고 전기진단 검사의 중증도와 관련된 인자를 알아보고자 하였다.