일 대학병원 정신과에 협진 의뢰된 환자 중 의뢰의가 섬망 진단을 놓치게 하는 요인: 예비연구

최정원,박한선,유재홍,연규월,김영철,임원정,김의정,김수인 대한신경정신의학회 2010 신경정신의학 Vol.49 No.4

Objectives: The misdiagnosis of delirium may result in a delay of correct diagnosis and appropriate treatment of the delirium. Additionally, aggravation of physical illnesses can occur. The objective of this study was to investigate patient characteristics in cases of misdiagnosed delirium upon psychiatric consultation in a university hospital. Methods: Subjects included patients with delirium among all who we had consulted over a 12week span. Psychiatric diagnosis was made by two well-trained psychiatrists by means of the DSM-IV-TR. Cognitive function, level of delirium, and physical function were evaluated by the Korean version of Mini Mental Status Examination (MMSE-K), the Delirium Rating Scale-Revised-98(DRS-R-98), the Clinical Global Impression-Severity (CGI-S), the Eastern Cooperative Oncology Group Performance Status (ECOG-PS), and the Global Assessment of Functioning Scale (GAF). In addition, we collected socio-demographic information, date of admission and consultation, present causes of consultation, and speculated psychiatric diagnoses made by referring physicians. Results: Among 45 subjects with delirium, only 28 patients (62%) were diagnosed with delirium by referring physicians at the time of consultation. The remaining 17 patients (38%) had been diagnosed with other illnesses. The group of misdiagnosed patients tended to have a longer duration of formal education than those that had been correctly diagnosed. Conclusion: Early diagnosis and intervention of delirium can minimize subsequent problems related to delayed diagnosis. Therefore, it is vital to identify the factors related to misdiagnoses by referring physicians. This study showed that a longer duration of formal education is a contributing factor for the misdiagnosis of delirium. Longer education may cover up the typical symptoms of delirium. This can keep referring physicians from making a correct diagnosis. This study was a pilot study investigating diagnostic accuracy of delirium by referring physicians. Additional, well-controlled studies are warranted.

A novel HB-SC-MCCNN model for intelligent fault diagnosis of rolling bearing

Hui Liao,Pengfei Xie,Yan Zhao,Jinfang Gu,Lei Shi,Sier Deng,Hengdi Wang 대한기계학회 2023 JOURNAL OF MECHANICAL SCIENCE AND TECHNOLOGY Vol.37 No.12

The incompleteness and lack of bearing fault data have become important problems in bearing fault diagnosis. This paper presents an intelligent fault diagnosis method for rolling bearings based on a similarity clustering multi-channel convolution neural network with the hierarchical branch (HB-SC-MCCNN). First, the relevant features are extracted by MCCNN, and combined with the similarity clustering principle, the accurate binary classification is realized in the case of insufficient labeled data. Second, the similarity clustering module and additional loss are added to the SC-MCCNN network to form a hierarchical-branch network, which simplifies the problem of fault multi-classification into binary classification with multiple steps, and to reduces the dependence on the amount of label data in multi-classification. Finally, based on the self-learning characteristics of HB-SC-MCCNN, the unlabeled data and the missing fault types in the training set are re-labeled to realize the re-training of the network. On the benchmark dataset, the comparison experiment results with several salient deep learning models show that the method proposed in this paper successfully realizes the hierarchical diagnosis of bearing faults and presents more substantial competitiveness in the case of insufficient labeled data and missing fault types.

의학강좌/놓친 유방암의 영상소견: 후향적 분석

한부경 대한의사협회 2008 대한의사협회지 Vol.51 No.9

Screening mammography has been proved to be an effective tool to detect early breast cancers and to decrease mortality. However, the rate of false-negative mammograms has been reported to be still high as 10~30%. Missed breast cancers are cancers that are visible at previous mammograms only retrospectively and can be classified as three types; interval cancers, subsequent screen-detected cancers, and alternative imaging-detected cancers. In a small group, screen-detected abnormalities recalled for further evaluation may be dismissed due to false negative diagnostic assessment, leading to delays in breast cancer diagnosis. Possible causes for missing include perception errors, interpretation errors, and technical errors. Furthermore, every diagnostic examination has inherent limitations. Perception errors are often attributed to combined multiple factors; peripheral lesions, single view abnormalities, subtle findings, distracting lesions, and dense parenchyma obscuring a lesion. To decrease the false negative rate, radiologists should be alert to take additional mammograms and ultrasonography, and should try to improve the image quality and interpretation techniques comparing with the previous imaging, considering the use of computer-aided detection or double reading.

치근단병소로 오인된 하악치아의 백악질골형성이상 ; 콘빔CT 기반 증례보고

한원정 대한치과의사협회 2024 대한치과의사협회지 Vol.62 No.7

Cemento osseous dysplasia (COD) is a lesion that occurs in the periapical and tooth-bearing area where normal bone tissue is replaced by fibrous tissue and metaplastic bone. The cause is not clearly known. COD is often discovered incidentally without any symptoms. It is more common in females and mandibular molars. The involved tooth is vital. In radiological imaging, the lesion has a well defined border. The internal density of the lesion depends on the maturity of the lesion. Radiolucent and mixed lesions of COD are sometimes mistaken for periapical lesions and root canal treatment is performed. Because COD has limited growth, no special treatment is required. Accordingly, The author reports cases of COD in mandibular teeth region referred from other clinics for accurate diagnosis or removal of the lesions and presents the cone beam computed tomography images of the cases to help clinicians make an accurate diagnosis.

An analysis of missed injuries in patients with severe trauma

Ju EunGyu,Baek Sunyoung,Hong Sung Soo,Kim Younghwan,Youn Seok Hwa 대한외상학회 2022 大韓外傷學會誌 Vol.35 No.4

Purpose: To analyze the data of trauma patients with undetected injuries at the time of initial resuscitation during the primary and secondary surveys.Methods: We retrospectively reviewed the medical records of 807 patients who were hospitalized at the National Trauma Center, Seoul, Korea from June 1, 2019 to June 30, 2021.Results: In trauma patients with an Injury Severity Score ≥16 accounted for 38.0% in the non-missed injury group (non-MIG), but this rate was considerably higher at 71.2% in MIG. The mean hospitalization longer in MIG (50.90±39.56) than in non-MIG (24.74±26.11). The proportion of patients with missed injuries detected through tertiary trauma survey (TTS) was 28 patients (23.5%) within 24 hours, 90 patients (75.6%) after 24 hours to before discharge. The majority of missed injuries were fractures (82.4%) and ligament tears (8.4%), which required consultation with the orthopedic department. The final diagnoses of missed injuries were confirmed by computed tomography (44.5%), magnetic resonance imaging (19.3%), X-ray (19.3%), bone scan (11.8%), and physical examination (5.0%).Conclusions: TTS is considered a useful process for detecting missed injuries that were not identified at the time of initial resuscitation in the primary and secondary surveys. In the future, to detect missed injuries quickly, it is necessary to develop a suitable TTS program for each trauma center. In addition, further research is needed to verify the effectiveness of the protocolized TTS and survey chart to improve the effectiveness of TTS.

Extremely well-differentiated adenocarcinoma of the stomach: diagnostic pitfalls in endoscopic biopsy

이종원,이인섭,안지용,박영수,김지훈 대한병리학회 2022 Journal of Pathology and Translational Medicine Vol.56 No.2

Background: Extremely well-differentiated adenocarcinoma (EWDA) is a deceptively bland-looking adenocarcinoma of the stomach. It often causes diagnostic problems, especially in endoscopic biopsy samples. To better recognize this deceptively bland lesion, we carefully reviewed a series of EWDAs treated at our institution.Methods: A total of 55 specimens from 19 patients were obtained. Endoscopic, gross and microscopic features defining EWDA were described and documented. For comparison, hyperplastic polyp specimens were randomly selected and analyzed.Results: Most cases (18 of 19, 94.7%) were advanced gastric cancer (AGC) and primarily located in the body of the stomach (15 of 19, 79.0%). The majority of AGCs were non-ulcerated (11 of 18, 61.1%) with an undermining growth pattern and a relatively small mucosal involvement. Specific histologic features included an irregular glandular shape, an undulating apical cytoplasmic border, disproportionately large glands, a variably distended mucinous cytoplasm. Classical features, such as small infiltrating glands or desmoplastic reactions, were barely observed. Identification of irregularly spaced nuclei and disruption of the foveolar epithelial structure, along with atypical features described above were helpful in making a diagnosis especially in gastric forceps biopsies.Conclusions: Awareness of the histomorphologic characteristics described in this report would lead to timely diagnosis and prevent repeated endoscopic procedures.

단순 포진 감염으로 오인된 자매에서 발생한 소아 얼굴 백선 2 례

황지훈 ( Jihoon Hwang ),강지만 ( Ji-man Kang ),안종균 ( Jong Gyun Ahn ) 대한소아감염학회 2021 Pediatric Infection and Vaccine Vol.28 No.1

얼굴 백선은 얼굴에 발생하는 드문 피부 사상균 감염으로, 붉은 발진과 함께 작은 융기가 있는 피부 병변이 특징적이다. 소아에서 얼굴 백선은 흔하지 않으며 다양한 피부질환과 발진 양상이 유사하여, 단순포진감염, 접촉 피부염, 원판형 홍반성 루푸스, 여드름, 아토피 피부염 등으로 오진 될 수 있다. 본 증례에서는 4살, 3살의 자매가 베트남 여행을 다녀온 후 발생한 피부염으로 본원에 내원하였고, 아토피 피부염에 합병된 단순포진감염을 의심하여 항바이러스제제 및 전신 스테로이드 제제를 투약하였으나, 경과는 호전되지 않았다. 혈액 검사상 혈청 beta-D-glucan 수치가 두 환자 모두에서 상승되어 있었고, 약 2주 후 언니의 피부 진균 배양 검사에서 T. interdigitale이 동정 되었다. 두 환자 모두 국소 및 전신 항진균 요법 후 재발이나 부작용 없이 회복되었다. 소아에서 기존 치료에 반응하지 않는 얼굴의 피부 병변은 반드시 진균 검사를 통해서 얼굴 백선의 가능성을 확인해야 하며, beta-D-glucan 검사는 보조적 수단으로서 얼굴 백선 진단에 도움을 줄 수 있다. Tinea faciei is a rare dermatophyte infection of the face that most often appears as a facial rash, followed by patches of small and raised bumps. Since it is uncommon in children and has similar rash patterns with various skin diseases, it is likely to be misdiagnosed as herpes simplex infection, contact dermatitis, disc-shaped lupus erythematosus, acne, and atopic dermatitis. In this case, siblings aged 3 and 4 were hospitalized due to skin rashes that occurred after traveling to Vietnam, and were administered antiviral drugs and systemic steroids under suspicion of herpes simplex infection with atopic dermatitis. Despite administration of these drugs, skin lesions did not show improvement. Serum beta-D-glucan assays were elevated in both patients, and after approximately 2 weeks, Trichophyton interdigitale was cultured in the older sister's skin fungal culture test. Both patients recovered after local and systemic antifungal therapy, without relapse or side effects. Skin lesions on the face, which do not respond to the existing treatment in children, should be checked for the possibility of tinea faciei through repeated fungal tests, and the beta-D-glucan assay can be a useful tool in diagnosing tinea faciei.

Concurrent Posterolateral Corner Injury Associated with a Schatzker Type 2 Tibial Plateau Fracture - A Case Report -

심재천,정충원,남태석 대한골절학회 2020 대한골절학회지 Vol.33 No.1

Isolated posterolateral corner (PLC) injury associated with a Schatzker type 2 fracture is a very rare combination of injuries. A male who was driving a motor vehicle was injured after a collision accident. The plain radiographs and computed tomography scans of the knee showed a Schatzker type 2 fracture of the tibial plateau, mostly in the anterolateral portion of tibial plateau, and an avulsion fragment on the fibular tip. Magnetic resonance imaging showed no injury to cruciate ligaments, medial collateral ligament, or any meniscal injury. We performed an open reduction operation and internal fixation for treating the fracture. Six months later, he complained of instability. At 11 months later after initial operation, we performed the second operation for stabilizing the PLC. We present here a rare case of an isolated PLC injury associated with a Schatzker type 2 fracture. We discuss the mechanism of injury and review similar cases.