영상검사의 이상소견을 주소로 내원한 46세 여자 환자가 다발성 간 전이를 동반한 췌장 신경내분비종양으로 진단되었다. 표적치료제를 투여하였으며 두 차례의 간동맥화학색전술을 시행한 뒤 유문보존췌십이지장절제술을 시행하였다. 종양의 수술적 절제와 병리검사를 시행한 결과 췌장 신경내분비종양 grade 2로 확인되었다. 수술 이후 4차례의 간동맥화학색전술을 추가적으로 시행하였다. 1년 후 진행한 추적관찰 결과 간의 양쪽 엽에 전이된 종양의 크기가 증가한 것이 확인되어 복강경을 통한 좌외측구역절제술을 시행하였다. 2년 6개월 경과한 후 추적관찰을 진행한 결과 간 전이가 재발하여 7번째 간동맥 화학색전술을 시행하였고, 현재까지 추가적인 치료를 시행하지 않고 장기 생존 중이다. 본 증례를 통해 다발성 간 전이가 동반된 췌장내분비종양 환자애서 간동맥화학색전술, 원발 부위의 절제, 전이 부위 제거 및 분자표적치료 등을 환자의 상태에 맞게 복합적으로 적용시켜 치료할 수 있다는 것을 알 수 있었다. 결과적으로 간 전이를 동반한 췌장내분비종양 환자의 경우 다양한 치료방법을 적극적으로 적용시켜 생존 기간을 늘릴 수 있다고 사료된다.

Purpose: The purpose of this study was to understand the lived experience of a main caregiver, in charge of a family member with a severe chronic disease. Methods: The participants of this study were 13 main caregivers, who have a family member with a severe chronic disease. The data were analyzed through the phenomenological research method. Results: This research concluded with: one core theme, five theme clusters and 13 themes. The one core theme was: ‘My Life is Not Mine.’ The five theme clusters include: ‘The Dark Days Ahead, of What We Do,’ ‘Serious Pressure,’ ‘My Body is Broken (caregivers),’ ‘Overcoming,’ and finally ‘Endless, Long and Long tunnel.’ Conclusion: We must emphasize to a main caregiver of a chronic disease patient, to the fact that their life should be theirs, not the patients. In addition, we need to be attentive of their well-being, as well as the chronic disease Patients, and sensitively responsive to their problems.

The aim of this study was to examine the effects and the sensitivity of antifungal therapy for patients with oral candidiasis and to investigate the relationship among the signs & symptoms of patients and the ratio change of Candida species to antifungal therapy. Candida fungus culture test with ChromeIDTM Candida agar (CAN2) was carried out more than twice for 10 patients who visited Oral Medicine department of Chonnam National University Dental Hospital during the period from Dec. 2015 to Aug. 2016. After culturing the smear sample before and after antifungal therapy in ChromeIDTM Candida agar (CAN2), the number of colonies was counted to compare. Patients were divided into 5 group according to the therapeutic effects of the antifungal agents used: 1) high susceptibility to nystatin, 2) low susceptibility to nystatin, 3) high susceptibility to fluzonazole, 4) low susceptibility to fluzonazole, and 5) increased ratio of new Candida species. Although nystatin is used as first-line therapy in oral candidiasis, it is desirable to use fluconazole if patients had a history of the low sensitivity to nystatin or chemotherapy. Even if the patient's symptoms and signs are improved, there is a possibility of oral candidiasis recurring, so that clinicians should be careful during the treatment with antifungal agents.

The purpose of this case study was to identify the effects of posteroanterior (PA) mobilization on the cervical spine in a patient with chronic whiplash-associated disorder (WAD). The subject of this study was a 58-year-old woman who sustained a chronic WAD as a result of a motor vehicle accident two years prior. The subject has progressively worsening neck pain and stiffness. The subject was determined to have a grade Ⅱb WAD the use of the Modified Quebec Classification. The intervention was central and unilateral PA mobilization on the spinous process of C4 and C5. The PA mobilizations were performed at the end of range to Maitland grade Ⅳ. The PA mobilization was conducted once daily for a total of eight days. Two sets of measurements were done one before and one after the intervention. Neck pain, cervical stiffness, range of motion and lordosis of the cervical spine were measured. Experimental intervention decreased the neck pain, and increased the neck stiffness and cervical ROM (range of motion) such as flexion, extension, lateral flexion and rotation. X-ray photographs also represented that cervical curvature increased from 35° to 40°. This study suggested that PA cervical mobilization applied to hronic WAD is effective in decreasing pain, increasing cervical ROM and cervical curvature.

미리찌 증후군은 담낭절제술을 받은 환자들 중 2% 이하를 차지하는 드문 질환이다. 담낭관 변이와 동반된 미리찌 증후 군의 경우는 수술 중 변이의 발견이 어렵고, 수술 후 합병증이 높아 수술적 치료에 어려움이 있다. 본 증례는 과거 복강경 담 낭절제술을 받은 상태에서, 담관염 소견으로 방문하여 저위 합류 담낭관의 잔여 담낭관에 담석이 감돈되어 발생한 미리 찌 증후군을 진단하고, 내시경으로 성공적으로 치료한 사례 이다. 저위합류 담낭관과 같은 해부학적 변이를 동반한 미리 찌 증후군의 경우 수술적 치료가 어렵거나, 불완전할 수 있다. 이에 내시경 역행담췌관조영술을 통한 인공배액관 삽입술 및 UDCA 약물요법 이후 풍선확장술을 이용한 담석 제거술이 수술적 치료의 대안 치료로 고려될 수 있다.

목 적：임상에서 많이 사용되고 있는 A(ionic contrast) 조영제와 B(Non-ionic contrast) 조영제를 사용 후 Breast 병변 환자의 dynamic검사 시 병변확인에 중요한 요소인 Time-signal intensity curve의 곡선변화를 분석하여 병변을 wash-out 으로 판단하는데 좀 더 효과적인 조영제가 어떤 조영제인지를 알아보고자 하였다. 대상 및 방법：연구 대상은 본원에 Breast MRI를 위해 내원한 환자 중 종양으로 진단 된 환자 32명을 대상으로 하였고, 검사 기간은 2015년 6월부터 2015년 12월 까지 이었으며, 평균연령은 54.1세(35~67세)이었다. 장비는 3Tesla 자기공명영상장치(Magnetom Verio, Siemens, Germany)와 Breast코일을 사용하였으며, 영상의 획득은 T1 FLASH 3D 방법을 이용하여 검사하였고, Auto shimming 시행 후 조영제 자동주입기를 통해 ionic 조영제인 A(2ml/sec)조영제와 생리식염수(30ml, 2ml/sec)를 주입하였고 non-ionic조영제인 B(1ml/sec)조영제와 생리식염수(30ml, 1ml/sec)를 주입하여 영상을 얻었다. Time-signal intensity curve에 대한 분석은 Syngo MR MEAN CURVE Card(Siemens)를 통하여 평균 ROI의 직경을 5mm로 하고 Time-signal intensity curve의 peak time으로부터 기울기를 구해 비교 분석하였다. ionic 과 non-ionic 조영제의 Time-signal intensity curve 값에 대한 비교 분석은 Independent two – sample (T- Test)를 이용하여 통계학적으로 검정하였다. 결 과：Breast cancer 로 확진된 환자 32명의 ionic 과 non-ionic 조영제의 Time-signal intensity curve를 분석한 결과 ionic 평균 기울기는 -7.70(sd=4.78) 이며, non-ionic 조영제 평균 기울기는–12.45(sd=4.84)이였으며 ionic 과 non-ionic 조영제의 Time-signal intensity curve에 대한 T- Test 검정결과 P Valu 값이 0.01으로 두 그룹 간에 유의한 차이가 있음을 보여주고 있다. 결 론：병변판단에 중요한 기준이 되는 Time-signal intensity curve는 검사 시간에 따라 기울기에 변화를 나타낸다. 이러한 제한적인 시간내의 곡선변화는 병변을 판단하는데 있어서 중요한 요소이다. 따라서 임상에서 많이 사용되는 ionic contrast와 non-ionic contrast를 개별적으로 사용한 결과 non-ionic 조영제를 사용한 검사의 Time-signal intensity curve 기울기가 ionic 조영제를 사용한 검사의 기울기보다 좀 더 큰 변화를 나타냈다. 결론적으로 breast dynamic 검사 시 ionic 조영제 보다 non-ionic 조영제를 사용하는 것이 좀 더 유용하리라고 보여진다.

목적 : 본 연구는 일상생활활동에 대해 환자의 능력과 보호자의 인식을 비교해봄으로써 뇌졸중 환자가 점 차 독립적인 생활을 수행하도록 하기 위한 효율적인 재활중재가 필요함을 강조하고자 하였다. 연구방법 : 부산, 대구, 거제에서 재활치료 중인 뇌졸중 환자 및 보호자 각각 95명을 대상으로 한글판 수 정바델지수(Korea Modified Barthel Index; K-MBI)를 이용하여 일상생활활동 평가를 실시하였다. 환 자의 능력에 대해 연구자가 직접 관찰하고, 보호자의 인식에 대해 보호자가 충분한 설명을 들은 후 문서 에 기입하도록 하였다. 환자의 능력과 보호자의 인식 비교를 위해 독립표본 t-test를 사용하였다. 결과 : 일상생활활동에 대해 환자의 능력과 보호자의 인식을 비교해본 결과 보호자가 인식하는 것보다 환 자의 능력이 더 좋은 경우 환자의 능력은 78.65±14.55점, 보호자의 인식은 70.89±15.35점으로 유의 하게 나타났고(p<.05), 보호자가 인식하는 것보다 환자의 능력이 더 좋지 않은 경우에도 환자의 능력은 69.63±9.82점, 보호자의 인식은 76.11±10.72점으로 유의하게 나타났다(p<.05). 결론 : 연구결과 환자의 일상생활활동 능력과 보호자가 생각하는 환자의 일상생활활동 능력 간에 차이가 있었다. 따라서 후속 연구에서는 환자의 독립성을 향상시킬 수 있는 구체적 방안에 관한 연구가 필요할 것이다.

The purpose of this article was to investigate the effects of Maitland’s transverse movement on change of pain, trunk flexion movement and Cobb’s angle in patient with upper thoracic scoliosis. The subject are 37 years old with chronic low back pain participated in this study and has no experience surgery within the last six months due to back pain. 10 set was applied 10 times on the T3-T5 applied the transverse movement with grade Ⅳ to each segment by skilled physical therapist. Transverse movement was applied convex toward the concave side. Pressure pain threshold was reduced from 4/10 to 2/10. Trunk flexion range that is the distance between the middle finger and floor was increase from 7.3cm to 2cm. Cobb’s angle was decreased from degree 18 to 16. This result demonstrated that the Maitland’s transverse movement was benefit to reduce the pain and Cobb’s angle, and to increase the trunk flexion movement.

The purpose of this study was to investigate the effects of occipital bone stimulation by cervical stabilizing exercise on the muscle tone, stiffness, ROM, and cervical lordosis in patient with forward head posture( FHP). This study was a case study of a single patient with forward head posture. This study used a ABA' design, A and A' were the baseline phases and B was the intervention phase. The intervention was occipital bone stimulation by cervical stabilization exercise. It was administered once daily for 7 days. The therapist kept hands together, and placed the two index fingers under the subject's occipital bone. The subject performed the chin-in exercise with a maximum isometric contraction for 20 sec.The exercise was implemented by performing the movements 10 times as a set and repeating the set three times. The muscle tone was not significantly changed after intervention. However, the stiffness was decreased and lasted the effect lasted without intervention. The cervical flexion angle was increased, but the cervical extension angle was not significantly changed after the intervention. The left and right lateral flexion angles were increased and the effect lasted without any intervention. However, the left and right rotation angles were significantly changed after the intervention. Cervical lordosis increased not from 37° to 41° after the intervention. These results suggest that occipital bone stimulation by cervical stabilizing exercise had a positive effect on cervical stiffness, flexion and lateral flexion ROM, and lordosis in a patient with forward head posture.

Kodamaea ohmeri, previously known as Pichia ohmeri or Yamadazyma ohmeri, is an ascosporogenous yeast that belong to the Saccharomycetaceae family, and it is a rare yeast-form fungus recently identified as an etiological agent of fungemia, endocarditis, urinary tract infection and peritonitis in immunocompromised patients. This paper presents a case of K. ohmeri fungemia in a 70-year-old man with carcinoma of the ampulla of Vater. After receiving endoscopic retrograde cholangiopancreatography (ERCP) for releasing obstruction of ampulla of Vater by insertion of the biliary stent, he was pyrexial with a temperature of 38.5°C. Two set of blood samples were obtained from a peripheral vein for culture. The pathogen was identified as K. ohmeri using the Vitek YST card (bioMérieux, France) and was confirmed by the sequencing of the D1/D2 domains of the 26S rRNA gene and the internally transcribed spacer region. The minimal inhibitory concentrations of the antifungal agents were as follows: amphotericin B 0.5 μg/mL; fluconazole 2 μg/mL; voriconazole ≤ 0.12 μg/mL; fluocytosine ≤ 1 μg/mL. According to the Clinical and Laboratory Standard Institute recommended breakpoint for Candida spp, the isolate was susceptible to fluconazole, amphotericin B, voriconazole, and flucytosine. This is the first report of the isolation of K. ohmeri in the patient with a gastrointestinal neoplasm following ERCP.

Purpose: This study was tried to identify the effects of simulation program by applying hazard perception training on self-efficacy of patient safety, error recovery and problemsolving process in nursing students. Methods: A nonequivalent control group designed was used. The study was composed of hazard perception training and simulation program. Sixteen teams of a total of 61 nursing students participated in the simulation program using a high fidelity simulator. The collected data were analyzed by descriptive statistics, χ2-test and t-test using PASW 18.0 program. Result: There were statistically signigicant in self-efficacy of patient safety(t=2.55, p=.013), error recovery(t=2.82, p=.007), and problem-solving process(t=3.29, p=.002) in the experimental group. Conclusion: These results indicate that the simulation program by applying hazard perception training is effective in improving self-efficacy of patient safety, error recovery and problem-solving process for nursing students. Further study is recommended to confirm the long-term effects of the simulation program by applying hazard perception training.

Beam hardening artifact can be caused by metal material when performing PET exam. Therefore, we studied a solution decreasing artifact caused by metallic dental implant. The higher voltage, the lesser artifact in CT exam. But Higher voltage dosen't affect PET exam. The thicker silicon the lesser artifact in CT and PET exam. Both methods make less artifact in CT and PET exam. But considering safety of patient, the way of using silicon is better.

Chest lateral decubitus is a chest examination to determine the persence of pleural fluid in thorax. In this study, we prepare recumbent holding position time standard of chest lateral decubitus. The records of 15 patients with chest lateral decubitus between May and Jun. Recumbent holding time is 30, 60, 90, 120, 180, 210, 240 seconds. The result is fluid level change between 0.88mm to 9.63. Fluid heigh change between 9.9 percent to 42.5 percent. We can confirm fluid level change with chest decubitus image. The proper time for fluid level change is 180 seconds.

L-아스파라기나제는 급성 림프모구백혈병 환자에서 사 용이 증가하는 약물로, 췌장염은 이 약제의 중요한 합병증 중 하나이며, 항암화학치료 중 이에 대한 주의가 필요하다. 급성 췌장염은 드물지만 치명적 합병증인 괴사성 췌장염 으로 진행할 수 있으며 빠른 진단과 적절한 처치가 중요하다. 본 증례는 괴사성 췌장염에 동반된 췌관 누출 그리고 췌장가성낭이 경유듀적 췌관 스텐트 삽입으로 호전되었던 증례이다. 향후 이러한 L-아스파라기나제 유발 췌장염 및 췌관 누출의 치료를 위한 다양한 접근 및 안전성에 대해 추가적인 연구가 요구된다.

In this study, to find out the effect of psychological anxiety of the patients during MRI examination on the claustrophobia and vital signs, As for a study tool, to measure Anxiety Sensitivity Index(ASI), Kamsung Evaluation Index of Life Environmental Noise(KEI), Diagnostic and Statistical Manual of Mental Disorders(DSM-IV) was used, and for vital signs, blood pressure and pulse rate were measured pre and post MRI examination. In conclusion, it was indicated that though the effect of the general characteristics, psychological anxiety, on noise sensitivity and claustrophobia was small, the psychological anxiety of the patients during MRI examination affected claustrophobia and vital signs.

In this study, We designed and implemented a assistant device for the standing X-ray views which is the one of the clinical X-ray imaging position. To evaluate the usability of the proposed assistant device, We choose 11 clinical patient postures that are used frequently and applied the postures to 5 volunteers. 11 images was taken from a volunteer for the patient postures. And we conducted a survey on safety and clinical usefulness, the 5 volunteers responded to the safety and 5 experts responded to the clinical usefulness. The survey results show that the volunteers feel more safe and the obtained images are very clear and clinically useful. The result for the image quality is 4.69 of 5(best) and safety is 2.84 of 3(best). It will be very profitable to both patients and hospitals by using the proposed assistant device.

This case report describes the effectiveness of cervical corrective exercises in a patient with cervical radiculopathy (CR) who experienced radicular pain, upper limb paresis, and limited functional activity. A 39-year-old male with cervical radiculopathy performed the cervical corrective exercises for reducing pain. Pain intensity, cervical posture, and active range of motion of cervical intersegmental spine motion were measured baseline, after 4 weeks, and after 8 weeks with self-reported questionnaire and radiographs. After 8 weeks of intervention, the patient demonstrated alleviated radicular symptoms, improved neck posture and active range of flexion and extension of the cervical intersegmental spine. Especially in the angle between the cervical vertebra 6 and 7, the angle was changed from -4.69° to 3.30° during resting position after intervention. The present case indicates that the cervical corrective exercises might be a possible treatment to effectively reduce radicular symptoms, improve neck posture, and active cervical intersegmental motion for patient with CR.

본 증례는 다발성 골수종을 진단 후 Bortezomib, Melphalan, Prednisolone 항암치료 중에 급성 췌장염이 발생된 매우 드문 경우이다. 급성 췌장염이 원인을 알기 위하여 알코올 병력, 담석증, 외상, 고칼슘혈증, 고중성지방혈증 등에 대한 혈액검사 및 영상의학적 검사를 시행하였지만 특별한 소견은 없었다. 급성 췌장염을 유발할 수 있는 약제인 Bortezomib이 그 원인일 가능성으로 판단되어 Bortezomib 중단과 보존적 치료로 급성 췌장염이 호전되었다. Bortezomib은 다 양한 비특이적인 위장관 증상을 흔하게 유발할 수 있지만 복통이 지속되거나 재발하면 드물지만 급성 췌장염이 발생할 수 있음을 염두에 두어야 하겠다.

목 적: 콘택트렌즈의 부작용으로 감염성 각막염이 의심되는 환자에서 분리한 균주들을 동정하고, fluoroquinolone 항생제 내성균주를 감별하여 내성기전에 관여하는 gyrA 유전자를 분석해 내성의 원인을 알아보고자 한다. 방 법: 감염성 각막염이 의심되는 기질성 침입 환자 30명을 대상으로, 각막에서 분리한 균주를 Ofloxacin(5㎍/㎖), Ciprofloxacin(5㎍/㎖), Levofloxacin(5㎍/㎖) 항생제 배지에 배양하여 16S rRNA gene PCR 방법으로 동정하였다. 디스크 확산법으로 내성균주를 감별하고, genomic DNA를 추출하여 PCR를 통 해 증폭한 후 gyrA QRDR 부위의 유전자를 분석하였다. 결 과: Ofloxacin이 첨가된 배지에서 배양된 균주는 Achromobacter xylosoxidans (N101, N102), Staphylococcus epidermidis (N105)로 동정되었고, Ciprofloxacin이 첨가된 배지에서 배양된 균주는 Achromobacter xylosoxidans (N101, N102), Staphylococcus epidermidis (N103, N104, N105, N106), Staphylococcus warneri (N107), Staphylococcus hominis (N108), Staphylococcus saprophyticus (N109), Alcaligenes sp.(N110)로 동정되었다. 항생제 디스크 확산법으로 Staphylococcus epidermidis (N105)는 Ofloxacin에 내성, Ciprofloxacin과 Levofloxacin은 중간내성으로 나타났으며, gyrA 유전자의 분 석 결과 QRDR부위에서 Ser(TCT)84 →Phe(TTT)으로 아미노산 변이가 관찰되었다. 결 론: 감염성각막염 의심환자 각막에서 그람양성균 7균주, 그람음성균 3균주가 동정되었다. fluoroquinolone 항생제 감수성 검사에서 내성균주가 나타났으며, gyrA 유전자의 codon 84 부위에서 아미 노산 변이가 나타나 내성에 영향을 미치고 있다는 것을 확인할 수 있었다. 향후 항생제의 지속적인 사용으로 많은 내성균주들이 나타날 것이라 예측되며 fluoroquinolone 항생제를 사용할 때 내성에 대한 주의가 필요 할 것으로 생각된다.

Through the inspector's real name to improve the quality of inspection is to show the design Radiological examination pursuant to the Ordinance of the Ministry of Health and Welfare for patient safety in the Image. However, the use of existing and in EMR, equipment within the handwriting input, the individual initial use has a problem. In this study, increasing the stability of the patient and the precise inspection, In order to increase the efficiency and convenience than the real-name system for quality control inspectors of medical equipment, Using the EMR and PACS developed and applied to evaluate the usefulness of automatic enrollment. Enter your information in the EMR, which was developed markers that inspectors use to compare the before and after images PACS satisfaction. Convenience than using traditional, consistency, the entry of the missing were higher as a statistically significant difference. A test strip automatic enrollment programs are developed in this study. You can increase the stability of the patient by checking the image to show the real tester, we expect the quality of care would be improved.