관상동맥 스텐트 혈전증 치료에 있어서 혈소판 당단백 IIb/IIIa 수용체 차단제와 카테터를 이용한 혈전 흡입술을 동시에 시행한 경우의 효과에 대하여 알아보고자 하였다. 2008년 07월부터 2017년 07월까지의 일대학교병원 심혈관센터에서 경피적 관상동맥 스텐트 삽입술 후 관상동맥 조영술에서 스텐트 혈전증이 발생한 환자 267명(64.6±12.1년, 187남자) 그룹 I(혈전용해술과 혈전흡입술 동시 시행한 경우, n=32명), 그룹 II (혈전용해술이나 혈전흡입술 한 가지만 시행한 경우 혹은 둘 다 시행하지 않은 경우, n=235명)로 분류하여 주요심장사건, 사망 발생률, 표적병변 재개통술 그리고 스텐트 혈전 등을 1 년동안 추적 관찰하였다. 두 군 간에 임상 특성에서 연령(그룹I: 60.8±12.9 vs. 그룹II: 65.1±11.9, p=0.603), 남성(그룹I: 75.0% vs. 그룹II: 69. 4%, p=0.681), 좌심실구혈율(그룹I: 58.1±9.0 vs. 그룹II: 59.5±11.9, p=0.127)등 양군 간에 차이는 없었다. 주요 심장사건은 두 군간에 차이를 보이지 않았으나(그룹I: 12.5% vs. 그룹II: 23.8%, p=0.180), 세부적으로 살펴보면 사망발생률(그룹I: 0% vs. 그룹II: 13.2%, p=0.034), 표적병변 재개통술(그룹I: 9.4% vs. 그룹II: 6.4%, p=0.4 61) 그리고 스텐트 혈전증(그룹I: 3.1% vs. 그룹II: 4.7%, p=1000)으로, 사망발생률은 혈소판 당단백 IIb/IIIa 수용체 차단제와 혈전흡입술을 동시에 시행한 군에서 유의하게 낮았다. 결론적으로, 관상동맥 스텐트 혈전증 치료에 있어 혈전용해술과 혈전흡입술을 동시 시행하는 경우에 비교군보다 사망 발생율을 감소시켰다.

본 연구는 초음파상 지방간을 세 등급으로 구분하여 적용하는 것이 어떠한 임상적 의의가 있는지 알아 보고자 하였다. 2018년 6월부터 2019년 4월까지 부산 P 검진센터에서 복부초음파 검사를 받은 3607명 중 지방간으로 진단된 1047명(남 818명, 여 229명)을 대상으로 하였다. 초음파상 간 실질의 에코정도, 음향감 쇄정도, 간 내 혈관 및 횡격막이 보이는 정도에 따라 GradeⅠ군(경증 지방간), GradeⅡ군(중등도 지방간), GradeⅢ군(중증 지방간)의 세 등급으로 분류하고, 각 군별 비만지표(체질량지수, 허리둘레), 혈액학적 분석 및 대사증후군과의 연관성을 남녀로 구분하여 분석하였다. 결과로 지방간 등급이 올라갈수록 남자는 여자에 비해 중증 지방간의 비률이 높게 나타났다. 성별에서는 남자가 지방간 등급이 올라 갈수록 각 군별 평균연령이 높게 나타났다. 체질량지수, 허리둘레는 남녀 모두에서 유의하게 지방간 등급이 올라갈수록 증가 하는 차이를 나타내었다(p=.000). 혈액학적 분석에서는 남자는 AST, ALT, γ-GTP, TG, 공복혈당, 당화혈색소에서 유의한 차이를 나타내었다(p<.05). 여자는 ALT, γ-GTP, TG에서 지방간의 등급이 올라갈수록 유의한 차이가 나타났다(p<.05). 대사증후군의 유병률은 남녀 모두 지방간의 등급이 올라갈수록 유의하게 증가 하였다(p=.000). 연구결과를 기초로 초음파상 지방간을 등급에 따라 세분하여 적용함에 있어 혈액학적 변수, 대사증후군 등을 고려하여 지방간 등급을 나눈다면 지방간의 치료 및 경과관찰에 도움이 될 것으로 사료된다.

Purpose: The incidence of pediatric herpes zoster has been increasing year by year. Pediatric herpes zoster is generally known to be less severe than adult cases, but may cause various complications such as secondary bacterial infections, encephalitis, meningitis, and Ramsay Hunt syndrome. In this study, we performed epidemiological and clinical investigations of children and adolescents diagnosed as herpes zoster. The incidence and clinical factors associated with complications of herpes zoster were studied. Methods: This study was retrospectively analyzed the medical records of 62 patients under 18 years who were diagnosed and treated with herpes zoster at Chosun University Hospital from 2007 to 2017. This patients were evaluated with regard to gender, age, dermatomal distributions, accompanying symptoms, underlying disease, treatment and complications. These patients were divided into two groups according to the presence or absence of complications. Results: Children under 18 years old account for 3.2% of all herpes zoster patients who were hospitalized at Chosun University Hospital from 2007 to 2017. The incidence of males was higher than that of females. The number of enrolled patients was increasing according to age. The number and the proportion of pediatric patients has been increasing year by year. Lesions of herpes zoster were most frequently found in the thoracic region, followed by the cervical, trigeminal, lumbar regions. The most common accompanying symptom was pain, followed by pruritus, fever, headache. Among the 62 cases, 27 cases (27.4%) were complicated by herpes zoster. Ramsay Hunt syndrome was the most common (16.1%), followed by meningitis and herpes ophthalmicus. Neither secondary bacterial infection nor postherpetic neuralgia were observed. Skin lesions in the trigeminal dermatomes was associated with complications (p=0.006). The mean of hospitalization period is longer in the group with complications (p=0.003). The patients accompanying symptoms such as headache was more likely to occur complications (p value＜0.05). There was no difference in age, sex, and underlying disease between the two groups. Conclusion: Patients with complications had longer duration of treatment and had more frequent with trigeminal and cervical region. The patients accompanying symptom such as headache were more likely to occur complications.

The aim of this study was to investigate the factors associated with cerebrospinal fluid (CSF) pleocytosis in pediatric enteroviral meningitis. A retrospective analysis of the medical records was performed in 281 patients under 18 years of age who were diagnosed with enteroviral meningitis by reverse transcription-polymerase chain reaction (RT-PCR) at Kwangju Christian Hospital from January to December 2016. Clinical symptoms and laboratory findings were compared according to the presence or absence of CSF pleocytosis. 112 children (39.9%) did not have CSF pleocytosis. When we compared the group of meningitis without pleocytosis and the group with pleocytosis, age were younger (< 2years), and the interval between onset of symptoms and the time of lumbar puncture was shorter (<24 hours), peripheral white blood cell counts were lower, but C-reactive protein (CRP) was higher in the group of meningitis without pleocytosis. Enteroviral meningitis should not be excluded even if CSF pleocytosis is not seen in patients. And enterovirus CSF RT-PCR should be performed with high suspicion in children younger than 2 years.

본 연구는 방사선학과 학생들의 비판적 사고성향과 임상실습만족도와의 관련성을 확인하고자 한 서술연구이다. 임상실습 경험이 있는 187명의 방사선학과 학생들을 대상으로 하였다. 자료 수집은 2017년 12월 1 일부터 15일까지 본인이 스스로 기록하는 설문을 실시하였고, SPSS 프로그램을 이용하여 변수들의 기술통계와 평균비교를 위한 t-test, ANOVA, Pearson 상관분석을 실시하였다. 비판적 사고성향 점수는 3.68, 실습 만족도 점수는 3.59이었고, 방사선학과에 대한 전공 적응도가 좋고, 전공만족도가 높을수록, 지도교수에 대한 만족도가 높을수록 비판적 사고 성향이 높게 나타났다(p<.05). 또한 비판적 사고성향과 임상실습만족도는 유의한 양의 상관관계가 있었다(r=.522, p<.05). 따라서 방사선학 교육 프로그램을 통해 임상실습만족도와 비판적 사고성향을 더욱 강화하는 것이 필요하다.

In Korea, most of college of medicine have runned integrated curriculum of system-centered or organ-centered subjects until now. But after graduation, medical students practically face on the patients who have symptoms, real problems. At that time, to resolve real problems of the patients, medical students need clinical reasoning and problem solving ability. After gradua-tion, through integrated curriculum of system-centered or organ-centered subjects, most medical students didn’t have a suit-able clinical competency to solve the real problems such as headache, epigastric pain, depression. So we need a new curricu-lum such as a clinical presentation curriculum to evoke more clinical reasoning and problem solving ability. The Korean Association of Medical Colleges (KAMC) selected 105 clinical presentations of the patients and published the learning out-comes of basic medical educations to have a clinical competency as primary physicians after graduation of medical school. So we have to learn the history taking, physical examination, possible diagnoses, appropriate investigation, natural history, prognosis and complications of the diagnosed conditions and prevention, treatment and management complications of treat-ment of 105 clinical presentations. Now, I will investigate the Objectives for the Qualifying Examination of Medical Council of CANADA and review the existing medical literature to provide practical insight into the clinical presentation curriculum introduced by University of Calgary. And I will suggest a model of a new curriculum as a clinical presentation curriculum of our university.

본 연구는 원양선박에서 발생하는 선원들의 질환을 원격의료시스템을 통해 실태를 파악하고, 이에 대한 진단명 및 질병분류의 분석을 통해 원양선박 선원들의 질병예방과 건강증진에 기여하는데 그 목적이 있다. 2016하반기부터 2017년까지 약 14개월 동안 원격 진 료를 통해 수집된 총 195명의 선원들의 진단명, 개인적, 건강적 특성을 수집하여 양적분석을 하였다. 질환발생 빈도에서 두드러기(5.6%), 요부염좌(4.1%), 급성위장관염(3.1%) 및 불안(3.1%) 등이 가장 흔하게 발생되는 상병으로 분석되었다. 질병분류에서는 근골격계(25.1%), 피부계(17.9%), 소화기계(11.3%) 순으로 나타났다. 원격의료의 발생은 30세미만이 가장 많았으며, 사관 보다는 부원의 질병발생이 많았다. 교차분석(Ⅹ² 검정)에서 질병이 외상보다 통계학적으로 유의하게 발생이 많았으며(p<.001), 선박의 종류(상선과 어선)에 따른 병인 간에도 차이가 있었다(p<.005).

This study aimed to identify the respiratory viral etiology and clinical features in febrile neonates and young infants younger than 3 months of age. From June 2015 to March 2016, 126 patients who admitted to the pediatrics department of Kwangju Christian Hospital due to febrile illness (body temperature ≥ 38.0℃) without definite focus of fever. We tested nasopharyngeal aspiration specimens with real time reverse transcriptase polymerase chain reaction. Respiratory viruses identified in 66 patients, and not identified in 60 patients. Among identified viruses, the most common pathogen was rhinovirus. Respiratory virus identified patients showed significantly higher presence of sibling (p=0.015), sibling who attending day care center (p=0.022), respiratory symptoms of family members (p=0.022), concomitant respiratory symptoms of the patient (p=0.001).

The incidence of ischemic stroke increases with age due to improvements in health care and living conditions. With increasing proportion of old age, the proportion of old age is rapid expansion in acute ischemic stroke patients. Young and old age groups in acute ischemic stroke patients have different risk factors and clinical features. But, many patients of old age are excluded from active treatment like thrombolysis due to hemorrhagic transformation, poorer clinical outcome etc. So we studied clinical features, risk factor, outcome in ≧80 years old patients compared with <80 years. We enrolled 1,445 patients, who diagnosed acute ischemic stroke in Chosun university hospital, from January 2013 to December 2015. Patients were divided into two groups: ≧80 years versus <80 years. We compared with two groups about risk factors, stroke subtypes, thrombolysis, complications in hospital, initial National Institutes of Health Stroke Scale (NIHSS) score, prognosis. Of the total 172 patients, 54(31.4%) patients were 80 years or older. Symptomatic hemorrhage and asymptomatic hemorrhage was not different between both groups [over 79 years patients: 4/54 (7.4%) vs. under 80 years patients: 10/118 (8.5%), p>0.302], [16.7% vs. 17.7%, p>0.701]. There were no difference in mortality and favorable prognosis at 3 months later between both groups [over 79 years patients: 5/54 (9.3%) vs. under 80 years patients: 5/118 (4.2%), p=0.290], [over 79 years patients: 13/ 21 (24.1%) vs. under 80 years patients: 56/86 (47.5%), p=0.803]. There was difference in early neurological improvement rate(improvement > NIHSS 3) and degree of improvement (NIHSS at discharge - NIHSS at admission) were significant[over 79 years patients: 24/54 (44.4%) vs. under 80 years patients: 77/118 (65.8%), p=0.012], [2.69 vs 5.55, p=0.017]. Intracranial hemorrhage(symptomatic and asymptomatic) and favorable prognosis are not different significantly between two groups. Elderly patients is not a absolute contraindication for intravenous thrombolysis. For intravenous thrombolysis in elderly ischemic stroke patients, we need more study to exclude the poor prognostic factors and to consider of gain of patients.

Salivary gland tumors are relatively rare. Their relative infrequency, and highly variable biologic behavior make some difficulty, but some features can be drawn regarding the incidence, pathology, and pattern of behavior of the various benign and malignant tumors of salivary glands. The present study aims to provide a clinical characteristics of salivary gland tumors. We analyzed retrospectively clinical features of the 80 patients. The most common site of both benign and malignant was parotid gland. The most common presenting symptoms was palpable mass. Histopathologically, the most common type was pleomorphic adenoma in benign tumor and mucoepidermoid carcinoma in malignant tumor.

Recently, renal traumas caused by traffic and industrial accidents have risen sharply due to rapid industrialization and an increase in automobiles. The evaluation of patients with suspected renal trauma relies mainly on clinical assessment, urinalysis and imaging studies. We retrospectively reviewed the medical records of 76 patients who presented to our hospital with renal trauma between January 2008 and December 2014. According to the review, A total of 76 patients presented to our hospital with suspected renal trauma. There were 61 male and 15 female between 2 and 83 years old. By cause, traffic accident was the most common cause of injury, accounting for 39 cases. The remaining injuries were caused by falls in 26 cases, assault in 8 cases and sports-related trauma in 3 cases. Surgical exploration was required in 18 patients for renal or associated injuries. We are of the opinion that close and prompt cooperation with other associated medical departments is mandatory in order to reduce morbidity and mortality caused by multiple injury. Accurate renal injury staging was essential to successful management of traumatized patients.

폐암에 대한 방사선치료는 단독치료 또는 병용치료 시에 효과적인 치료이다. 연구에 의하면 최적의 방사선치료 이용률은 61%에서 74% 범위로 추정되고 있으나, 우리나라의 방사선치료 이용률은 낮은 것으로 조사되어 이에 대한 연구가 필요하다. 본 연구는 부산, 경남 지역에서 폐암환자의 방사선치료 이용률을 조사하여 방사선 이용의 적절성을 평가하고 방사선치료 이용관련 인자를 밝히고자 하는 것이다. 본 연구는 폐암으로 진단된 부산, 경남 지역 인구를 대상으로 하였다. 연구를 위하여 2개의 병원에 등록된 환자 1,036명의 환자 자료를 수집하여 최종적으로 연구에 적합한 897명을 대상으로 연구를 수행하였다. 연구는 적정 이용비율과 실제 방사선치료 비율을 비교하였고, 방사선치료 이용의 적정성과 관련인자를 확인하고자 하였다. 연구대상자 897명 중에서 503명(56%)은 내과적 치료가 시행되었고, 394명(44%)는 방사선치료가 시행되었다. 전체 폐암환자의 방사선치료 이용률은 42%이었다. 조직학적 분류에 의한 비소세포 폐암의 비율은 33%이었고, 소세포 폐암은 90%이었다. 폐암의 방사선치료 이용과 관련 인자는 연령, 조직학적 유형, 임상병기, 의뢰의사, 임상검사이었다. 부위(site)별 방사선치료 이용률을 비교했을 때 근치적 흉부치료는 42%이었고, 완화적 치료는 26%이었다. 조직학적 유형의 비교에서 소세포 폐암의 이용률은 낮았고 특히 병기 Ⅲ기에서 이용률은 가장 낮았다. 부산, 경남지역에서 방사선치료의 이용률은 적정한 이용률 보다 낮게 나타났다.이용률 차이는 환자요인, 종양요인, 의료 서비스 요인으로 설명할 수 있었다. 이용률 개선을 위해서는 아웃리치 서비스(outreach service) 프로그램의 개발과 다 학제적 팀의 활성화가 필요하다.

Guillain-Barré syndrome can be classified with several subtypes along with the union of each symptom. Autoimmune mechanism is accepted for pathogenesis. It is often difficult to predict the causative antibodies of the various types of Guillain- Barré syndrome, because there are considerable mismatches of causative antibody to clinical phenotype as well as phenotype or antibody heterogeneities. We investigated the clinical characteristics of the patients with positivity of anti-gangliosides antibody in the serum. Nineteen patients were enrolled who showed the positivity of anti-GM1 antibody, anti-GQ1b antibody and anti-GD1b antibody, who had visited the department of neurology of Chosun University Hospital. We classified the three patient groups; 8 patients had positivity for anti-GM1 antibody, 10 patients for anti-GQ1b antibody and 8 patients for GD1b antibody. The result of statistical analysis showed no clinical difference within the groups. Therefore, prediction of causative autoantibody can be risky when we considered only the symptoms and course of disease of Guillain-Barré syndrome.