사망진단서(사체검안서) 상의 선행사인으로부터 사망통계의 원사인이 선정되는 비율 : 3개 대학병원에서 교부된 사망진단서를 중심으로

박우성,박석건,정철원,김우철,탁우택,김부연,서순원,김광환,서진숙,부유경 한국의료QA학회 2004 한국의료질향상학회지 Vol.11 No.1

Background : To exatnine the problems intolved in writing practice of death certificates, we cotnpated the determination of underlying cause of death for wital statistics using recorded underlying cause of death in issued death statistics. Methods : We collected 688 rnortality certificates issue in year of 2,000 from 3 university hospitals. And we also collected vital statistics from ministry of statistics. The causes of death were coded by experienced medical record wpecialists. And causes of death determined at ministry of statistics for national vita statistics were mapped to causes of death recorded at each death certificates. The rate that underlying causes of death for vital statistics were derived from underlying causes of death recorded at issued death certificaties sere analysed. Results : 64.5% of underlying cause of death for could be derived from underlying cause of death recorded at issued death certificates, 8.6% derived from intermediate cause of death, and 3.9% derived from direct cause of death. In 23% of cases, underlying cause of death could not be derived using issued death certificates. The rate that underlying cause of death for vital statistics could be derived from underlying cause of death recorded at death certificates was different between 3 university hospitals. Ane the rate was also different between death certificates and postmortem certificates. We classified the causes of death using 21 major categories. The rate was different between diseases or conditions tha caused death too. Conclusion : When we examined the correctness of death certificate writing practice using abpve methods, cortectness of writing could not be told as satisfactory. There was difference in correctness of writing between hospotals, between death certificates and postmortem certificates, and between diseases and conditions that caused death. With this results, we suggested some strategy to improve the correctness of death certificate writing practice.

당뇨병 환자에서 혈장 Thrombin-Antithrombin Ⅲ 및 Plasmin-α_2-Plasmin Inhibitor 복합체의 임상적 의의

김경욱,김은숙,정상수,윤수지,박우일,이준희,남수연,안철우,문병수,김경래,차봉수,송영득,임승길,이현철,허갑범 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.25 No.5

연구배경:당뇨병 환자에서 혈액응고 및 섬유소용해 체계의 이상경향이 있어 그 결과로 여러 혈관합병증의 발생위험이 높다는 사실은 널리 알려져 있다. 그 기전은 아직 확실히 밝혀지지 않았으나, 고혈당으로 인한 혈장 단백질들의 비효소성 당화작용이나 산화성 스트레스로 인한 유리 라티칼 작용으로 응고항진이나 섬유소용해 활성의 저하를 유발하는 것으로 생각되고 있다. 최근 응고 및 용해인자와 그 억제자의 복합체들의 증가가 이 상태를 비교적 예민하게 반영한다고 알려져 있다. 방법:본 연구에서는 당뇨병 환자 101명과 정상 대조군 20명에서 혈장내 thrombin­antithrombin complex(TAT)와 plasmin­α₂­plasmin inhibitor complex(PIC)를 측정하여 비교하고, 당뇨병 환자에서 미세혈관 합병증과 대혈관합병증의 유무에 따른 차이와, 이미 혈관 질환의 위험인자로 알려져 있는 인자들간의 상관성을 알아보고자 하였다. 결과:1. 환자의 분포를 살펴보면 혈관합병증이 있는 군은 85명, 혈관합병증이 없는 군은 16명이었고, 평균연령은 각각 57.9±14.1세, 49.9±16.6세로 혈관 합병증이 있는 군에서 더 나이가 많았고, 체질량지수는 23.2±3.4㎏/㎡, 24.1±3.4㎏/㎡로 두 군간 유의한 차이는 없었다. 또 두 군간의 혈압 및 HbA1c, 공복혈당 및 인슐린과 C­peptide, 총 콜레스테롤, 중성지방, HDL­콜레스테롤, Lp⒜는 유의한 차이가 없었고, 미세혈관합병증이 있는 군에서 당뇨병의 유병기간이 길었다. 2. TAT 및 PIC의 농도는 정상 대조군에서는 2.8±1.2 ng/mL, 240.4±69.7 ng/mL이었고, 당뇨병 환자군에서는 9.5±22.6 ng/mL, 472.2±258.7 ng/mL이었다. TAT와 PIC 모두 당뇨병 환자군에서 정상 대조군에 비해 유의하게 증가되어 있었고(p<0.001), TAT/PIC ratio는 두 군간 차이가 없었다. 3. 당뇨병 환자의 혈관합병증에 따른 TAT 및 PIC, fibrinogen 농도는 합병증이 없는 군은 각각 4.1±2.4ng/mL, 362.2±272.0ng/mL, 322.7±102.4mg/mL으로 PIC와 fibrinogen의 증가를 보였으나, 연령을 보정한 후에는 통계학적 유의성은 없었다. 또 대혈관 합병증군에서는 각각 6.0±4.9 ng/mL, 507.4±321.6 ng/mL, 427.1±194.7 mg/dL이었으며 미세·대혈관 합병증군에서는 10.4±6.4 ng/mL, 484.8±269.7 ng/mL, 388.4±132.4 mg/dL으로 TAT의 증가를 보였으나 역시 연령을 보정한 후에는 통계학적 유의성은 없었다. 4. 미세혈관합병증군에서 HbA1c(>8%)가 높은 군의 PIC 농도가 유의하게 높았고(p=0.049), 대혈관합병증군에서 HbA1c(>8%)가 높은 군의 총 콜레스테롤 농도가 유의하게 높았다(p=0.042). 5. 총 당뇨병 환자군에서 PIC는 fibrinogen과 HbA1c와 양의 상관관계를, BMI와 음의 상관관계를 보였으며(r=0.47, 0.31,-0.25), 혈관 합병증이 없는 당뇨병 환자군에서만 TAT는 HbA1c와 양의 상관관계를 보였다(r=0.67). 결론:이상의 결과에서 혈장 TAT 및 PIC 농도는 당뇨병 환자에서 정상 대조군에 비해 의미있게 증가되어 있었고, 당뇨병 환자군에서는 연령의 증가와 유병기간이 혈액응고항진 및 용해의 장애에 큰 역할을 함을 알 수 있었으며, 총 당뇨병 환자군에 PIC와 HbA1c와 양의 상관관계를, BMI와 음의 상관관계를 보였으며 혈관 합병증이 없는 당뇨병 환자군에서만 TAT는 HbA1c와 양의 상관관계를 보였다. 따라서 당뇨병 환자에서 혈액응고 및 용해의 장애가 동반되어 있다고 볼 수 있으며, 혈장 TAT 및 PIC는 혈관합병증으로의 진행을 예측하는 지표로서 유용하리라 생각된다. 또 혈당조절정도와 상관성이 있으므로 혈당조절후에 추적검사를 시행하여 합병증의 예방이 가능한지 추후 연구가 필요하리라 생각된다. Background : Abnormality of coagulation and fibrinolystic system is known as a predisposing factor of vascular complication in diabetes. Although the pathogenesis is not well known, non-enzymatic glycation reaction and the increase in production of free radicals due to an increased oxidative stress may be linked to the hypercoagulibility and hypofibrinolytic activity. As indices of abnormality in coagulation and firinolysis in peripheral blood, plasma thrombin-antithrombin Ⅲ complex (TAT) and plasmin-α_2-plasmin inhibitor complex (PIC) were measured. The purpose of this study was to clarify whether hypercoagulability exists in diabetic patients with or without vascular complication. Methods : In our study, we measured plasma thrombin-antithrombin Ⅲ compelx (TAT) and plasmin-α_2-plasmin inhibit or complex (PIC) in 101 diabetic subjects and 20 controls. Comparing TAT and PIC levels in diabetic microvascular complication group, diabetic macrovascular complication group and controls, we examined correlation between risk factors associated with diabetic vascular complication. Results : 1. The group with diabetic vascular complication was older than group without complication. There was no significant difference in BMI, blood pressure, HbA_ic, blood sugar level, insulin, C-peptide, serum creatinine, total cholesterol, triglyceride, HDL-cholesterol, Lp (a) between two groups. The group with diabetic microvascular complication had longer duration of diabetes. 2. Concentration of TAT and PIC were 2.8±1.2 ng/ mL, 240.4±69.7 ng/ mL in controls and 9.5±22.6 ng/ mL, 472.2±258.7 ng/ mL in diabetic patients, respectively. TAT and PIC were significantly higher in diabetic patients than in control (p<0.001). But TAT/PIC ratio was no significant difference between two groups. 3. In diabetic patients, concentration of TAT and PIC and fibrinogen were respectively 4.1±2.4 ng/ mL, 362.2±272.0 ng/ mL, 322.7±102.4 mg/ dL in group without vascular complication and 5.3±4.1 ng/ mL, 529.5±258.7 ng/ mL, 374.9±106.2 mg/ dL in group with microvascular complication, which group had increase in PIC and Fibrinogen but no significance after correction of age. Concentration of TAT and PIC and Fibrinogen were 60.±4.9 ng/ mL, 507.4±321.6 ng/ mL, 427.1±194.7 mg/ dL in macrovascular complication, and 10.4±6.7 mg/ mL, 484.8±269.7 ng/ mL, 388.4±132.4 mg/ dL in combined vascular complication which group showed increase of TAT but also had no significant increase after correction of age. 4. In diabetic microvascular complication patients, group of high HbA_1c (>8%) (p=0.049) had significant high PIC concentration. In diabetic macrovascular complication patients, group of high HbA_1c (>8%) (p=0.042) had significant high total cholesterol concentration. 5. In all diabetic patients, PIC was positively correlated with fibrinogen and HbA_1c and negatively correlated BMI (r=0.47, 0.31, -0.25). Only in daibetic patients without angiopathy, TAT was positively correlated with HbA_1c (r=0.67). Conclusion : In this study, plasma TAT and PIC concentration significantly increased in diabetic patients compared with controls, and PIC was increased in group with microvascular complication, TAT were increased in group with combined micro macrovascular complication. However, there was no significance relationship existed when correctinf for age. PIC was correlated with HbA_1c. TAT was correlated with HbA_1c only in the group without angiopathy. Abnormality of coagulation and fibrinolysis were combined in diabetes, plasma TAT and PIC can be used as an index of vascular complication. Also we found the correlation with the degree of the blood glucose control. Therefore we need follow up study for the possibility of prevention of vascular complication after controlling the blood glucose to age-matched patients (J Kor Diaabetes Asso 25:354~363, 2001).

대장암 환자에서의 담즙 암태아성 항원(CEA)

김종우,박용태,정철운,권성원,장항석,손석우,안대호,이경포 대한대장항문학회 2000 Annals of Coloproctolgy Vol.16 No.6

총담관결찰이 담세관에 미치는 영향에 관한 투과 및 주사전자현미경적 연구

최경우,신영철 대한해부학회 1994 Anatomy & Cell Biology Vol.27 No.4

치성 낭종의 임상-병리학적 소견과 TGF-α 및 TGF-β 발현

한경민,김용환,박진혁,윤형기,윤혜경,김우형,이희철 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.4

Objective : Periapical cyst is a relatively common disease but heterogenous in histogenesis, and inflammatory reaction and fibrosis of varying degree are associated in the cystic wall. The aim of thes study is to evaluate the clinico-pathologic characteristics such as patient's age, ses, location, and the degree of inflammatory reaction and fibrosis of periapical cyst and the role of TGF-α and TGF-β cytokines in the inflammed periapical cyst. Methods and Material : The materials were 43 cases of periapical cyst and clinical information with age, sex, location(maxilla vs mandible, right vs left, region involved) were recorded. Histopathological examination on the degree of inflammatory reaction and fibrosis and immunohistochemical stining for TGF-α and TGF-β were perfomed. Satistical analyses between clinical parameters, the degree of inflammation and fibrosis and expressions for TGF-α and TGF-β were followed. Results : 1. Thirt(69.8%) of 43 cases were older than 20 year-old. and no significant differences of incidence according to patient's sex was noted. In 25(58.1%) out of 43 case. 20(54.1%) out of 37 cases, and 20(48.8%) of 41cases, the cyst was located on the maxilla. in right side and in premolar region respectively. 2. The cysts of developmental and inflammatory origin were 24(55.8%) and 19(44.2%) of 43 cases, respectively and there were no siginificant differences of patient's age, sex, and location of cysts according to the origin of cysts. 3. Fibrosis was more conspicuous in cases older than 20 year-old. (p=0.0179), but no significant difference in the degree of inflammatory reaction according to patient's age and in the degree of inflammatory reaction and fibrosis according to sex and location of the cysts were seen. 4. Inflammatory reaction was slightly more in cysts of inflammatory origin, but no significant defferences in degree of inflammation and fibrosis according to origin of the cysts. 5. The degree of inflammatory reaction and TGF-α and TGF-β expressions showed a tendency of positive correlation(p=0.1563), but there were no statistically significant relationships between the degree of inflammation and fibrosis and TGF-α and TGF-β expressions. 6. In the cysts of developmental origin, TGF-α expression in the epithelial cells was significantly increased than inflammatory origin, but TGF-α and TGF-β expressions in the inflammatory cells and stromal cells showed no significant difference according to the origin Conclusion : The degree of inflammatory reaction and fibrosis of periapical cysts was different according to patient's age and location of the cyst. TGF-α and TGF-β cystokines seemed to be involved in the inflammatory reaction and fibrosis of periapical cyst, however, TGF-α and TGF-β expressions was not parallel to the degree of inflammatory reaction and fibrosis. These results suggest that other cytokines in addition to TGF-α and TGF-β may also be involved in the inflammatory reaction and fibrosis of periapical cyst. Increased TGF-expression in the epithelial cells of the cysts of developmental origin could be a helpful finding to defferentiate the origin of the periapical cyst.

구강외과 수술용 스텐트 기반 영상유도 수술 시스템의 개발

이우진,김대승,이원진,이삼선,최순철,허민석,허경회,김명진,이지호 대한구강악안면방사선학회 2009 Imaging Science in Dentistry Vol.39 No.3

Purpose : The purpose of this study was to develop a stent-based image guided surgery system and to apply it to oral and maxillofacial surgeries for anatomically complex sites. Materials and Methods : We devised a patient-specific stent for patient-to-image registration and navigation. Threedimensional positions of the reference probe and the tool probe were tracked by an optical camera system and the relative position of the handpiece drill tip to the reference probe was monitored continuously on the monitor of a PC. Using 8 landmarks for measuring accuracy, the spatial discrepancy between CT image coordinate and physical coordinate was calculated for testing the normality. Results : The accuracy over 8 anatomical landmarks showed an overall mean of 0.56±0.16 mm. The developed system was applied to a surgery for a vertical alveolar bone augmentation in right mandibular posterior area and possible interior alveolar nerve injury case of an impacted third molar. The developed system provided continuous monitoring of invisible anatomical structures during operation and 3D information for operation sites. The clinical challenge showed sufficient accuracy and availability of anatomically complex operation sites. Conclusion : The developed system showed sufficient accuracy and availability in oral and maxillofacial surgeries for anatomically complex sites. (Korean J Oral Maxillofac Radiol 2009; 39 : 149-56)

방사선사진에서의 골질과 임상적으로 평가한 골질 분류의 상관관계

김현우,허경회,박관수,김정화,이원진,허민석,이삼선,최순철 대한구강악안면방사선학회 2006 Imaging Science in Dentistry Vol.37 No.1

Purpose : To investigate the validity of digital image processing on panoramic radiographs in estimating bone quality before endosseous dental implant installation by correlating bone quality in radiographic images with clinical bone quality classification. Materials and Methods : An experienced surgeon assessed and classified bone quality for implant sites with tactile sensation at the time of implant placement. Including fractal dimension eighteen morphologic features of trabecular pattern were examined in each anatomical sites on panoramic radiographs. Finally bone quality of 67 implant sites were evaluated in 42 patients. Results : Pearson correlation analysis showed that three morphologic parameters had weak linear negative correlation with clinical bone quality classification showing correlation coefficients of -0.276, -0.280, and -0.289, respectively (p<0.05). And other three morphologic parameters had obvious linear negative correlation with clinical bone quality classification showing correlation coefficients of -0.346, -0.488, and -0.343 respectively (p<0.05). Fractal dimension also had a linear correlation with clinical bone quality classification with correlation coefficients -0.506 significantly (p<0.05). Conclusion : This study suggests that fractal and morphometric analysis using digital panoramic radiographs can be used to evaluate bone quality for implant recipient sites. (Korean J Oral Maxillofac Radiol 2006; 36 : 25-32)

니켈과 코발트를 함유한 황산용액으로부터 Cyanex 272에 의한 코발트의 용매추출

박경호,정선희,남철우,신선명,김동수 대한금속재료학회 2004 대한금속·재료학회지 Vol.42 No.11

The solvent extraction to separate and recover cobalt and nickel from sulfuric acid solution was studied using Cyanex 272 in kerosene. The solution processed was equivalent to that expected from leaching of a matte, intermediate product of manganese nodules. The extraction of both metals increased with increasing equilibrium pH and extractant concentration. However, cobalt was preferentially extracted over nickel. The extraction efficiencies of cobalt and nickel were 80% and 1.9% respectively with 0.2M Cyanex and O/A of 1 at equilibrium pH 5.0. The separation factor of Co/Ni increased with raising the extraction temperature (205 at 20℃, and at 441 at 50℃). The saponification of Cynanex 272 increased the extraction of cobalt due to the increase of equilibrium pH. Nickel (0.40 g/l) loaded in an organic phase could be scrubbed with a solution containing 10 g/l Co at equilibrium pH of 6.0. The stage numbers and cobalt recoveries in extraction and stripping processes required for the counter current operations are predicted using the equilibrium isotherm plots. (Received May 19, 2004)

임의의 횟수의 휴가를 갖는 M^x/G/1 및 Geo^x/G/1 대기행렬의 분석

채경철,김남기,이호우 한국경영과학회 2002 韓國經營科學會誌 Vol.27 No.2

By using the arrival time approach of Chase et al. [6], we derive various performance measures including the queue length distributions (in PGFs) and the waiting time distributions (in LST and PGF) for both M^x/G/1 and Geo^x/G/1 queueing systems, both under the assumption that the server, when it becomes idle, takes multiple vacations up to a random maximum number. This is an extension of both Choudhury[7] and Zhang and Tian[11]. A few mistakes in Zhang and Tian are correscied and meaningful interpretations are supplemented.

中學生의 科學과 科學敎育에 대한 認識調査

李春雨,朴敬哲 공주대학교 사범대학 과학교육연구소 1990 과학교육연구 Vol.22 No.1

The purpose of this paper is to collect the basic data to develop the middle school students understanding about science and science education. The data for this study are based on a written questionaire. After dividing the collected questionaire by school year and sex distinction, frequency and percentage was investigated. And also, χ relation(likeness) test was used in this study to tell the difference of understanding according to school year and sex destinction. The findings of this surdy are as follows: 1. Most students think that 1) science is a study which researches the world of materials theoretically. 2) science is developed by consistent research and observation. 3) science knowledge is must be proved by an experiment and that there are many ways in explaining the natural phenomena 4) science and scientists not only influence the development of human culture, but also contribute to it. 2. Most student think they have to learn science because it must be developed in order to develop techniques. 3. The students think highly of science and scientists` contribution to the development of human civilization. 4. The students not only think that science is most important, but also are interested in making an experiment and research work. But in reality the students negatively about having a job related to science of being a scientist in the future. The reason for such response is basically caused by the teachers` teaching methods which are focused on teaching the scientific knowledge in science lesson, and by teachers` carelessness dealing with scientific problems. 5. Based on the findings and analyses of the study, the following things can be concluded. (1) The students think that the aims of science is to think scientifically and to improve the ability to solve the problems creatively. (2) The students think that science education is very important. But they show little interest in studying science and find it too difficult. (3) The reasons of studying science turns our as follows: Firstly, to improve the spirit of inquiry and the ability of solving problems. Secondly, because society ban be developed only when science is developed beforehand. Thirdly, to get some more science knowledge. Fourthly, to enter an high school. (4) Most students want laboratory-centered science lesson.