대한민국 흉부외과 수술자료수집을 위한 코드

김경환,김광택,노환규,박승일,박영환,선경,성숙환,송현,심영목,원태희,임청,이정렬,정경영,전태국,박수정,Kim, Kyung-Hwan,Kim, Kwang-Taek,Rho, Hwan-Kyu,Park, Seung-Il,Park, Young-Hwan,Sun, Kyung,Sung, Sook-Hwan,Song, Hyun,Shim, Young-Mok,Won, Tae-He 대한흉부심장혈관외과학회 2001 Journal of Chest Surgery (J Chest Surg) Vol.34 No.1

고양지역 두 병원에서의 약물 중독 양상

김경환,박준석,신동운,노준영,김혜진,구홍두,조진경,김아진,Kim Kyung-Hwan,Park Jun-Soek,Shin Dong-Wun,Rho Jun-Young,Kim Hey-Jin,Gu Hong-Du,Cho Jin-Kyung,Kim Ah-Jin 대한임상독성학회 2006 대한임상독성학회지 Vol.4 No.1

Purpose: In the year of 2005, it enforced the basic study for establishing program of Poison Control Center by National Institute of Toxicologic Research. The object of our survey is to analyze the characteristics of intoxication from the City of Goyang by same protocol. Methods: We retrospectively reviewed the data of medical records of the intoxication patient in the two hospitals of the Goyang from 2004 June 1st to 2005 May 31th. The investigation protocol applied the TESS report form which was used from the Basic study for establishing program of Poison Control Center. Results: The intoxication patients were total 269 persons, the patients of A hospital were 184 persons, B hospital were 185 persons. The most common intoxication materials were medicines, in afterwords it was an agricultural chemical. The most common place of intoxication was the home. The intentional suicidal attempts in the reason of intoxication were 51.2%. The rate of the patients who discharges from the emergency department was 50.4% and death rate was 4.3%. Conclusion: We concluded that the continuous and systemic report and analysis should be accomplished from the Goyang area.

CPM Bar Chart 기법을 활용한 일정계획

김경환,김수유,김재준,Kim Kyung-Hwan,Kim Soo-Yoo,Kim Jae-Jun 한국건설관리학회 2004 건설관리 : 한국건설관리학회 학회지 Vol.5 No.5

본 연구에서는 바차트(bar chart) 기법과 CPM 기법의 장점을 결합한 CPM bar chart(CBC) 기법을 제시한다. CBC는 기존의 fenced bar chart(FBC)의 장점을 유지하면서 단점을 보완한 것으로, 작업 관계를 나타내는 fence에 방향성을 부여함으로써, 기존 FBC에서 상당한 혼란을 유발하는 fence의 분리과정 없이 작업들의 관계를 표현할 수 있다. 또한, fence의 분리를 파악하기 위해 더미작업(dummy activity)을 확인하는 과정이 생략되어 보다 손쉽게 작성할 수 있는 장점도 있다. 바차트의 간결성을 유지하면서 CPM의 네트워크 논리 표현이 가능해짐에 따라, CBC는 다양한 프로젝트 참여자들 간의 원활한 의사소통에 기여하리라 예상된다. 또한, resource constrained scheduling, resource leveling, 작업 분리가 고려된 일정 조정, 공기 지연 분석 등의 CPM 기법에 기초한 다양한 일정 계획 및 관리에도 적용이 용이하여, 실무뿐만이 아니라 공정관리 교육과정에서도 활용성이 높으리라 기대된다. This paper proposes the CPM bar chart (CBC), a hybrid of the bar chart and the critical pad method (CPM). The CBC overcomes shortages of the fenced bar chart, while still keeping advantages. The fence with direction is applied instead of the broken fence, which triggers considerable problems to identify and apply in the fenced bar chart. In addition, the notorious task to find dummy activities is no longer required. Upon the benefits of simplicity in the bar chart and logical work sequence in the CPM network. the CBC provides a relatively easy way to create and understand a schedule, thus improving communication quality between project participants. With the advantages, the CBC can also be effectively applied to various scheduling techniques such as resource constrained scheduling, resource leveling, scheduling with activity split, delay impact analysis, etc.

수직자기기록용 박막의 제작

김경환,김명호,손인환,김재환 ( Kyung Hwan Kim,Myung Ho Kim,In Hwan Son,Jae Hwan Kim ) 한국전기전자재료학회 1997 한국전기전자재료학회 추계학술대회논문집 Vol.1997 No.1

앉고 일어서기 동작에서 점진적 체중 이동을 이용한 시각적 되먹임 훈련이 만성 편마비 환자의 균형 및 보행능력에 미치는 영향

김경환,박성훈,김형민,박노욱,김다연,Kim, Kyung-hwan,Park, Sung-hoon,Kim, Hyung-min,Pak, Noh-wook,Kim, Da-yeon 대한고유수용성신경근촉진법학회 2017 PNF and Movement Vol.15 No.1

Purpose: This study aimed to investigate the effect of visual feedback training-for gradual weight shift in sit-to-stand training-on the balance and walking abilities of chronic hemiplegia patients. Methods: Twenty patients with chronic hemiplegia volunteered to participate in this study. The experimental group received visual feedback for gradual weight shift in the sit-to-stand training, while the contrast group followed the standard process for the sit-to-stand training. The evaluation of the balance and walking ability was conducted with the functional reach test (FRT), Berg balance scale (BBS), five time sit-to-stand (FTSTS) test, timed up and go (TUG) test, 10 m walk test (10MWT), balancia, activities-specific balance confidence (ABC) scale, and falls efficacy scale (FES). Results: In the results before and after intervention, there was a significant difference in TUG, 10MWT, ABC, and FES in the visual feedback training group (p < 0.05). In the control group, there was a significant difference in the 10MWT and ABC (p < 0.05). Also, in the evaluation of the postural fluctuations, the control group data showed a significant increase in Covar. The visual feedback group showed a significant difference in the W average. Conclusion: The visual feedback training group showed some improvement in terms balance and walking ability and on the ABC scale and FES. Therefore, if the diagonal progressive weight bearing exercise is combined with the various patterns and basic principles of PNF, it may be a more efficient intervention method.

베체트씨병에 의한 대동맥판 폐쇄부전의 수술적 치료

김경환,김기봉,김원곤,김주현,안혁,Kim, Kyung-Hwan,Kim, Ki-Bong,Kim, Won-Gon,Kim, Joo-Hyun,Ahn, Hyuk 대한흉부심장혈관외과학회 2000 Journal of Chest Surgery (J Chest Surg) Vol.33 No.5

Background: Cardiac involvement of Behcets disease is very rate, however, the prognosis of Behcet disease depends on cardiovascular complications. In this article, we described surgical treatment of aortic insufficiency with Behcets disease. Material and Method: From March 1986 to February 1998, we operated on 10 patients of aortic insufficiency with Behcets disease. Male to female ratio was 8 to 2, and age ranged from 21 to 40 years(mean 32.8 years). There were 8 patients with evidence of Behcets disease and another 2 patients had some suspicious findings of Behcets disease(i.e., prosthetic value dehiscence, hypertrophied aortic wall). Adequate preoperative medical treatment for Behcets disease was done in 3 patients. Result: We performed 24 open heart surgeries in 10 patients. Redo value replacements using prosthetic valves were done in 4 patients. Among them, 2 patients were operated on for a second redo valve replacement and one of them operated on for a 4th and 5th operation because of recurrent paravalvular leakage. These 4 patients expired. 1 patient who had undergons tissue value replacement is alive. 1 patient who underwent Cabrol operation expired dut to rupture of graft anastomosis site. We used homografts in 3 patients. In 2 of them, we performed aortic root replacement and subcoronary valve replacement in another patient. The patient who underwent subcoronary valve insertion had remnant aortic insufficiency, so we are closely observing him. We also performed Ross operation in a 24 year old female who suffered severs aortic insufficiency and endocarditis after aortic valvuloplasty. 5 patients are alive and mean follow up duration is 49.0 months. Among them, we used homografts or sutografts in 4 patients. We could observe excellent clinical results in the patients who underwent aortic root replacement using homograft and they were treated medically for Behcets disease. Conclusion: We concluded that adequate preporative diagnosis, clinical suspicion, and periopertive medical treatment for Behcets disease are very important for the result of surgical management of aortic insufficiency with Behcets disease. The use of homograft or autograft was helpful for the healing of anastomosis site and we should carefully observe the long term follow up results.

승모판 질환에 동반된 심방세동에 대한 폐정맥 분리술의 중기성적

김경환,김태헌,안혁,Kim, Kyung-Hwan,Kim, Tae-Hun,Ahn, Hyuk 대한흉부심장혈관외과학회 2001 Journal of Chest Surgery (J Chest Surg) Vol.34 No.4

배경: 항부정맥 술식으로서의 메이스 술식은 우수한 동율동 전환율을 보고 있으나, 술식의 복잡성과 상대적으로 긴 수술 시간 등으로 모든 환자들에게 적용할 수는 없기에, 일부 환자군에서 보다 간단한 항부정맥술인 폐정맥 분리술을 시행 받은 환자들을 대상으로 동율동 전환율 등의 수술 성적과 위험 인자 등에 대해 알아보고자한다. 대상 및 방법: 1995년 10월부터 1999년 2월까지, 폐정맥 분리술을 시행받은 96명의 환자들을 대상으로 후향적 연구를 시행하였다. 남자가 37명(38.5%), 여자가 59명(61.5%) 이었고, 평균 연령은 46.9$\pm$11.6세 이었다. 승모판 협착 환자가 50명(52.1%), 폐쇄 부전이 24명(25%), 협착과 폐쇄부전이 같이 있었던 경우가 22명(22.9%)이었다. 판막 술식과 폐정맥 분리술을 시행하고 좌심방이 제거술을 시행하였다. 모든 환자들은 술 후 6개월 내지 1년 이내에 외래에서 심전도와 심초음파를 시행받았다. 평균 추적 관찰 기간은 25.9$\pm$11.5개월 이었다. 술 후 최근 추적일까지 동율동으로 전환된 군과 안된 군으로 나누어 분석을 하였다. 결과: 조기 성적으로는 사망이 3명(3.1%), 술 후 6개월 이내의 추적관찰 유실이 2명(2.1%) 이었다. 조기 합병증으로 재수술이 필요 했던 출혈이 4례, 심폐바이패스 이탈 실패오 심실보조장치 등의 삽입이필요했던 경우가 1례, 뇌혈관질환 1례, 심근경색이 1례 등이 있었다. 만기 합병증으로는 동기능 부전 증후군으로 영구 심박동기를 삽입한 경우가 1례, 일시적인 뇌경색 1례 있었고 다른 판막과 연관된 합병증은 없었다. 동율동 전환 환자 수는 75명(82%)이었다. 동율동으로의 전환이 어려운 위험인자로 50세로 이상의 연령(p=0.03), 65mm 이상의 좌심방 크기(p=0.03), 동반 우심 술식 시행(p=0.02)등이 있었다 결론: 승모판 질환을 동반한 심방 세동 환자에서 폐정맥 분리술을 시행하여 만족할 만한 동율동 전환율을 얻을 수 있었다.

흉부 대동맥 질환에서 스텐트-그라프트의 임상적 적용

김경환,이철,장지민,정진욱,안혁,박재형,Kim, Kyung-Hwan,Lee, Cheul,Chang, Ji-Min,Chung, Jin-Wook,Ahn, Hyuk,Park, Jae-Hyung 대한흉부심장혈관외과학회 2001 Journal of Chest Surgery (J Chest Surg) Vol.34 No.9

배경: 하행 흉부대동맥류를 포함한 대동맥 질환을 가진 환자들에서 히생한 대동맥내 스텐트-그라프트 삽입술의 치료효과와 추적성적 및, 대상 환자들의 임상적 특징을 통해 치료방법으로서의 적응과 역할을 알아보았다. 대상 및 방법: 1995년 이후 모두 8명의 환자에서 진단방사선과와 협진으로 스텐트-그라프트 삽입술을 시행하였으며, 시술 전 진단으로는 외상성 대동맥 파열이 3례, 동맥경화증성 대동맥류 3례, 흉부가성대동맥류 파열 1례, 매독성 대동맥염에 의한 흉복무대동맥류가 1례였다. 시술은 혈관조영실에서 혈관조영을 하면서 시행하였고, 전신마취가 3례, 국소마취가 3례였고, 2례에서 경막외 마취하에 시술하였으며, 사용한 스텐트-그라프트는 0.35mm 굵기의 스테인레스 강철사를 지그재그 형태로 구부려 만든 스텐트를 서로 연결하고 인조혈과(Dacton)을 입힌 후 봉합한 것으로 제조회사에 의뢰하여 자체제작 하였다. 결과: 시술받은 환자의 전례에서 스텐트-그라프트 삽입시 기술적 어려움은 없었으며, 스텐트-그라프트 삽입후 4일에서 7일 사이에 시행했던 추적검사(4례)에서 스텐트-그라프트 주위부 누출이나 당초 목표했던 위이에서의 이탈은 없었다. 1례의 외사성 대동맥 파열이 었었던 환자가 시술 후 13일째 급성호흡곤란증후군 및 다장기부전으로 사망하였고, 매독성 대동맥염이 있었던 흉복부 대동맥류 환자가 시술 후 6일째 상행대동맥 및 대동맥궁에 대한 수술을 시행받고 술후 22일째 문합부위 파열로 사망하였다. 결론: 대동맥내 스텐트-그라프트를 이용한 흉복부 대동맥 질환의 치료는 수술에 따른 이환률 및 사망률을 고려할 때 특히 다장기부전으로 수술이 어려운 경우 또는 수술 후 합병증의 발생이 강력히 우려되는 경우에 안전하게 시행할 수 있는 치료의 한 방편으로서 의미를 가진다고 사료된다.행성 이하선염과 파라인플루엔자 바이러스는 외피가 있는 170-180nm 이었다.$\pm$0.10(100분), 0.46$\pm$0.11(120분), 0.52$\pm$0.15(심폐기 재가동 30분), 0.62$\pm$0.15(60분), 0.76$\pm$0.17(심폐기이탈 30분), 0.81$\pm$0.20(60분), 0.84$\pm$0.23(90분) and 0.94$\pm$0.33(120분)를 보였고 이는 역행성 뇌관류 전에 비해 유의하게 증가된 소견이었다(p<0.05). 뇌신피질, 기저핵, 해마에서 전자현미경 조직 소견을 관찰하였으며 마이토콘드리아의 부종을 관찰할 수 있었다. 결론 : 역행성 뇌관류 120분 후에 S100 베타 단백의 유의한 증가를 관찰할 수 있었으며 뇌조직 손상과의 관련성은 좀 더 연구되어야 할 부분으로 생각된다. 장기 생존 모델을 통한 재평가가 필요하다고 사료되며 심폐바이패스 시행 등의 교란 인자도 고려해야 할 것이다.비해 Progenitor II의 형질전환 효율이 현저히 떨어졌다. L. acidophilus HY7008과 HY7001은 두 기기 모두 형질전환이 이루어졌으나, L. acidophilus WEISBY와 NCFM은 Progeni-tor II에서 전이가 일어나지 않았으며, Gene Pulser에서 전이균주를 얻어 두 electroporator간에 형질전환 효율의 차이를 보였다. 11. L. casei 102S에 pLZ12를 electroporation시 낮은 전압에서 형질전환 효율이 비교적 좋았으며, 배양 시기를 달리하여 전이시켰을 때 대수생장 말기의 세포가 형질전환 효율이 좋았다. 12. Background: Endovascular stent-graft insertion in aortic diseases is now generally accepted as an attractive alternative treatment modality. We reviewed our clinical experiences of endovascular stent-graft insertion in thoracic aorta. Material and Method: Since 1995, we performed 8 cases of endovasclar stent-graft insertion. Preoperative diagnoses were aortic aneurysms in 4, traumatic aortic ruptures in 3, and ruptured aortic pseudoaneurysm in 1. All procedures were performed in angiography room with the guidance of fluoroscopy. The stent-graft device is a custom-made 0.35mm thickness Z-shaped stainless steel wires, intertwined with each other using polypropylene suture ligation. It is covered with expanded Dacron vascular graft. Result: All procedures were performed successfully. Follow-up studies revealed 2 minimal perigraft leakages. There was no significant leakage or graft migration. 2 patients expired due to multiple organ failure and fungal sepsis. Other survivors(6) are doing well. Conclusion: Endovascular stent-graft insertion is relatively saft and effective treatment modality in the managment of various types of aortic diseases. In may be an effective alternative in aortic diseases of great surgical risk.

PNF 하지굴곡패턴운동이 체간근육 활성도에 미치는 영향

김경환,기경일,윤혜진,Kim, Kyung-Hwan,Ki, Kyong-Il,Youn, Hye-Jin 대한고유수용성신경근촉진법학회 2011 PNF and Movement Vol.9 No.3

Purpose : The purpose of this study was to analyze the effect of PNF lower extremity flexion pattern on the eletromyographic (EMG) activity in rectus abdominis, internal oblique abdominal, external oblique abdominal, erector spinae. Methods : Twenty-six healthy adults volunteered to participate in this study. Subjects were required complete following two PNF lower extremity patterns; flexion-adduction-external rotation with knee flexion (D1) and flexion-abduction-internal rotation with knee flexion (D2). A paired t-test was used to determine the influence of the PNF two patterns on muscle activity for each muscle and descriptive statistics was used to determine local/global muscle ratio. Results : The D1 pattern was showed significant rectus abdominis (p<.05) and Median of internal oblique/rectus abdominis ratio was 2.23 and internal oblique/external oblique ratio was 1.53. The D2 pattern showed significant erector spinae (p<.05) and Median of internal oblique/rectus abdominis ratio was 3.06 and internal oblique/external oblique ratio was 1.72. Conclusion : The D1 pattern made rectus abdominis activation increase. The D2 pattern made erector spinae activation increase. As compared D1 and D2 pattern on trunk muscle activation, it's will be useful decision making for the trunk muscle strength and stabilization.

펀측 상지에 적용된 고유수용성 신경근 촉진법이 반대측 하지의 근 활성도에 미치는 영향

김경환,박지원,배성수,Kim, Kyung-Hwan,Park, Ji-Won,Bae, Sung-Soo 대한고유수용성신경근촉진법학회 2006 PNF and Movement Vol.4 No.1

Purpose: The purpose of this study was to investigate the effect of Proprioceptive Neuromuscular Facilitation (PNF) applied to the unilateral upper extremity on the muscle activation of contralateral lower extremity. Twenty-two healthy subjects (mean age of 23.7 years) participated in this study. Method : PNF patterns applied on the unilateral upper extremity in all subjects were the flexion/abduction/external rotation and lifting pattern. The hold and appoximation techniques for the irradiation were applied to end range of both patterns. Muscle activations in four patterns were measured in vastus medialis, tibialis anterior, rectus femoris, and gastrocnemius medial muscles of contralateral lower extremity using surface EMG system. Each EMG value in individual muscle was normalized for maximal voluntary contraction. The data were analyzed by one factor analysis of variance with repeated measure test. Result : There were significant differences in the between-subject effect (muscles) and within-subject effect (patterns) in comparison of muscle activation by application of PNF patterns (p<.05). The irradiation led to higher activation in the flexion/abduction/external rotation pattern than that of lifting pattern in all muscles (p<.05). The approximation techniques revealed more activations than these of hold technique in all muscles (p<.05). Conclusion : These results suggest that the application of PNF patterns to the unilateral upper extremity affect on the muscle activation of contralateral lower extremity and increase according to the intensity of resistance. This mechanism of contralateral effect might provide a help to the development of treatment method for the affected side and functional improvement for the patients who have damages of central nervous system or musculoskeletal problems by orthopedic injury.