Prevention of medical malpractice and disputes through analysis of lawsuits related to coronary angiography and intervention

Cheol Won Hyeon,Won Lee,So Yoon Kim,Ji Yong Park,Su Hwan Shin 대한내과학회 2020 The Korean Journal of Internal Medicine Vol.35 No.3

Background/Aims: Possible fatal complications arising from coronary angiography (CAG), percutaneous coronary intervention (PCI), and coronary artery disease itself, are likely to cause medical disputes. Presenting the current status and reasons for judgments given in lawsuits related to CAG/PCI, this study aimed to identify ways to prevent unnecessary disputes and medical malpractice suits related to CAG/PCI through lawsuit analysis. Methods: A total of 13 cases (20 judgments) found in the Supreme Court of Korea’s Written Judgment Management System from 1998 to 2017 were analyzed. Results: Coronary artery injury was the most common causative complication that led to lawsuits (n = 6, 46%). Six cases (46%) were ruled in favor of the plaintiff for violation of duty of care (n = 4) and duty of explanation (n = 2), respectively. Cases that violated duty of care included two errors in intra-procedure device manipulation, one in pre-procedure diagnosis, and one in management of post-procedure complication. Lack of explanation regarding the risk of complications was pointed out in both cases that violated duty of explanation. The average awarded amount for the damages was 114,436,064 Korean won. Conclusions: Physicians need not fear unfair judgments so long as they follow standard of care because the Court consistently looked at the probability, the foreseeability, and the evidence. Therefore, maintaining standard of care is important. Besides, specific, detailed, and comprehensible explanations, including the risk of complications in addition to the necessity of procedures, are important to ensure the patient clearly understands the possible risk of adverse outcomes.

전기 방열기가 국화재배온실의 난방에 미치는 영향

서원명 ( Won Myung Suh ),임재운 ( Jae Woon Leem ),김영주 ( Young Ju Kim ),민영봉 ( Young Bong Min ),김현태 ( Hyeon Tae Kim ),허무룡 ( Moo Ryong Huh ),윤용철 ( Yong Cheol Yoon ) 경상대학교 농업생명과학연구원(구 경상대학교 농업자원이용연구소) 2010 농업생명과학연구 Vol.44 No.4

경상대학교 교내에 설치되어 있는 1-2W형 온실을 대상으로 전기 방열기를 이용하여 국화 재배온실의 난방효과를 검토한 결과는 다음과 같다. 실험기간동안 최고, 평균 및 최저 외기온은 각각 -3.8~21.3℃, -5.2~16.1℃ 및 -12.5~14.4℃ 정도의 범위로 나타났으며, 온실 내외의 평균상대습도 각각 43.5~98.6% 및 35.2~100%로 나타났다. 12월 중순부터 2월 상순까지 최저 외기온은 대략 -5.0~-10.0℃ 전후로 나타나 진주기상대의 최근 자료와 비교하면 상대적으로 최저기온이 낮게 나타나는 경향이 있었다. 야간의 경우, 방열기 직하부의 엽온이 방열기 중간 지점에서 측정한 엽온 보다 크게 2~3℃정도 높게 나타나거나 또는 미미하지만 약간 높게 나타나는 경향이 있었다. 근권부의 경우, 직하부나 중간 지점에서의 온도 차이는 거의 없는 것으로 나타났고, 근권부의 최고온도와 기타 최고 온도의 발생 시점을 보면, 약 2시간정도의 지체현상이 있음을 알 수 있었다. 그리고 실험기간동안 난방에 소요된 총 소비전력량, 공급에너지 및 총 난방비는 각각 2,800kWh, 2,408,000kcal 및 112,000won 정도였다. 화석연료인 경유로 난방할 경우, 총 난방비는 224,500won 정도였다. 방열기를 이용하여 난방할 경우, 난방비를 약 50% 정도 줄일 수 있을 것으로 판단되었다. An analysis in heating effects of an electric radiator located in a 1-2W type chrysanthemum (3 cultivars) cultivation greenhouse installed in Gyeongsang National University drew the following conclusions. During the experiment period, the highest, average, and the lowest outside temperatures were in the ranges of -3.8~21.3℃, -5.2~16.1℃ and -12.5~14.4℃, respectively, and the average relative humidity inside and outside the greenhouses were in the ranges of 43.5~98.6% and 35.2~100%, respectively. From mid-December to early February, the lowest outside temperature was recorded as approximately -5.0~-10.0℃, which showed that it tended to be relatively lower than the temperatures recorded at the Jinju Meteorological Observatory. During the night, the leaf temperature measured directly under the radiator tended to be higher by 2~3℃ than that those at the middle point of the radiator, or higher by anegligible amount. In the case of root zone temperature, it was found that there was almost no difference between temperatures of the part directly under and the middle point, and the time when the highest temperature of root zone and other highest temperatures took place showed that there was about a 2-hour delay phenomenon. The total electricity consumption, energy supply and total heating cost during the experiment period were 2,800 kWh, 2,408,000 kcal and 112,000 won, respectively. When diesel, a kind of fossil fuel, was used as heating oil, the total heating cost was around 224,500 won. It was estimated that the total heating cost could be reduced by around 50% if a radiator was used.

온수배관을 이용한 온실의 난방성능

윤용철(Yong Cheol Yoon),신익수(Yik Soo Shin),김현태(Hyeon Tae Kim),배승범(Seoung Beom Bae),최진식(Jin Sik Choi),서원명(Won Myung Suh) (사)한국생물환경조절학회 2012 생물환경조절학회지 Vol.21 No.2

본 연구는 온실의 난방 에너지 절감을 목적으로 온실 내부에 알루미늄 온수배관을 설치하여 난방효과에 대한 기초자료를 구축하고자 수행되었다. 그 연구결과를 요약하면 다음과 같다. 전체 실험을 포함하여 온실내의 높이별 온도편차는 4.0~7.0℃ 정도의 범위로서 그 차이가 크게 나타났다. 팬코일유니트(FCU)를 작동시킨 경우가 작동시키지 않은 경우에 비해 유출입수의 온도차가 3.3℃ 정도 크고, 소비전력량은 36.2~40.1% 정도 증가하였으며, 시간당 방열량은 44.6~52.0% 정도 증가하는 것으로 나타났다. 실험기간동안 순환유량은 0.48~0.49L · s<SUP>?1</SUP> 정도의 범위에 있었고, 평균유속은 1.53~1.56m · s<SUP>?1</SUP> 정도였다. 유출입수의 평균 온도차는 6.24~11.50℃이었다. 최저 외기온 ?14.0~?0.6℃ 범위에서 설정온도별 방열량은 135,930~307,150㎉ 정도의 범위로서 시간당 9,610~19,630㎉ · h<SUP>?1</SUP> 정도의 범위에 있었다. 이것은 최대난방부하의 약 23~53% 정도의 난방에너지를 공급할 수 있을 것으로 나타났다. 전체 방열량과 소비전력량은 각각 2,548,306㎉ 및 3,075.7㎾h이다. 화석연료인 경유로 난방할 경우, 소요되는 경유의 총 소비량은 281.6L 정도이고 비용은 321,000won인 것으로 나타났다. 농가용 전력요금을 적용하면 전력사용에 대한 총비용은 110,730won 정도로서 경유 소비 비용의 33.5% 정도로 나타났다. 실험구의 온도가 대조구보다 약 8.3~14.6℃ 정도 높게 나타났다. This research was conducted to obtain basic data with regard to the heating performance that would be produced by installing an aluminum hot water pipe inside the greenhouse with the goal of reducing the heating energy in greenhouse. The research results are summarized as follows. The degree of difference in relation to the temperature by height within the greenhouse during the entire experiment was significant - within the range of 4.0~7.0℃. The temperature difference between incoming and outgoing water was about 3.3℃ greater when FCU was activated compared to when it was not activated. Meanwhile, the amount of energy consumed increased about 36.2~40.1%. The amount of pyrexia per hour also increased by 44.6~52.0%. During the experiment period, circulated flux was within the range of 0.48~0.49 L · s<SUP>?1</SUP> while average fluid speed was 1.53~1.56 m · s<SUP>?1</SUP>. The average temperature difference between incoming and outgoing water was 6.24~11.50℃. The amount of heating value by each set temperature within the minimum outdoor temperature range of ?14.0~?0.6℃ was 135,930~307,150 ㎉, and the range was within the 9,610~19,630 ㎉ · h<SUP>?1</SUP> per hour. This demonstrated that about 23~53% heating energy of the maximum heating load could be supplied. Total radiating value and amount of energy consumed were 2,548,306 ㎉ and 3,075.7 ㎾h, respectively. When heating takes place using oil, which is a fossil fuel, the total amount of light oil consumed was 281.6 L while the cost was 321,000 won. When the electricity cost for farms is applied, the total cost was about 110,730 won, which is about 33.5% of the cost required compared to oil consumption. The temperature at in the experiment area was about 8.3~14.6℃ higher compared to that of the control area.

Inhibition of oxidative stress induced‑cytotoxicity by coptisine in V79‑4 Chinese hamster lung fibroblasts through the induction of Nrf‑2 mediated HO‑1 expression

Hyeon‑Gyun Jo,Cheol Park,이혜숙,Gi‑Young Kim,Young‑Sam Keum,Jin Won Hyun,Taeg Kyu Kwon,Yung Hyun Choi,Su Hyun Hong 한국유전학회 2021 Genes & Genomics Vol.43 No.1

Background Coptisine is a natural alkaloid compound and is known to have multiple benefcial efects including antioxidant activity. However, whether it can protect lung fbroblasts from oxidative damage has not been studied yet. Objectives To investigate the potential inhibitory efect of coptisine against oxidative stress in V79-4 lung fbroblast cells. Methods V79-4 cells were treated with H2O2 (1 mM) in the presence or absence of coptisine (50 µg/ml), N-acetyl cysteine (NAC, 10 mM) or zinc protoporphyrin IX (ZnPP, 10 µM) for the indicated times. The alleviating efects of coptisine on cytotoxicity, cell cycle arrest, apoptosis, reactive oxygen species (ROS) production, DNA damage, mitochondrial dynamics, and inhibition of ATP production against H2O2 were investigated. Western blot analysis was used to analyze the expression levels of specifc proteins. Results Coptisine inhibited H2O2-induced cytotoxicity and DNA damage by blocking abnormal ROS generation. H2O2 treatment caused cell cycle arrest at the G2/M phase accompanied by increased expression of cyclin-dependent kinase (Cdk) inhibitor p21WAF1/CIP1 and decreased expression of cyclin B1 and cyclin A. However, these efects were attenuated in the presence of coptisine or NAC. Coptisine also prevented apoptosis by decreasing the rate of Bax/Bcl-2 expression in H2O2-stimulated cells and suppressing the loss of mitochondrial membrane potential and the cytosolic release of cytochrome c. In addition, the activation of nuclear factor-erythroid-2-related factor 2 (Nrf2) and heme oxygenase-1 (HO-1) was markedly promoted by coptisine in the presence of H2O2. However, zinc protoporphyrin IX, a potent inhibitor of HO-1, attenuated the ROS scavenging and anti-apoptotic efects of coptisine. Conclusions Based on current data, we suggest that coptisine can be used as a potential treatment for oxidative stress-related lung disease.

Mo¨nckeberg 중막 석회화로 인해 초기자궁내막암이 진행성 자궁내막암으로 판독되었던 1례

김승만,배철성,김동훈,김정란,이현경,윤혜원 동국대학교 경주대학 1997 東國論集 Vol.16 No.1

Mo¨nckeberg 중막 석회화는 크거나 중간크기의 근육성 동맥(large and medium-sized muscular arteries)의 중막(media)에 노화와 관련되어 퇴행성 과정인 윤상석회화가 특징적으로 나타나는 동맥경화증의 일종으로, 근본적으로 폐쇄성 죽상경화증(occlusive atherosclerosis)과는 다른 과정으로 동맥의 관강(lumen)을 막는 경우는 드물어 상대적으로 임상적 의의는 적거나 거의 없다. 저자들은 Mo¨nckeberg 중막 석회화때문에 초음파 및 컴퓨터 단층촬영에 의한 병기결정에 혼란을 초래하였던 초기 자궁내막암 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. The Mo¨nckeberg medial calcification is aging change rather than disease entity. The Mo¨nckeberg medial calcification involve muscular arteries of limb, head, and genital track and cause fibrosis change associated with hyalinization and fine basophilic staining, suggesting early calcification with little or no clinical significance but is demonstrable on roentgenograms as regular and diffuse radiopaque shadow under intima. We experienced one case of mis-staging of early endometrial cancer due to the Mo¨nckeberg medial calcification therefore, we report this case with a brief review of the literature of the Mo¨nckeberg medial calcification.

Angiotensin Concerting Enzyme 유전자의 유전적 다형성(Genetic Polymorphism)이 관상동맥 질환 위험인자에 따른 혈중 Plasminogen Activator Inhibitor-1의 농도에 미치는 영향

김덕경,김종원,권현절,류재춘,박승우,김준수,이상훈,홍경표,박정의,이원로 대한고혈압학회 1996 대한고혈압학회지 Vol.2 No.2

오원천의 식물플랑크톤 군집에 대한 연구

주현수,김진,박종천,정원석,송현철,이용탁,이우범 國立麗水大學校 環境問題硏究所 2004 環境硏究論文集 Vol.6 No.-

We carried out a study on phytoplankton community at Owon stream, Jeollabukdo, Korea. The author have examined 83 taxa of the phytoplankton from researched area. These were composed of 5 classes, 11 orders, 21 families, 44 genera, 79 species, and 9 varieties. The composition of occurrence species were as follows: green algae are 48.2%, diatoms are 33.7%, blue green algae are 10.8% and etc(7.3%). Dominant species were Chlamydomonas angulosa, Pandorina morum, Coelastrum microporum, Scenedesmus quadricauda, Staurastrum gracile, Melosira varians, Me. italica, Synedra ulna, Sy. acus, Cocconeis placentula, and Cymbella tumida. The standing crops varied from 1,650cells/ℓ to 47,000cells/ℓ. Phytoplankton density of Owon stream were lower about 8.6 times to a 1,531 times than those of other lakes and rivers in Korea. So, to preserve the water quality in Owon stream we have to manage continuously on the nitrogen and phosphorus.

Review of a Case of Chronic Obstructive Pulmonary Disease in Workers Exposed to Synthetic Fibers

Hyeon-cheol Oh,Chae-seong Lim,Jung-won Kim,Eun-seok Kim,Ji-eun Lee,Sang-cheol Kim 한국산업보건학회 2023 한국산업보건학회지 Vol.33 No.3

Objectives: Objectives of this study were: 1) to introduce industrial situation and health hazards of synthetic fiber, 2) to review a case of chronic obstructive pulmonary disease in a worker exposed to synthetic fiber reported to the Korea Occupational Disease Surveillance Center, and 3) to suggest supplementary measures for the occupational health system for workers exposed to synthetic fibers. Methods: Respiratory exposure, health hazards, and exposure standards for synthetic fiber dust in Korea and other countries were reviewed. In addition, a case of chronic obstructive pulmonary disease due to exposure to nylon dust reported to the Korea Occupational Disease Surveillance Center was reviewed and summarized. Results: The worker was a 53-year-old non-smoking male who had been involved in the nylon weaving process for 26 years. He had shortness of breath from three years ago. He was diagnosed with chronic obstructive pulmonary disease. PM1.0, PM2.5, and PM10 were measured at 26.6 μg/m3, 48.2 μg/m3, and 91.7 μg/m3, respectively. Fiber components estimated as nylon fiber were detected in the microscopic examination of a solid sample. Conclusions: For workers exposed to synthetic fiber dust, special health examinations of the respiratory system, regular work environment measurement, and work environment management through workplace health management should be performed. It is necessary to research on health effects of synthetic fibers.

S-224 : The Early Repolarization Pattern EKG in patients with Acute Coronary Syndrome: IVUS study

( Cheol Won Hyeon ),( Young Hwan Choi ),( Jun Hwan Cho ),( Kyung Joon Kim ),( Sharath Kumar ),( Seong Hyeop Hyeon ),( Jee Eun Kwon ),( Eun Young Kim ),( Seung Yong Shin ),( Wang Soo Lee ),( Kwang Je L 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1

Background: Early repolarization pattern (ERP) has been considered as benign condition in great majority of cases. Recently, the presence of ERP can be an index of poor prognosis in various heart diseases. Method: We analyzed 59 consecutive patients with acute coronary syndrome underwent primary coronary intervention and virtual histology intravascular ultrasonography (VH-IVUS). Thin cap fibroatheroma (TCFA) was defined as necrotic core (NC) >10% of plaque area with a plaque burden of >40% and NC in contact with the lumen for >3 image slices. Positive remodeling was a remodeling index (lesion/reference vessel area) >1.05. The diagnostic criterion of ERP was defined when there is J-point elevation of ≥0.1 mV in two adjacent leads. Results: The presence of ERP was observed in 27 patients (45.8%). Although there was no significant difference in lesion length and remodeling index at minimal lumen area between the 2 groups, reference diameter and minimal luminal area were significantly smaller in patients with ERP (p=0.033, p=0.048, respectively). The lesion characteristics of patients with ERP demonstrated (1) more necrotic core (p<0.001), (2) lesser calcium component (p=0.028). Although the incidence of plaque rupture failed to demonstrate significant differences, TCFA was more frequently observed in patients with ERP (p=0.038). Conclusion: We report, for the first time, that the ERP in ACS might distinguish patients with more vulnerable plaque.

S-211 : Biventricular tachycardia induced by herbal medicine containing ephedra sinica

( Cheol Won Hyeon ),( Young Hwan Choi ),( Jun Hwan Cho ),( Kyung Joon Kim ),( Sharath Kumar ),( Seong Hyeop Hyeon ),( Jee Eun Kwon ),( Eun Young Kim ),( Seung Yong Shin ),( Wang Soo Lee ),( Kwang Je L 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1

Ephedra is a potent sympathomimetic agent with cardiovascular effects including tachyardia, positive inotropy, arterial vasoconstriction and hypertension. We report 1 case of biventricular tachycardia after taking herbal medicine containing ephedra sinica. A 77-year-old male with a 30-year-history of COPD prsented with acute onset chest discomfort and dyspnea. He was precribed herbal medicines containing ephedra sinica for abdominal discomfort 2 days ago. Initial electrocardiography (ECG, Fig. A) showed hemodynamically unstable monomorphic ventricular tachycardia with RBBB pattern in percordial leads, which was terminated by electrical cardioversion. ECG after cardioversion, atrial fibrillation was observed (Fig. B). About 1 hour later, hemodynamically unstable fast monomorphic ventricular tachycardia with LBBB pattern was spontaneously induced (Fig. C). Because of hemodynamic instability, additional electrical cardioversion was performed and sinus rhythm was restored (Fig.D). Electrolytes and arterial blood gas analyses were normal. To rule out structural heart disease, echocardiography was done and it revealed normal ejection fraction and no significant abnormalities. Coronary angiography showed a 80% stenosis in the proximal circumflex coronary artery and a 70% stenosis in the posterior descending artery. Percutanous coronary intervention was done to left circumflex artery. The patient was discharged on clopidogrel, warfarin, ACE inhibitor, beta-blocker, statin. His follow up was uneventful.