입원환자의 병원 재이용과 서비스만족도에 관한 연구

이규은,이근연 관동대학교 의과대학 의과학연구소 2005 關東醫大學術誌 Vol.9 No.1

Purpose : This study was to identify intention of hospital revisit and hospital services satisfaction by inpatient. Method : The subjects were 257 inpatients in G city. The data were collected from August 2nd to August 31st, 2004 by structured questionnaire. The data were analyzed using descriptive statistics, x^(2)test. Results : About 86.0% of the subjects had intention of hospital revisit. Decisive factor to choose a hospital was high-tech medical equipments and facilities. Among the factors of hospital services satisfaction, service satisfaction by nurses was in the highest at average marks 3.97. Hospital services satisfaction according to decisive factors to choose a hospital, there were statistically significant differences in treatment effect(x^(2)=9.69, p<.05), kindness of doctor(x^(2)=18.60, p<.00), kindness of nurses(x^(2)=20.55, p<.00). Intention of hospital revisit according to decisive factors to choose a hospital, there were statistically significant differences in excellent medical personnel(x^(2)=4.44, p<.05), tradition and confidence of hospital(x^(2)=5.29, p<.02). Conclusion : If satisfied with hospital services, patients tend to revisit hospital. Therefore it is essentials to raise the satisfaction level with hospital services by analyzing the areas with low services satisfaction in order to increase the competition of hospital.

LETTER TO THE EDITOR : Cytomegalovirus appendicitis with concurrent bacteremia after chemotherapy for acute leukemia

( Min Jung Cho ),( Jong Min Lee ),( Joo Yeun Hu ),( Jung Woo Lee ),( Sung Yeon Cho ),( Dong Gun Lee ),( Seok Lee ) 대한내과학회 2014 The Korean Journal of Internal Medicine Vol.29 No.5

Cytomegalovirus (CMV) remains one of the most common infectious complications of allogeneic hematopoietic stem cell transplantation (HSCT) or solid organ transplantation (SOT). There have been many reports of CMV infection and/or disease in transplantation recipients and patients with AIDS. The risk of CMV disease occurring with chemotherapy has gradually increased with the use of more intensive chemotherapy in patients with hematologic malignancies [1]. In the non-allogeneic HSCT setting such as autologous HSCT or immunosuppressive therapy, including fludarabin, high-dose cyclophosphamide and steroids, and granulocyte infusions from unscreened donors are considered predisposing factors for CMV disease [1]. The lung and gastrointestinal tract are the major targets for CMV disease, and it can present throughout the entire intestine. Nevertheless, CMV appendicitis is exceedingly rare, and its clinical course and treatment are not well characterized. Only a few cases of CMV appendicitis have been reported in kidney transplantation recipients or patients with AIDS. We report a case of CMV appendicitis with concurrent bacteremia after consolidation chemotherapy for acute lymphoblastic leukemia. A 40-year-old male with precursor B-cell acute lymphoblastic leukemia developed neutropenic fever and abdominal pain 9 days after starting consolidation chemotherapy (highdose cytarabine 2 g/m2, every 12 hours, days 1 to 5; mitoxantrone 12 mg/m2, days 1 to 2). The patient had a history of invasive pulmonary aspergillosis (IPA) and had been treated with itraconazole (400 mg/day) for more than 2 months. IPA was diagnosed according to the revised def inition from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group Consensus Group. IPA had developed during the third cycle of induction chemotherapy, and serial regression of the lung lesion was evident. Empirical antibiotic therapy with cefepime (4 g/day) and isepamicin (400 mg/day) was started. On day 13 after starting chemotherapy, the patient`s vital signs were as follows: blood pressure 120/70 mmHg, pulse rate 80 beats per minute, body temperature 37.7°C. Abdominal examination revealed direct tenderness and rebound tenderness in the right lower quadrant. Chest examination revealed clear breathing sounds. Laboratory results revealed a white blood cell count of 10/mm3 (neutrophils 0%, lymphocytes 0%), hemoglobin 8.4 g/dL, platelets 26,000/mm3, aspartate aminotransferase/alanine aminotransferase 24/39 IU/ L, total/direct bilirubin 0.94/0.24 mg/dL, blood urea nitrogen/creatinine 12.8/0.67 mg/dL, total protein/albumin 5.3/3.3 g/dL, and C-reactive protein 19.78 mg/dL. The antibiotic therapy was changed to piperacillin-tazobactam (piperacillin 12 g/day, tazobactam 1.5 g/day) to broaden the coverage of anaerobic bacteria. Bacterial growth was detected in blood culture and identified as extended spectrum β-lactamase (ESBL)-producing Escherichia coli. Piperacillin-tazobactam therapy was withdrawn, and meropenem (3 g/day) was initiated. An abdominal computed tomography (CT) scan was performed and revealed appendiceal wall thickening with a 2.4 × 2.1-cm hypodense lesion, suggesting appendicitis with periappendiceal abscess formation and microperforation (Fig. 1). There was no definitive bowel wall thickening at the terminal ileum and cecum. However, the patient was unable to tolerate surgical intervention due to persistent pancytopenia. Despite 6 days of antibiotic therapy the patient`s fever was sustained with aggravation of his abdominal pain. On day 20, the patient`s vital signs were: blood pressure 80/50 mmHg, pulse rate 170 beats per minute, and body temperature 38.6°C. The patient subsequently developed septic shock. Teicoplanin (400 mg/day after the initial loading dose) was administered in addition to meropenem. A follow-up abdominal CT scan revealed hemoperitoneum and progression of appendicitis, with developed edematous wall thickening of the terminal ileum, cecum, and ascending colon. Superior mesenteric arteriography showed extravasation of a branch of the ileocolic artery, and embolization was performed. The patient received a random donor granulocyte transfusion on day 23 and his absolute neutrophil count (ANC) increased from 450/mm3 to 4,370/mm3 (Fig. 2). However, his absolute lymphocyte count decreased from 300/ mm3 to 0/mm3. On day 35, percutaneous drainage of the periappendiceal abscess was performed under the guidance of ultrasonography. Enterococcus faecium and ESBL-producing E. coli were identified in bacterial culture of the drained abscess. On day 39 the patient`s ANC was 1,390/mm3 and platelet count was 118,000/ mm3 after transfusion, and he underwent right hemicolectomy and appendectomy. The appendiceal pathology revealed acute suppurative appendicitis, serositis, and cecal perforation. Hematoxylin and eosin (H&E) and CMV-specific immunohistochemical staining of the appendiceal specimen revealed inclusion bodies at the area of acute inflammation, consistent with CMV infection (Fig. 3). Pathology of the ascending colon revealed submucosal hemorrhage and edema without evidence of CMV infection. Serum CMV real-time quantitative polymerase chain reaction (RT-PCR; Roche Diagnostics, Mannheim, Germany) showed a positive result of 43,438 copies/mL on day 49 and 497,533 copies/mL on day 52. The patient had a fever of ~38.0°C at that time. No evidence of CMV retinitis was observed by an ophthalmologist. After surgical resection and administration of ganciclovir (5 mg/kg intravenous, every 12 hours) for 5 days, the fever subsided. However, the patient experienced adverse effects to the ganciclovir treatment, including neutropenia, nausea, and vomiting, and was subsequently switched to foscarnet therapy (60 mg/kg intravenous, every 12 hours). CMV DNAemia by PCR revealed negative conversion after 24 days of antiviral therapy with ganciclovir and foscarnet. On day 79, the patient was discharged without complications. CMV disease development is rare after chemotherapy other than HSCT; however, the risk of CMV disease is increasing with the use of chemotherapies that suppress cell-mediated immunity [1]. Our patient had acute lymphoblastic leukemia and showed persistent lymphopenia as well as neutropenia. Additionally, his absolute lymphocyte count continued to be < 500/ mm3 throughout hospitalization. These factors appear to have contributed to development of CMV disease. While granulocyte transfusion from a random donor could be considered a risk factor, the patient`s right lower quadrant pain and sustained fever presented prior to the granulocyte infusion. In this case, it is unclear whether the granulocyte infusion was a predisposing factor for development of CMV appendicitis. There have been cases of CMV pneumonia associated with chemotherapy reported in Korea [2,3]. However, to our knowledge this is the first report of appendicitis due to CMV infection after chemotherapy. We also detected E. coli and E. faecium in blood and/ or the appendiceal abscess simultaneously. In this patient, CMV appendicitis may have been accompanied by neutropenic enterocolitis. The general problem of reporting copathogens together with CMV in CMV disease is well known. In this case, E. coli and/or E. faecium appeared to be the true pathogens while CMV was considered an ‘innocent bystander.’ However, CMV disease is defined by identification of clinical symptoms with demonstration of CMV infection (by culture, histopathologic testing, or immunohistochemical staining) in a biopsy specimen. The diagnosis of CMV disease in this case was confirmed by H&E and CMV-specific immunohistochemical staining of the appendiceal specimen, revealing inclusion bodies at the area of acute inflammation. The diagnosis was also supported by the identification of CMV DNA in the patient`s blood using RT-PCR. Blood-based monitoring for CMV by antigenemia assay or detection of viral DNA or RNA has been used for patients who have undergone allogeneic HSCT or SOT [4,5]. However, whether the detection of CMV in blood is a predictive factor for CMV disease in a non-allogeneic HSCT setting has not been demonstrated [1]. While screening of asymptomatic chemotherapy patients may not be considered cost-effective, the significance of viral pathogen detection in symptomatic leukemia patients after chemotherapy.even in the presence of other pathogens.is underscored by this case. Currently, the def initions of CMV infection and disease are focused on the transplant recipients. However, this case demonstrates that not only HSCT recipients or AIDS patients but also acute leukemia patients can develop CMV disease during treatment with chemotherapy. Physicians should consider the possibility of CMV disease, especially when the patient presents with suppressed cell-mediated immunity, such as prolonged lymphopenia. The development of recommendations for the diagnosis and treatment of CMV disease in leukemia patients who did not receive HSCT would complement existing guidelines.

흉요추부 척추골절에 대한 내고정술 및 골 유합술

이충형,최영근,황성규,함인석,박연묵,김승래 慶北大學校 醫科大學 1993 慶北醫大誌 Vol.34 No.4

1992년 6월부터 1993년 8월까지 경북대학교병원 신경외과에 입원한 흉요추부 척추 손상 환자중 신경손상을 동반한 환자, 심한 불안정성을 보인 환자 및 추적관찰중 척추후만의 진행과 함께 심한 배부 동통을 호소한 환자를 대상으로 VSP나 ISOLA기기를 사용하여 감압, 고정술 및 골유합술을 시행하고 3내지 17개월(평균 12개월)간을 추적관찰하였다. 환자는 모두 남자였으며 연령은 20세에서 59세 사이로 평균연령은 41세었다. 손상의 원인은 추락, 교통사고, 골절부위의 직접외상이 각각 4예였다. 손상의 부위는 제11흉추 1예, 제12흉추 3예, 제1요추 4예, 제2요추 2예, 제3요추 2예로 제1요추가 제일 많았다. 신경학적 장애도 2예는 완전손상, 8예는 부분손상, 2예는 정상범위였다. 충분한 감압과 기기를 이용한 내고정술, 골유합술 시행후 조기운동을 시행하였다. 수술 1내지 2주후부터 4지 6개윌간 흉요추부 보조기를 착용하였다. 합병증은 수술부위 1예에 대하여는 발견즉시 혈종제거로 호전되었고, 수술부위에 감염이 발생된 2애에서도 각각 약 1개월간 투여로 호전되었다. 본 수술방법은 가능한한 조기에 충분한 감압고정으로 신경회복을 최대한 기대할 수 있으며 조기에 더 이상의 신경손상에 대한 염려없이 움직일 수 있어 장기간 침상안정에 따른 합병증을 예방할 수 있는 좋은 치료방법으로 사료된다. From June 1992 to August 1993, 12 patients with thoracolumbar injuries of the spine were treated with VSP or ISOLA system and fusion. This report present the results of this procedure relates to decompession, stabilization and return of neural function. Solid fusion was obtained in all. Eight patients with incomplete or cauda equina lesions were much improved, which two patients^with complete lesions remained unchanged. The advantages of this procedure are effective stabilization which allowed early ambulation without further neuronal injury, adequate decompression and solid fusion.

Development of ⁶⁸Ga-SCN-DOTA-Capsaicin as an Imaging Agent Targeting Apoptosis and Cell Cycle Arrest in Breast Cancer

Lee, Jun Young,Lee, Sang-Yeun,Kim, Gun Gyun,Hur, Min Goo,Yang, Seung Dae,Park, Jeong-Hoon,Kim, Sang Wook Mary Ann Liebert 2017 Cancer Biotherapy & Radiopharmaceuticals Vol.32 No.5

IC 실현에 적합한 정현파 능동 발진기의 회로 및 특성에 관한 연구(Ⅱ)

이원건,손태호,박종연 江原大學校 産業技術硏究所 1991 産業技術硏究 Vol.11 No.-

Two kinds of simple active oscillators are proposed and analyzed assuming that operational amplifier has two-poles frequency characteristics. The first circuit is composed of one operational amplifier, one resistor and one grounded capacitor. The second oscillator is realized with one operational amplifier and three resitors. Proposed oscillators have the low sensitivity of the oscillation frequency for little variations of the passive element values. By the experimental results obtained with Op-Amp.?A741, the simple oscillators can be useful for the frequency range 1.25 KHz≤f? ≤400KHz for the active -R ocillator, and it is shown to transform the active-R oscillator circuit into the voltage controlled type.Therefore, two kinds of oscillators circuit are attractive for the IC realization, because they hve one operational amplifier, one resistor and one grounded capacitor, or three resistors.

Poster Session 1 : Additional sex comb-Like 1 (ASXL1) is a cell-specific dual regulator of nuclear hormone receptor RAR: (1) Function as a Ligand-dependent coactivator

( Yang Sook Cho ),( Yeun Gun Lee ),( Ui Hyun Park ),( Soo Jong Um ) 한국생화학분자생물학회 (구 한국생화학회) 2005 생화학분자생물학회 춘계학술발표논문집 Vol.2005 No.-

양극산화를 이용한 나노템플레이트 기공 크기 제어에 관한 연구

이수호(Su-Ho Lee),서문수(Mun-Su Seo),유현민(Hyun-Min Yoo),이재형(Jae-Hyeong Lee),정연호(Yeun-Ho Joung),임동건(Dong-Gun Lim),황현석(Hyeon-Seok Hwang) 대한전기학회 2011 대한전기학회 학술대회 논문집 Vol.2011 No.7

Case Report : Laparoscopic repair of indirect inguinal hernia containing endometriosis, ovary, and fallopian tube in adult woman without genital anomalies

( Ji Hyun Kim ),( Gun Oh Chong ),( Ji Young Lee ),( Yoon Hee Lee ),( Dae Gy Hong ),( Soo Yeun Park ),( Ji Young Park ) 대한산부인과학회 2014 Obstetrics & Gynecology Science Vol.57 No.6

Indirect inguinal hernia containing an ovary is a rare condition, especially in adult women who do not have any other genital tract anomalies. In addition, inguinal hernia containing an ovary and endometriosis is exceedingly rare. In the present report, we describe a case of indirect inguinal hernia containing an ovary, fallopian tube, and endometriosis. Laparoscopic repair was performed successfully using polypropylene mesh for the treatment of the inguinal hernia.

Laparoscopic repair of a rectal fistula due to a benign ovarian dermoid cyst

( Ji Hye Kim ),( Gun Oh Chong ),( Da Som Chun ),( Soo Yeun Park ),( Yoon Hee Lee ),( Dae Gy Hong ) 대한산부인과학회 2017 Obstetrics & Gynecology Science Vol.60 No.4

Ovarian dermoid cysts are one of the most common benign neoplasms in women. Rectal fistula formation due to an ovarian dermoid cyst, particularly a benign dermoid cyst, is extremely rare. A 17-year-old girl with symptoms of lower abdominal pain, passage of sebaceous materials in the stool, and hematochezia was found to have an 11-cm dermoid cyst complicated with a rectal fistula formation. Laparoscopic repair of the rectal fistula was performed successfully with bilateral ovarian cystectomies. This case presents the rare formation of a fistula between a benign dermoid cyst and the rectum and its treatment using laparoscopic repair without laparotomy.

Poster Session 1 : oral Presentation ; Gene Structure and Regulation : Additional sex comb-Like 1 (ASXL1) is a cell-specific dual regulator of nuclear hormone receptor RAR: (1) Function as a Ligand-dependent coactivator

( Yang Sook Cho ),( Yeun Gun Lee ),( Ui Hyun Park ),( Soo Jong Um ) 한국생화학분자생물학회 (구 한국생화학회) 2005 62회 KSBMB Annual Meeting in 2005 Vol.- No.-