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김지연 ( Ji Yeoun Kim ),유교상 ( Kyo Sang Yoo ),오영하 ( Young Ha Oh ),최종민 ( Jong Min Choi ),이상기 ( Sang Ki Lee ),여유미 ( Yoo Mi Yeo ),황순우 ( Soon Woo Hwang ),윤혜진 ( Hye Jin Yoon ) 대한췌장담도학회 2014 대한췌담도학회지 Vol.19 No.1
Autoimmune pancreatitis or IgG4-related sclerosing cholangitis often involves the liver. Most common lesion involving the liver is shown as mass or masses often referred as inflammatory pseudotumor. Inflammatory pseudotumor usually needs to be discriminated with malignancy. Here we report a case of IgG4-related sclerosing cholangitis with liver involvement presented as a mass. It was proven by biopsy and did not show any evidence of autoimmune pancreatitis. The mass infiltrated around the portal tract and portal vein thrombosis was also present. Korean J Pancreatobiliary 2014;19(1):26-30
Listeria monocytogenes 에 의한 자발성 세균성 복막염
김병식 ( Byung Sihk Kim ),김태엽 ( Tae Yeob Kim ),김지연 ( Ji Yeoun Kim ),유교상 ( Kyo Sang Yoo ),전용철 ( Yong Chul Jeon ),한동수 ( Dong Soo Han ),손주현 ( Joo Hyun Sohn ),김지은 ( Ji Eun Kim ) 대한소화기학회 2013 대한소화기학회지 Vol.62 No.3
Spontaneous bacterial peritonitis (SBP) is a life-threatening complication in patients with ascites caused by advanced liver disease. While gram negative bacteria, such as Escherichia coli and Klebsiella pneumonia are the common pathogens, Listeria monocytogenes has been recognized as a very rare pathogen. Empirical treatment with third generation cephalosporins does not provide adequate antibiotics coverage against L. monocytogenes. Diagnosis is often delayed as it requires confirmation from ascitic fluid culture. Herein, we describe the first case of SBP caused by L. monocytogenes in a patient with advanced alcoholic liver cirrhosis in Korea. Clinicians should be aware of the atypical pathogens, especially in patients with inadequate response to empirical antibiotics. (Korean J Gastroenterol 2013;62:179-181)
정윤중,김혜현,김은한,김지연,차세정,김유진,강정은,정연화,정영선,김영환,경규혁,홍석경,Jung, Yooun-Joong,Kim, Hea-Hyun,Kim, Eun-Han,Kim, Ji-Yeoun,Cha, Se-Jung,Kim, You-Jin,Kang, Jung-Eun,Chung, Yeon-Hwa,Jung, Young-Sun,Kim, Young-Hwan,Kyou 한국의료질향상학회 2014 한국의료질향상학회지 Vol.20 No.1
Objective: The objective of this research was to develop a guideline for more effective use of physical restraint on patients in the intensive care unit and training the nurses on it and applying it on clinical practice to assess its effectiveness. Method: This research analyzed the before and after effect of the development of a guideline for physical restraint by dividing the category into nurse and patient. In the case of nurse, a comparison of knowledge and nursing service regarding the use of physical restraint from before the training on physical restraint guideline(Jan. 2011) and after the training on physical restraint guideline(Dec. 2011) was made. In the case of patient, a comparison of physical restraint usage rate and average usage time, the number of unplanned extubation cases were compared from before the use of physical restraint (Jan.~Apr. 2011) and after the use of physical restraint (Sep.~Dec. 2011) were made. Result: After the training on the physical restraint guideline, the knowledge of the nurse and the nursing practice showed notable improvement by (p<0.000) and (p<0.048) respectively and in patient, physical restraint usage rate and average time of usage decreased by (p<0.001) and (p<0.001) respectively. And despite the decrease in the number of cases in which the physical restraint was used, the number of unplanned extubation cases remained the same. Conclusion: Physical restraint guideline training and guideline usage can be stated to have brought out positive effect in both the nurse and patient. In order to maintain such positive effects, continuous training is necessary and continuous revaluation is necessary, regarding knowledge and nursing practices.
원위부 십이지장 정맥류의 대량 출혈에 대한 풍선-폐쇄 역행 경정맥 폐쇄술의 장기적인 치료 성공 1예
황순우 ( Soon Woo Hwang ),손주현 ( Joo Hyun Sohn ),김태엽 ( Tae Yeob Kim ),김지연 ( Ji Yeoun Kim ),이지영 ( Ji Young Yhi ),곽동신 ( Dong Shin Kwak ),김해수 ( Hae Su Kim ),송순영 ( Soon Young Song ) 대한소화기학회 2014 대한소화기학회지 Vol.63 No.4
Duodenal variceal bleeding in patients with portal hypertension due to cirrhosis or other causes is uncommon. We report on a case of a 55-year-old male with an ectopic variceal rupture at the distal fourth part of the duodenum who presented with massive hematochezia and shock. Shortly after achievement of hemodynamic stability, due to the limitation of an endoscopic procedure, we initially attempted to find the bleeding focus by abdominal computed tomography, which showed tortuous duodenal varices that drained into the left gonadal vein. He was treated with first-line balloon-occluded retrograde transvenous obliteration (BRTO), resulting in a favorable long-term outcome without rebleeding three years later. This case suggests that BRTO may be a first-line therapeutic option for control of ruptured duodenal varices, especially at a distal location.
심폐우회술시 Roller Pump 와 Centrifugal Pump 사용에 따른 혈액학적 차이
김지연,김유홍,함병문,곽미숙,김갑수,김정수,박계현 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.6
Background: Prolonged extracorporeal circulation entails tremendous threats of red cell lysis, severe bleeding problems due to platelet injury and activation, and endothelial damages by sequestered leukocytes. In consideration of these problems, a new centrifugal pump was developed and tested clinically to evaluate its effectiveness. Methods : We compared the effects of a centrifugal pump with those of a roller pump on hematological responses during cardiopulmonary bypass(CPB) in 20 coronary artery bypass surgery patients. The patients were divided into two groups of 10 each. The studied parameters included WBC counts, platelet counts, plasma Hb and D-dimer. Blood samples were taken after sternotomy, at 60 min, 120 min and 180 min after CPB start, and at 2 hr after CPB stop. Results : No differences between the groups were found in bypass time, aortic cross clamp time, extracorporeal circulation flow and hematocrit. The centrifugal pump group demonstrated less platelet depletion(p<0.05), hemolysis(plasma Hb,p<0.05) and fibrinolysis(D-dimer, p<0.05). These differences were CPB time dependent and became statistically significant after 120 min bypass. Conclusions: We conclude that roller pump still can be safely used for standard cardiac procedures with bypass time less than 120 minutes and the centrifugal pump has significant potential to be safely applied to CPB for long ypass time in order to avoid postperfusion syndrome. (Korean J Anesthesiol 1998; 34: 1208∼1215)
임상가를 위한 외상후 스트레스 장애 척도의 신뢰도, 타당도 연구
이병용,김임,이선미,은헌정,김동인,김지연 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.3
연구목적 : 본 연구의 목적은 임상가를 위한 외상후 스트레스 장애 척도의 신뢰도와 타당도를 알아보고자 하는 것이다. 방 법 : 28명의 PTSD 군, 30명의 Non-PTSD군, 36명의 정상군에 대하여 임상가를 위한 외상후 스트레스 장애 척도를 실시하였다. 면담자간 신뢰도를 평가하기 위하여 10명의 외상후 스트레스 장애 환자를 2명의 검사자가 동시에 평가하였다. 타당도를 평가하기 위하여 모든 피검자들을 대상으로 사건 충격 척도, Beck의 우울 검사, Spielberger의 상태 특성 불안 검사 Ⅰ, Ⅱ를 시행하였다. 결 과 : Cronbach's α와 면담자간 일치도는 각각 .95와 .89였다. 임상가를 위한 외상후 스트레스 장애 척도는 각각 사건 충격 척도(r=.80), Beck의 우울 검사(r=.70), Spielberger의 상태 특성 불안 검사 Ⅱ(r=.56)와 높은 상관을 가지고 있었다. 그러나 Spielberger의 상태 특성 불안 검사 Ⅰ(r=.20)과는 상관을 보이지 않았다. 임상가를 위한 외상후 스트레스 장애 척도는 임상 진단과 82.1%의 일치도를 보였다. 결 론 : 임상가를 위한 외상후 스트레스 장애 척도는 충분한 신뢰도와 타당도를 가지고 있었다. 임상가를 위한 외상후 스트레스 장애 척도는 외상후 스트레스 장애를 진단하기에 유용한 도구라 할 수 있다. Objectives : The purpose of this study was to examine the reliability and validity of A Clinician-Administered PTSD Scale (CAPS). Methods : CAPS was administered to 28 PTSD subjects, 30 non-PTSD subjects, and 36 normal subjects, Interrater reliability for the CAPS was established by interviewing 10 PTSD subjects. The interviews were conducted by 2 interviewers simultaneously. The authors administered to all the subjects Impact of Event Scale(IES), Beck Depression Inventory(BDI), State Trait Anxiety InventoryⅠ, Ⅱ(STAI-I, Ⅱ) for measuring concurrent validity. Results : The value of Cronbach's α and interrater agreement were .95 and .89, respectively. The CAPS was highly correlated with IES(r=.80), BDI(r=.70), STAI-Ⅱ(r=.56). But the CAPS was not correlated with STAI-I(r=.20). The CAPS showed an overall agreement with clinical diagnosis of 82.1%. Conclusions : The CAPS shows a reasonable degree of reliability and validity. The CAPS could be a valuable tool to diagnose PTSD.
성인 환자의 병원 내 심폐소생술 현황 조사 : Incidence and Survival Rate according to the Utstein Template
김지연,신터전,안원식 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.4
Background: Cardiopulmonary resuscitation (CPR) is one of the most impertant medical procedures. However, we could not find any survival rates from in-hospital cardiopulmonary resuscitation in Korea. The objective of this study was to report outcomes according to a Utstein template for in-hospital CPR and to use this report as basic material to enhance our CPR skills and outcome. Methods: We reviewed all medical records of arrest cases in our hospital in 2001, which were coded as CPR, care for arrest, defibrillation/cardioversion, and Ambu. The data was summarized and analyzed in Utstein style. Most of the data was described in percentage, and the t-test was used to compare survival rate by sex. A P-value below 0.05 was considered significant. Results: In 2001, 218 patients was resuscitated in our hospital and 53 patients (24.3%) survived after CPR. Their mean survival was 10 days. Twenty-seven victims died within the first 24 hours after resuscitation. Nobody was discharged alive from our hospital. The time interval from collapse to CPR was 1.7 minutes, to intubation, 5.62 minutes, to epinephrine injection 7.4 minutes and to defibrillation, 23minytes. Glascow coma scale and cerebral performance category were less than 8 and 4 for a majority of patients. Conclusions: In our hospital, we had a low survival rate and quality of life. To improve outcome, we should prepare a better education program and more equipment and well-trained personnel for CPR. (Korean J Anesthesiol 2002; 43: 443~450)