Thoracic Air-leak Syndromes In Hematopoietic Stem Cell Transplant Recipients with Graft-versus-Host Disease: A Possible Sign for Poor Response to Treatment and Poor Prognosis

문미형,사영조,조규도,조건현,이선희,심성보 대한의학회 2010 Journal of Korean medical science Vol.25 No.5

Bronchiolitis obliterans (BO) or bronchiolitis obliterans organizing pneumonia (BOOP)is one of manifestations of graft-versus-host disease (GVHD), a complication of hematopoietic stem cell transplantation (HSCT). Recently there are reports about thoracic air-leakage syndrome (TALS), but real incidence, clinical course, and implications of TALS remain unclear. Retrospective review of 18 TALS patients among 2,177 patients who received allogeneic HSCT between January 2000 to July 2007was done. Clinical manifestations, treatments, and outcomes of TALS were reviewed. The incidence of TALS was 0.83% (18/2,177). The onset of TALS was mean 425.9±417.8 days (60-1,825 days) after HSCT, and the duration was mean 16.3±21days (2-90 days). The most common types of TALS were spontaneous pneumothroax (n=14), followed by subcutaneous emphysema (n=6), pneumomediastinum (n=5), interstitial emphysema (n=2), and pneumopericardium (n=1). TALS persisted in six patients, who died during the same hospitalization. The 12 patients recovered from TALS, but only 2 survived, while others died due to aggravation of GVHD. TALS may complicate BO/BOOP and be an initial manifestation of BO/BOOP. TALS is hard to be resolved, and even after the recovery, patients die because of aggravation of GVHD. We suggest specifically in HSCT patients, when once developed,TALS seems hard to be cured, and as a result, be related to high fatality.

Rosemary 에센셜 오일이 學生 學業成績에 미치는 影響

문미형 대한피부미용학회 2003 대한피부미용학회지 Vol.1 No.3

This study is a method of the direction for inspiring the juveniles with the schoolwork. The object of this study is to research the effect on the improvement of schoolwork, using an Aromatherapy program about the Rosemary essential oil. This research design was to analyze the experimental research using SAS T-test and significance probability p-value, Null hypothesis method. Also it was to investigate thoroughly the degree of knowledge and the amount of recognition about Aroma essential oil that the juveniles have perceived. The grand mean score of Korean language was 45.6 in the experimental group and 45.4 in the control group, and the mean differences between the groups were 0.2. The grand mean score of Mathematics was 54.9 in the experimental group and 50.1 in the control group, and the mean differences between the groups were 4.8. The significance probability had 0.043 less than 0.05 in the significance level from the result of t-test. Accordingly, the mean differences between the two groups were significant with the inhalation of aroma statistically. The grand mean score of Japanese language was 57 in the experimental group and 56.1 in the control group, and the mean differences between the groups were 0.9. This study was examined and investigated as an object of the students who were defined from the defined schools. Accordingly, it had a limit in the side of nationwide and to interpret the result of experimental group generally. Also, this study analyzed one time test result without the procedure of verification in order to use the momentary memory and concentration after inhaling the Rosemary essential oil aroma. However as a result of research above, it came to a conclusion that the aroma will be very helpful to the mental stability and the improvement of schoolwork for the juveniles, if the aroma of Rosemary essential aroma will be researched deeply and systematically.

뷰티 산업에 있어서의 수익률 제고를 위한 운영방안 개선사례 연구

문미형,성백서 한국피부과학연구원 2012 대한피부미용학회지 Vol.10 No.4

The purpose of this study is to investigate methodology to improve the rate of return in beauty industry. In the esthetic salon now growing rapidly, this study focused on the human resource management system on which the labor productivity and quality of service depends. For the effective HR management, dropping employee turnover rate plan is suggested. Data was collected from B esthetic salon of A cosmetic company. For this study, the survey in B esthetic salon and the case study in the same line of business are analyzed. According to the analysis, self development and industrial training influences to esthetician’s intention to change jobs and the relationship with a salon director has a decisive effect. With the survey result, case study of "C cosmetic company " and " D cosmetic company " suggested more realistic solution:strengthen the training system for estheticians and the salon directors. For esthetician training, attracting voluntary participation with "pre-training benefits after" system and providing the better training with the professional courses satisfies esthetician’s self development need and reduces the intention to change jobs. Professional expertise and management training courses improve the salon director’s HR management skills. On the basis of the analysis, through the practical resolution to drop an employee turnover rate of B esthetic salon, A cosmetic company’s stable growth in esthetic service industry is anticipated.

의인성 기흉에 대한 임상 고찰

최시영,문미형,권종범,김용환 대한흉부외과학회 2009 Journal of Chest Surgery (J Chest Surg) Vol.42 No.6

Background: This study was designed to determine etiologic factors for iatrogenic pneumothorax in an era of increased use of invasive procedures and to evaluate its impact on morbidity. Material and Method: Subjects were 112 patients (65 men and 47 women ranging in age from 20 to 90 years) who were diagnosed with an iatrogenic pneumothorax between January 2005 and December 2008. We reviewed medical records retrospectively. Result: The leading causes of iatrogenic pneumothorax were percutaneous needle aspiration (50), central venous catheterization (29), acupuncture (14), thoracentesis (8) and positive pressure ventilation (7). The majority of the patients (60 of 114) were treated with chest tubes. The mean duration of hospital treatment was 5.8 (±4.0) days. Hospitalization was prolonged in 24 patients (21.1%). No patient died from iatrogenic pneumothorax. Conclusion: In our study, the most common cause of iatrogenic pneumothorax was percutaneous needle aspiration. The mortality and morbidity from iatrogenic pneumothorax is not significant. The recognition of pneumothorax, depends on careful examination after completion of an invasive procedure, and should be followed by prompt and definitive therapy. 배경: 이 연구를 통해 침습적인 시술이 증가 함에 따른 의인성 기흉의 원인과 그에 따른 이환율을 알고자 한다. 대상 및 방법: 2005년 1월부터 2008년 12월까지 의인성 기흉의 진단으로 입원치료를 받은 112명의 환자(20세부터 90세까지의 연령분포를 보인 65명의 남자 환자와 47명의 여자 환자)에게서 후향적으로 의무기록을 조사하였다. 결과: 의인성 기흉의 호발 원인은 경피적 폐생검(50), 중심정맥관 삽입(29), 침술(14), 흉수천자(8), 양압환기(7)의 순서였다. 60명의 환자에서 흉관삽관술을 통해 치료하였다. 평균 치료 기간은 5.8 (±4.0)일이었다. 24명의 환자에서 재원 기간이 길어졌으며, 의인성 기흉으로 인한 사망은 없었다. 결론: 이 연구에서는 의인성 기흉의 가장 흔한 원인은 경피적 폐생검이었다. 이에 따른 사망률이나 이환율은 미미한 수준이었다. 의인성 기흉의 진단에 있어 침습적인 시술 이후의 신중한 검사 및 그에 따른 치료가 중요할 것으로 생각된다.

Thoracic Chordoma Misdiagnosed as Primary Adenocarcinoma of the Mediastinum

윤승근,문미형,문석환 대한흉부외과학회 2021 Journal of Chest Surgery (J Chest Surg) Vol.54 No.2

Chordoma is a rare malignant bone tumor originating from the embryonic notochord. Herein, we present a case of thoracic chordoma located at T3–T5 that was misdiagnosed as primary mediastinal adenocarcinoma. The patient underwent neoadjuvant chemoradia- tion and the disease showed little response. Due to vertebral body invasion, we performed en bloc mass removal and partial corpectomy (T4–5) in collaboration with orthopedic sur- geons.

Hybrid Coronary Revascularization Using Limited Incisional Full Sternotomy Coronary Artery Bypass Surgery in Multivessel Disease: Early Results

강준규,이석인,문미형,김환욱,조건현,송현 대한흉부외과학회 2014 Journal of Chest Surgery (J Chest Surg) Vol.47 No.2

Background: There are several modalities of coronary artery revascularization for multivessel coronary artery disease. Hybrid coronary revascularization (HCR) with minimally invasive direct coronary artery bypass grafting was introduced for high-risk patients, and recently, many centers have been using it. Limited incisional full sternotomy coronary artery bypass (LIFCAB) involves left internal thoracic artery (LITA)-to-left anterior descending coronary artery (LAD) anastomosis through a sternotomy with a minimal skin incision; it could be considered another technique for minimally invasive LITA-to-LAD anastomosis. Our center has performed HCR using LIFCAB, and in this paper, we report our short-term results, obtained in the past 3 years. Methods: The medical records of 38 patients from May 2010 to June 2013 were analyzed retrospectively. The observation period after HCR was 1 to 37 months (average, 18.3±10.3 months). The patency of revascularization was confirmed with postoperative coronary angio-computerized tomography or coronary angiography. Results: There were 3 superficial wound complications, but no mortalities. All the LITA-to-LAD anastomoses were patent in the immediate postoperative and follow-up studies, but stenosis was detected in 3 cases of percutaneous coronary intervention. Conclusion: HCR using LIFCAB is safe and yields satisfactory results from the viewpoint of revascularization for multivessel disease.

Effect of total intravenous versus inhalation anesthesia on long-term oncological outcomes in patients undergoing curative resection for early-stage non-small cell lung cancer: a retrospective cohort study

서권휘,홍지형,문미형,황원정,Lee Sea-Won,Chon Jin Young,Kwon Hyejin,홍숙희,Kim Sukil 대한마취통증의학회 2023 Korean Journal of Anesthesiology Vol.76 No.4

Background: Propofol-based total intravenous anesthesia (TIVA) improves long-term outcomes after cancer surgery compared with inhalation anesthesia. However, its effect on patients undergoing non-small cell lung cancer (NSCLC) surgery remains unclear. We aimed to compare the oncological outcomes of TIVA and inhalation anesthesia after curative resection of early-stage NSCLC. Methods: We analyzed the medical records of patients diagnosed with stage I or II NSCLC who underwent curative resection at a tertiary university hospital between January 2010 and December 2017. The primary outcomes were recurrence-free survival (RFS) and overall survival (OS) according to anesthesia type.Results: We included 1,508 patients with stage I/II NSCLC. The patients were divided into the TIVA (n = 980) and Inhalation (n = 528) groups. The two groups were well-balanced in terms of baseline clinical characteristics. The TIVA group demonstrated significantly improved RFS (7.7 years, 95% CI [7.37, 8.02]) compared with the Inhalation group (6.8 years, 95% CI [6.30, 7.22], P = 0.003). Similarly, TIVA was superior to inhalation agents with respect to OS (median OS; 8.4 years, 95% CI [8.08, 8.69] vs. 7.3 years, 95% CI [6.81, 7.71]; P < 0.001). Multivariable Cox regression analysis revealed that TIVA was an independent prognostic factor related to recurrence (hazard ratio [HR]: 1.24, 95% CI [1.04, 1.47], P = 0.014) and OS (HR: 1.39, 95% CI [1.12, 1.72], P = 0.002).Conclusions: Propofol-based TIVA was associated with better RFS and OS than inhalation anesthesia in patients with stage I/II NSCLC who underwent curative resection.

단독관상동맥우회로술 후 발생한 심방세동

서종희,박찬범,문미형,권종범,진웅,문석환,김치경,김영두 대한흉부외과학회 2009 Journal of Chest Surgery (J Chest Surg) Vol.42 No.1

Background: Postoperative atrial fibrillation (AF) is a common complication after coronary artery bypass graft (CABG) surgery. Although postoperative AF is regarded as benign, transient and self-limited, it has been associated with increased morbidity, thromboembolic events and an increased duration and cost of hospitalization. Material and Method: From January 1994 to December 2007, 190 patients that had isolated CABG surgery were divided into two groups. Group 1 (n=139) involved those who had postoperative atrial fibrillation, and group 2 (n=51) did not have any such events. We reviewed the medical records retrospectively including the incidence of postoperative AF, patient characteristics, surgery related factors and the outcome of the patients with postoperative AF. Result: The frequency of postoperative AF was 26.8%, the conversion rate to regular sinus rhythm before discharge was 82.4%; 82.4% of the AF developed within the first three postoperative days. Although the postoperative AF group was significantly older and had a prolonged postoperative Intensive care unit (ICU) stay, there was no difference in the aortic crossclamp time or duration of hospitalization. No spontaneous defibrillation at declamping, and longer duration of cardiopulmonary bypass were significantly related to the development of postoperative AF. However, postoperative treatment with a beta blocker was associated with a decreased incidence of postoperative AF. The multivariate analysis showed that age and ICU stay were significantly associated with the development of POAF. Spontaneous defibrillation and postoperative beta blocker treatment were significantly associated with a decreased frequency of POAF. Conclusion: AF after CABG surgery is a common complication associated with increased morbidity and a longer ICU stay. Therefore, various strategies aimed at reducing AF, and its complications, such as postoperative treatment with a beta blocker should be considered. 배경: 심방세동은 관상동맥우회로술후 흔히 발생하는 합병증으로, 대부분 일시적이고 양호한 경과를 보이나, 혈전색전증의 위험성을 증가시키며, 유병률의 증가와 재원기간의 증가로 인하여 의료비용의 증가를 초래할 수 있다. 대상 및 방법: 1994년 1월 1일부터 2007년 12월 31일까지 단독관상동맥우회술을 시행한 190명의 환자 중 수술 후 심방세동이 발생한 군(1군: n=139)과 발생하지 않은 군(2군: n=51)을 나누어 수술 후 심방세동 발생율, 환자의 특성, 수술관련 인자 및 수술 후 심방세동 발생으로 인한 결과를 의무기록을 토대로 후향적으로 분석하였다. 결과: 수술 후 심방세동의 발생율은 26.8%였으며, 퇴원전까지 정상동방결절리듬으로 회복된 경우는 82.4%였고, 심방세동 발생 환자의 82.4%는 수술 후 3일 이내에 발생하였다. 술후 심방세동군에서는 나이가 유의하게 많았으며, 대동맥겸자 차단시간의 차이는 없었으나, 대동맥 겸차차단 해제시 자발적으로 정상 심전도를 회복하지 못한 경우가 많았으며, 체외순환시간이 더 긴 것으로 나타났다. 수술후 베타차단제의 사용이 심방세동의 발생을 감소시키는 것으로 나타났으며, 재원기간의 차이는 없었으나, 중환자실 체류기간은 심방세동군에서 유의하게 길었다. 다변량 분석에서는 연령, 대동맥겸차 해제후 자발적 심박동 회복여부, 중환자실 재원기간 및 술후 베타 차단제의 사용이 유의한 인자로 분석되었다. 결론: 관상동맥우회로술후 심방세동은 매우 흔한 합병증으로 유병률이 증가되며, 중환자실 재원기간의 증가를 초래한다. 따라서, 술후 심방세동의 발생을 예방하기 위한 조치들이 필요할 것으로 생각되며, 특별한 금기사항이 없다면, 술후 베타 차단제를 적극적으로 사용하는 것이 좋을 것으로 생각된다.

피부 신경섬유종증을 동반한 환자에서의 종격동 신경섬유종 -1예 보고-

이종호,권종범,문미형,박건 대한흉부외과학회 2007 Journal of Chest Surgery (J Chest Surg) Vol.40 No.4

신경기원의 종양은 전체 종격동 종양의 19∼39%를 차지하며 후종격동 종양의 75%를 차지하는 가장 흔한 종양이다. 신경섬유종증은 상염색체 우성으로 유전되는 질환으로 임상 양상은 다양하며, 신경계에서는 말초신경, 신경근, 신경총 등에서 종양을 형성한다. 신경섬유종증 환자에서의 후종격동 신경섬유종은 드물어, 이에 1형(type 1) 신경섬유종증 환자에서 후종격동에 발생한 신경섬유종을 경험하게 되어 보고한다. Neurogenic tumors are the most common posterior mediastinal tumors and accounting for 19~39% of all mediastinal tumors and 75% of all posterior mediastinal tumors. Neurofibromatosis is an autosomal dominant disorder with variable expression of tumors, including neurologic tumors of the peripheral nerves, nerve roots, and plexi. A posterior mediastinal neufibroma in neurofibromatosis patients is rare. We report here a case of posterior mediastinal neurofibroma in a patient with type 1 neurofibromatosis.

16 채널 Multi-detector 컴퓨터 단층촬영과 심초음파를 이용한 좌심실 용적과 기능의 비교

박찬범,조민섭,문미형,조은주,이배영,진웅,김치경 대한흉부외과학회 2007 Journal of Chest Surgery (J Chest Surg) Vol.40 No.1

배경: 좌심실 기능의 평가는 대개 심초음파를 이용하여 시행되고 있으나, 최근 개발된 16채널 Multi- detector 컴퓨터 단층촬영(MDCT)은 관상동맥에 대한 평가뿐만 아니라 좌심실 기능의 측정이 가능하다. 따라서 MDCT를 이용한 측정결과를 심초음파 결과와 비교분석하여 MDCT의 좌심실 기능 평가에 대한 임상적 적용 가능성을 조사해 보고자 하였다. 대상 및 방법: 2003년 11월 1일부터 2005년 1월 31일까지 본원에서 MDCT를 시행한 49명의 환자중 동일 시기에 심초음파를 시행한 26명의 환자를 대상으로 하였다. 이완기말 좌심실 용적지수(LVEDVI), 수축기말 좌심실 용적지수(LVESVI), 심박출량지수(SVI), 좌심실 부피지수(LVMI) 및 심박출계수(EF)를 조사하였다. 결과: 평균이완기말 좌심실 용적지수(80.86 34.69 mL for MDCT vs 60.23 29.06 mL for Echocardiography, p<0.01), 평균수축기말 좌심실 용적지수(37.96 24.52 mL for MDCT vs 25.68 16.57 mL for Echocardiography, p<0.01), 평균심박출량지수(42.90 15.86 mL for MDCT vs 34.54 17.94 mL for Echocardiography, p<0.01), 평균좌심실 부피지수(72.14 25.35 mL for MDCT vs 130.35 53.10 mL for Echocardiography, p<0.01) 및 평균심박출계수(55.63 12.91 mL for MDCT vs 59.95 12.75 mL for Echocardiography, p<0.05)로 양군간에 유의한 차이를 보였으며, 평균이완기말 좌심실 용적지수, 평균수축기말 좌심실 용적지수, 평균심박출량지수는 MDCT군이 높게 나타났으며, 평균좌심실 부피지수, 평균심박출계수는 심초음파군이 높게 나타났다. 각 변수에서 양군의 상관관계를 보면, 이완기말 좌심실 용적지수(r2=0.74, p<0.0001), 수축기말 좌심실 용적지수(r2=0.69, p<0.0001), 심박출량지수(r2=0.55, p<0.0001)는 높은 상관관계를 보였으며, 좌심실 부피지수(r2=0.84, p<0.0001)는 아주 높은 상관관계를, 심박출계수(r2=0.45, p<0.0002)는 다소 높은 상관관계를 나타내었다. 결론: 16채널 MDCT를 이용한 좌심실 용적 및 기능의 평가는 심초음파의 결과와 비교하여 높은 상관관계를 보여 유용한 검사방법으로 생각된다. 그러나, 각 항목의 평균값에서는 유의한 차이를 보여 임상적 적용을 위하여는 양 검사의 절대적 결과치를 병용하여 사용할 수는 없을 것으로 생각되며, 향후 MDCT의 기술적 개발을 고려할 때 관상동맥 환자에 있어 관상동맥의 협착의 검사와 함께 좌심실 기능의 측정도 함께 간편하게 이루어질 수 있을 것으로 기대된다. Background: Although echocardiography is usually used for quantitative assessment of left ventricular function, the recently developed 16-slice multidetector computed tomography (MDCT) is not only capable of evaluating the coronary arteries but also left ventricular function. Therefore, the objective of our study was to compare the values of left ventricular function quantified by MDCT to those by echocardiography for evaluation of its regards to clinical applications. Material and Method: From 49 patients who underwent MDCT in our hospital from November 1, 2003 to January 31, 2005, we enrolled 26 patients who underwent echocardiography during the same period for this study. Left ventricular end-diastolic volume index (LVEDVI), left ventricular end-systolic volume index (LVESVI), stroke volume index (SVI), left ventricular mass index (LVMI), and ejection fraction (EF) were analyzed. Result: Average LVEDVI (80.86±34.69 mL for MDCT vs 60.23±29.06 mL for Echocardiography, p<0.01), average LVESVI (37.96±24.52 mL for MDCT vs 25.68±16.57 mL for Echocardiography, p<0.01), average SVI (42.90±15.86 mL for MDCT vs 34.54±17.94 mL for Echocardiography, p<0.01), average LVMI (72.14±25.35 mL for MDCT vs 130.35±53.10 mL for Echocardiography, p<0.01), and average EF (55.63±12.91 mL for MDCT vs 59.95±12.75 mL for Echocardiography, p<0.05) showed significant difference between both groups. Average LVEDVI, average LVESVI, and average SVI were higher in MDCT, and average LVMI and average EF were higher in echocardiogram. Comparing correlation for each parameters between both groups, LVEDVI (r2=0.74, p<0.0001), LVESVI (r2=0.69, p<0.0001) and SVI (r2=0.55, p<0.0001) showed high relevance, LVMI (r2=0.84, p<0.0001) showed very high relevance, and EF (r2=0.45, p=0.0002) showed relatively high relevance. Conclusion: Quantitative assessment of left ventricular volume and function using 16-slice MDCT showed high relevance compared with echocardiography, therefore may be a feasible assessment method. However, because the average of each parameters showed significant difference, the absolute values between both studies may not be appropriate for clinical applications. Furthermore, considering the future development of MDCT, we expect to be able to easily evaluate the assessment of coronary artery stenosis along with left ventricular function in coronary artery disease patients.