위출구 폐쇄를 동반한 진행성 위암에서 스탠트 삽입 후 발생한 위 천공의 스탠트 재 삽입을 통해 호전된 1예

안혜미,박상현,이정민,이봉규,이남훈,서영호 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1

서론: 외과적 수술이 불가능한 위암 환자에게 내시경적 스탠트 삽입술은 삶의 질 향상에 큰 도움이 되고 있지만 시술 후 스탠트 이동이나 시술부위의 출혈, 천공으로 재시술을 요하는 경우가 종종 발생한다. 합병증 중 천공이 생기면 단순흉부 방사선 촬영으로 위장관 외부의 공기음영을 확인해 외과적 수술 혹은 보존적 치료를 시행한다. 저자들은 위출구 폐쇄를 동반한 진행성 위암에서 스탠트 삽입 후 발생한 위 천공을 스탠트 재 삽입과 보존적인 치료로 호전된 증례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. 증례: 진행성 위암 진단을 받은 78세 여자가 식욕감퇴와 구토 증상 하에 내원하였다. 생체 징후 안정적이었고, 과거력 상 진행성 위암 진단을 받은 것 외에 특이 소견은 없었으며 복부 진찰 상 압통이나 반발통은 없었다. 혈액 검사 상 백혈구 2900/mm3, 혈색소 6.0 g/dL로 혈색소 낮아 1차례 rbc수혈 시행하였다. 위 출구 폐쇄 확인을 위해 상부 위장관 내시경을 시행해 폐쇄부위에 스탠트(7cm partial covered SEMS) 삽입 시행하였고, 시술 직후 복부 팽만 및 통증 있어 확인한 단순흉부 방사선 촬영상에서 기복증을 관찰할 수 있었다. 바로 다시 상부 위장관 내시경을 시행했고 천공여부 확인위해 스탠트 제거하고 관찰하였다. 내시경에서 육안상 천공은 확인되지 않았으나, 협착 상단에 있는 악성 궤양의 저부가 스탠트 삽입으로 천공 유발된것으로 추정해 볼수 있었다. 이에 더 길이가 길어 궤양 저부를 덮을 수 있는 스탠트(9cm partial covered SEMS)를 삽입 후 보존적 치료 및 추적 관찰하기로 하였다. 이 사이 18G medicut으로 복부 타진상의 공명음이 증가된 부위에서 복강 내로 세어 나가는 공기를 흡입하였으며 항생제(ceftriaxone, ciprofloxacin, clindamycin) 정주하면서 금식 유지하고 단순흉부 방사선 촬영 및 혈액 검사 시행하였다. 이 후, 신체 징후는 안정적 이였으며 혈액 검사 상에 백혈구 3600/mm3, 혈색소 12.0 g/dL으로 이상 없었고 단순흉부 방사선 촬영에서 공기음영 점점 감소하는것 확인되었다. 10일 가량 안정적인 상태 보여서 공기 누출 여부 확인 위한 상부 위장관 조영술(gastrografin) 시행하였고 조영제의 복강내 누출은 보이지 않아 조심스럽게 식이 시행한 후 복통 없고 안정된 상태로 외래 경과 관찰중이다.

원문정보공개 서비스에서의 개인정보 보호 실태

안혜미 한국기록관리학회 2019 한국기록관리학회지 Vol.19 No.2

원문정보공개 서비스가 제공되면서 원문정보의 공개를 결정하는 데에 소모되는 시간이 매우 짧아지고 원문정보공개 건수는 크게 증가하였다. 공공기관에서는 개인정보 노출의 위험성 또한 높아졌다. 본 연구에서는 원문정보공개 서비스에서의 개인정보 보호 실태를 알아보고 개인정보 노출 원인을 분석하여 개선방안을 제안하였다. 실태 조사 결과는 다음과 같다. 첫째, 수집한 원문정보 중 13%의 원문정보가 비공개 대상정보인 개인정보를 포함하고 있었다. 둘째, 비공개 대상정보인 개인정보가 포함된 원문정보 중 공무원의 개인정보가 포함된 원문정보가 가장 많은 비중을 차지했다. 특히 휴가․병가에 관한 기록물이 많았다. 셋째, 계약업무를 주로 다루는 기관에서는 대표자 개인에 관한 정보가 노출되는 사례가 많았다. 넷째, 개인정보 필터링에 감지되지 않는 개인정보가 많았다. 개인정보 노출 원인을 분석하여 제안한 개선방안은 다음과 같다. 첫째, 개인정보 보호지침을 재설계해야 한다. 둘째, 원문정보의 공개․비공개를 결정하는 업무담당자의 교육을 강화해야 한다. 셋째, 정부의 양적 실적 위주의 과도한 정보공개정책을 완화해야 한다. 넷째, 원문정보공개 시스템의 개인정보 필터링 기능을 개선해야 한다. With the provision of the original text information disclosure service, the time spent on determining the disclosure of the original text information decreased, and the number of original text information disclosure significantly increased. In public institutions, the risk of the exposure of personal information also increased. In this study, the status of personal information protection in the original text information disclosure service was investigated. Moreover, the causes of the exposure of personal information were analyzed, and improvements were proposed. The survey presented the following results. First, 13% of the original text information collected contains personal information, which is the nondisclosure information. Second, among the original text information that includes personal information, the original text information, including the personal information of the public official, was the most important. In particular, many records about vacation and medical leaves were found. Third, there were many cases in which information about the individual of the representative was exposed in the agency that deals mainly with the contract work. Fourth, a large volume of personal information was not detected by filtering personal information. Upon analyzing the cause of the exposure of personal information, the following improvements are suggested. First, privacy guidelines should be redesigned. Second, the person in charge of the task of deciding whether or not to disclose original text information should be trained further. Third, the excessive disclosure of information based on the government’s quantitative performance should be eased. Fourth, the filtering function of the personal information of the original text information disclosure system should be improved.

Below the Knee Intervention Using Multidisciplinary Methods Including an Antegrade, Retrograde Approach Without the Use of a Sheath but With a Plaque Excision Device

안혜미,강원유,김연화,임철환,황선호,김원,김완 대한심장학회 2012 Korean Circulation Journal Vol.42 No.2

Below the knee (BTK) interventions are increasing in patients with rest pain or critical limb ischemia, and these interventions are frequently successful in facilitating limb salvage. New intervention techniques and devices allow successful recanalization of occluded BTK arteries. Here, we report a case of successful recanalization of BTK arteries using multidisciplinary methods, including an antegrade approach and retrograde approach without the use of a sheath, but with simple balloon angioplasty, and plaque excision using Silverhawk atherectomy device.

고혈압 청소년에서 tissue Doppler imaging과 strain rate imaging을 이용한 좌심실 기능 이상에 대한 연구

안혜미,정선옥,권정현,홍영미 대한소아청소년과학회 2010 Clinical and Experimental Pediatrics (CEP) Vol.53 No.1

Purpose: Left ventricular (LV) hypertrophy and impaired diastolic function may occur early in systemic hypertension. Diastolic dysfunction is associated with increased cardiovascular risk. Tissue Doppler imaging (TDI)-derived tissue velocity and strain rate are new parameters for assessing diastolic dysfunction. The aim of this study is to determine whether TDI and strain rate imaging (SRI) would improve the ability to recognize early impaired diastolic and systolic functions compared with conventional echocardiography in hypertensive adolescents. Methods: We included 38 hypertensive patients with systolic blood pressure above 140 mmHg or diastolic blood pressure above 90 mmHg. Ejection fraction and myocardial performance index (MPI) were estimated by conventional echocardiography. Peak systolic myocardial velocity, early diastolic myocardial velocity (Em), and peak late diastolic myocardial velocity (Am) were obtained by using TDI and SRI. Results: In the hypertensive group, interventricular septal thickness was significantly increased on M-mode echocardiography. Em/Am was significantly decreased at the mitral valve annulus. Among hypertensive subjects, the E strain rate at basal, mid, and apex was significantly decreased. Systolic strain was significantly decreased at the septum in the hypertensive group. Conclusion: Strain rate might be a useful new parameter for the quantification of both regional and global LV functions and could be used in long-term follow up in hypertensive patients. Early identification by SRI of subjects at risk for hypertensive and ventricular dysfunction may help to stratify risk and guide therapy. Further studies, including serial assessment of LV structure and function in a larger number of adolescents with hypertension, is necessary. 목 적:고혈압에서 이완기 기능 이상은 수축기 기능 장애가 나타나기 전에 질환 경과에 일찍 발견되고 흔하게 관찰된다. 이완기 심기능을 평가하기에는 TDI가 고식적 심초음파보다 더 우수한 것으로 알려져 있다. 그러나 소아 및 청소년에서의 연구는 많지 않은 실정이다. 청소년 고혈압에서 심실 기능 이상을 발견하는데 있어서 SRI의 유용성을 알아보고자 본 연구를 실시하였다. 방 법: 수축기 혈압이 140 mmHg 이상이거나 이완기 혈압이 90 mmHg이상인 고혈압을 가진 16-17세 사이의 38명의 청소년을 대상군으로 하였고, 같은 연령의 정상 혈압을 가진 청소년 19명을 대조군으로 하였다. M-mode 심초음파로 심실 중격 두께, 좌심실 후벽 두께를 측정하였고, 이면성 심초음파로 ejection fraction (EF), myocardial performance index (MPI)를 측정하였다. TDI를 이용하여 심근 수축기 심근속도, E 심근속도, A 심근속도를 측정하였고, SRI를 이용하여 strain과 strain rate을 측정하였다. 결 과: M-mode 심초음파 소견상 심실벽 두께, 좌심실 후벽 두께가 고혈압군에서 유의하게 증가하였다. EF, MPI와 modified MPI는 두군간에 유의한 차이가 없었다. 고식적 심초음파 검사결과 고혈압군에서 A 혈류속도가 유의하게 증가되었고, TDI 검사상 A 심근 속도는 고혈압군에서 유의하게 증가하였고 E/A 심근속도비는 유의하게 감소되었다. SRI에 의한 E strain rate은 고혈압군에서 기저, 중간 부위, 심첨부에서 유의하게 감소되었고, strain은 중격에서 고혈압군은 19.15±8.65%, 정상군은 22.63±5.55%으로 고혈압군에서 유의하게 감소하였다(P<0.05). 결 론:고식적 초음파로는 좌심실 이완기 기능 이상만 관찰되었으나 SRI로 좌심실 이완 기능 외에 수축 기능이 유의하게 감소됨을 알 수 있었다. SRI를 이용하여 심실 기능의 이상을 조기에 발견할 수 있었다. 앞으로 더 많은 고혈압 청소년을 대상으로 한 연구가 필요할 것으로 생각한다.

Interleukin-6 (-636 C/G) Gene Polymorphism in Korean Children With Kawasaki Disease

안혜미,박인숙,홍수정,홍영미 대한심장학회 2011 Korean Circulation Journal Vol.41 No.6

Background and Objectives: Kawasaki disease (KD) is a multi-systemic vasculitis with coronary artery involvement. Serum interleukin (IL)-6 levels during acute phase showed a significant correlation with the duration of fever in patients with KD who were not treated with intravenous immunoglobulin (IVIG), suggesting that the regulation of IL-6 expression in KD patients may differ from that in normal children. However, there are controversies surrounding the association between IL-6 (-636 C/G) gene polymorphism and development of KD. Subjects and Methods: One hundred and nine children with KD and 191 children with congenital heart disease were included in this study. Echocardiography was performed to examine cardiac involvement in patients with KD. Genotyping of the IL-6 (-636 C/G) gene polymorphism was performed using the single-base extension method, and serum IL-6 concentrations were estimated using the sandwich enzyme immunoassay method. Results: Neutrophil, platelet count, liver function test, total protein and albumin concentrations were significantly different in the KD group and the serum IL-6 concentration was significantly higher in the KD group than the control group. There was no difference between the patients with coronary arterial dilatation (CAD) and those without CAD in the IL-6 (-636 C/G) polymorphism. The serum albumin concentration was significantly lower in patients with KD who had the -636 C/G or GG genotype compared with the control group. The serum IL-6 concentration was significantly higher in patients with KD who had the -636 C/G or GG genotype. Conclusion: There was no association between the IL-6 (-636 C/G) gene polymorphism and development of coronary arterial lesions in KD. Further multicenter studies are required to establish the relationship between the IL-6 (-636 C/G) gene polymorphism and development of KD.

위출구 폐쇄를 동반한 진행성 위암에서 스탠트 삽입 후 발생한 위 천공의 스탠트 재 삽입을 통해 호전된 1예

안혜미,박상현,이정민,이봉규,이남훈,서영호 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.-

새로운 Aminopyrimidinylmethanone 유도체의 합성

안혜미 ( Hye Mi Ahn ),유경호 ( Kyung Ho Yoo ) 한국유화학회 2009 한국응용과학기술학회지 Vol.26 No.1

급성심근경색 환자의 증상 발현 후 골든타임내 응급의료센터 도착율 및 지연에 관련된 요인

안혜미(Ahn, Hye Mi),김형수(Kim, Hyeongsu),이건세(Lee, Kun Sei),이정현(Lee, Jung Hyun),정효선(Jeong, Hyo Seon),장성훈(Chang, Soung Hoon),이경룡(Lee, Kyeong Ryong),김성해(Kim, Sung Hea),신은영(Shin, Eun Young) 한국간호과학회 2016 Journal of Korean Academy of Nursing Vol.46 No.6

Purpose: This research was done to identify the hospital arrival rate and factors related to prehospital delay in arriving at an emergency medical center within the golden time after symptom onset in patients with acute myocardial infarction (AMI). Methods: Data used in the research was from the National Emergency Department Information System of the National Emergency Medical Center which reported that in 2014, 9,611 patients went to emergency medical centers for acute myocardial infarction. Prehospital time is the time from onset to arrival at an emergency medical center and is analyzed by subdividing arrival and delay based on golden time of 2 hour. Results: After onset of acute myocardial infarction, arrival rate to emergency medical centers within the golden time was 44.0%(4,233), and factors related to prehospital delay were gender, age, region of residence, symptoms, path to hospital visit, and method of transportation. Conclusion: Results of this study show that in 2014 more than half of AMI patients arrive at emergency medical centers after the golden time for proper treatment of AMI. In order to reduce prehospital delay, new policy that reflects factors influencing prehospital delay should be developed. Especially, public campaigns and education to provide information on AMI initial symptoms and to enhance utilizing EMS to get to the emergency medical center driectly should be implemented for patients and/or caregivers.

Carotid Intima-Media Thickness and Pulse Wave Velocity After Recovery From Kawasaki Disease

이수진,안혜미,유정현,홍영미 대한심장학회 2009 Korean Circulation Journal Vol.39 No.7

Background and Objectives: Kawasaki disease (KD) is an acute inflammatory process affecting the arterial walls that results in panvasculitis. Recent studies have shown that even after resolution of the disease, endothelial dysfunction persists and may progress to atherosclerosis. The pulse wave velocity (PWV) and the ankle-brachial index (ABI) are simple and non-invasive methods for evaluating the degree of atherosclerosis, and are known as the predictors of cardiovascular disease in adults. Carotid intima-media thickness (cIMT) is also known as a predictor of cardiovascular disease. We conducted this study to determine the change in arterial stiffness by measuring the PWV, ABI, and cIMT in children who have recovered from KD. Subjects and Methods: Twenty-five patients with KD and coronary aneurysm were recruited. They all recovered from KD and were normal for more than 8 years. Fifty-five healthy children were evaluated as the control group. Their height, weight, body mass index, and blood pressure (systolic, diastolic, and the mean) were measured. The PWV, ABI, ejection time (ET), and pre-ejection period (PEP) were measured by ultrasonography. The cIMT was measured by ultrasonography. Results: The left brachial ankle PWV was significantly higher in the KD group (1020.6±146.5 cm/sec) than the control group (984.0±96.5 cm/sec). The ABI did not differ between the two groups. There was no difference in PEP/ET and cIMT. Conclusion: The PWV in children who recovered from KD was higher than the control group. Long-term follow up is necessary in children after recovery from KD even if there is no abnormality in echocardiography. Background and Objectives: Kawasaki disease (KD) is an acute inflammatory process affecting the arterial walls that results in panvasculitis. Recent studies have shown that even after resolution of the disease, endothelial dysfunction persists and may progress to atherosclerosis. The pulse wave velocity (PWV) and the ankle-brachial index (ABI) are simple and non-invasive methods for evaluating the degree of atherosclerosis, and are known as the predictors of cardiovascular disease in adults. Carotid intima-media thickness (cIMT) is also known as a predictor of cardiovascular disease. We conducted this study to determine the change in arterial stiffness by measuring the PWV, ABI, and cIMT in children who have recovered from KD. Subjects and Methods: Twenty-five patients with KD and coronary aneurysm were recruited. They all recovered from KD and were normal for more than 8 years. Fifty-five healthy children were evaluated as the control group. Their height, weight, body mass index, and blood pressure (systolic, diastolic, and the mean) were measured. The PWV, ABI, ejection time (ET), and pre-ejection period (PEP) were measured by ultrasonography. The cIMT was measured by ultrasonography. Results: The left brachial ankle PWV was significantly higher in the KD group (1020.6±146.5 cm/sec) than the control group (984.0±96.5 cm/sec). The ABI did not differ between the two groups. There was no difference in PEP/ET and cIMT. Conclusion: The PWV in children who recovered from KD was higher than the control group. Long-term follow up is necessary in children after recovery from KD even if there is no abnormality in echocardiography.

Determinants and Frequency of Stent Fracture in the Superficial Femoral Artery in Korea

김연화,임철환,안혜미,김원,강원유,김종태,황승환,황선호,김완 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1

BACKGROUND: Despite improved patency by development of the nitinol stent, stent fracture has emerged as a new problem in the percutaneous transluminal angioplasty of the superficial femoral artery (SFA). However, the factors influencing SFA stent fracture are not well understood. The aim of our study was to delineate the factors influencing and frequency of nitinol stent fracture in the SFA. METHODS: 89 consecutive patients with de-novo peripheral artery disease who underwent rescue stenting with a nitinol stent (SMART stent, Cordis) in the SFA were enrolled between May 2006 and January 2009. Follow-up angiography was performed 12.6± 1.0 months later to detect stent fracture. Patients were divided to 2 groups based on the results of F/U angiography and/or fluroscpy: those with or without stent fracture. RESULTS: Stent fracture occurred in 15 patients (16.8%). Baseline patient characteristics were similar between those with and without stent fracture. The degree of limb ischemia and the ankle brachial index before the procedure were also similar between the groups. Lesion length >100 mm, the number of stents used, the lesion involving the distal SFA, TASC C and D, chronic total occlusion, and calcified lesion were more frequently observed in those with stent fracture than in those without fracture. Of these variables, Lesion length >100 mm, the number of stents used were the strongest independent determinant associated with stent fracture by discriminant analysis (p=0.01). CONCLUSION: Long lesion and multiple stenting adversely affects stent fracture in patients implanted with a nitinol stent in the SFA.