화상강의 시스템을 이용한 외과 실습교육의 효과

양한광(Han-Kwang Yang),이혁준(Hyuk-Joon Lee),유문원(Moon Won Yoo),장성환(Seong-Hwan Chang),김상준(Sang Joon Kim) 한국의학교육학회 2003 Korean journal of medical education Vol.15 No.2

Purpose: Observation of operations is believed to be a major part in the clinical clerkship of surgery, but it is very hard to be performed effectively due to the difficulty of providing an appropriate view of surgical field for many students. To overcome this problem, we have started to provide a tele-video system for clinical clerkship of surgery since 2001. The aim of this study was to evaluate the effectiveness of educational program of surgery using tele-video system. Methods: We provided the tele-video system with camera systems in two operating rooms and 2 video projection systems in the teaching room to the third year medical students as a curriculum of clinical clerkship of surgery. Education using tele-video system was performed in the form of the interrogatory teaching between the teacher (operator) and students using microphone. The questionnaires about the program of clinical clerkship of surgery and the education with tele-video system were filled up by 190 students who had completed the 4 weeks clerkship schedule. After then, items in the questionnaires were analyzed in September and in December to evaluate the change of the students response for the education with tele-video system. Results: Eighty-eight percent of students had experienced the education with tele-video system. Most students (96%) recommended this system to their juniors, and 78% of students wanted this system to be also used in other departments clinical clerkship. The advantages of tele-video system were revealed as the better view of surgical field, followed by clear explanation for the surgical procedure, interrogatory teaching between the operator and the students, and so on. The most effective teaching methods were revealed as direct participating in the operation (33%), followed by tele-video system (32%), reading of textbook (19%), and simple observation of the operation (15%). General satisfaction for tele-video system were scored with five (11%), four (48%), three (25%), two (7%), and one (1%) (5=excellent, 1=very poor). General satisfaction rate about tele-video system was markedly improved from September to December. Conclusions: The education with tele-video system in the clinical clerkship of surgery seems to be very effective method for teaching the medical students.

커팅 효과가 포함된 디지털 과학 교과서의 설계 및 구현

양현록(Hyun-Roc Yang),강경규(Kyung-Kyu Kang),한광파(Kwang-Pa Han),김동호(Dongho Kim) 한국콘텐츠학회 2009 한국콘텐츠학회논문지 Vol.9 No.1

디지털 시대의 개막과 함께 교육의 패러다임은 변화하고 있다. 이렇게 변화해 가는 패러다임은 더 많은 상호 작용이 존재하는 디지털 교과서 콘텐츠를 필요로 한다. 우리의 목표는 편리한 인터페이스를 갖추고, 커팅효과가 추가되어 기존에 비해 상호작용성이 높은 타블렛 PC 기반의 디지털 교과서를 제작하는 것이다. 이러한 목표를 달성하기 위해서 여러 차례 디지털 교과서를 개발해 온 전문가들과의 회의를 토대로 설계한 인터페이스 및 학습내용에 대해서 설명한다. 그리고 사용자가 임의로 입력한 스트로크에 기반하여 다층 구조의 3D 객체의 단면을 생성하기 위해서 구현된 커팅 알고리즘에 대해서 설명한다. 마지막으로 우리가 개발한 콘텐츠를 시범서비스 했을 때의 결과를 설문 조사 내용을 토대로 하여 상호작용성이 높은 디지털 교과서의 교육적 효과에 대해서 토론할 것이다. The emergence of the digital age has changed the paradigm of education. Recently, the new paradigm needs new digital books that contain more interactive contents. Our goal is to design the digital textbook with convenient interfaces and cutting effects for interactive and effective education. To achieve these goals, we propose interfaces and contents which are designed after a lot of discussion with educational experts. In the implementation step, cutting algorithm is proposed to generate the cut planes of the 3D objects, based on the free strokes specified by the users. In order to test the performance of the contents, the testbed was implemented so that students try our digital book and present their evaluation results on the convenience and the effectiveness.

전국 위암 환자 데이터 관리에 관한 설문조사 결과

양한광,대한위암학회 정보전산위원회,Yang Han-Kwang 대한위암학회 2004 대한위암학회지 Vol.4 No.1

This nationwide survey was conducted to evaluate the current status of the database system on gastric cancer patients in Korea. The Information Committee of Korean Gastric Cancer Association (KGCA) sent questionnaires about the database management to all 402 KGCA members in 110 institutes. In addition, we asked them to send the gastric cancer sheet and the pathologic report of gastric cancer used in their institutes. Response rates were $18.9\%$ (76/402) for individuals and $51.8\%$ (57/110) for institutes, respectively. Most of the university hospitals responded to the questionnaire (response rate of university hospital: $74.6\%$, 44/59). A regular conference of gastric cancer and a digitalization of the database on gastric cancer patients were performed in 29 ($50.9\%$) and 43 ($75.4\%$) out of 57 institutes, respectively. MS excel was most commonly used for the digitalization of the database, followed by MS access and SPSS. A regularly formed gastric cancer sheet and pathologic report were used in 38 ($66.7\%$) and 49 ($86.0\%$) institutes, respectively. Hospital computerization, such as an Order Communicating System, an Electric Medical Record, and a Picture Archiving/Communicating System had been set up previously or would be set up in the near future in most institutes. In 25 gastric cancer sheets collected, the mean number of total items was 72.9 ($15\∼177$). Identification datafor the patients, surgical data, and pathologic data were included on most of the sheets, but preoperative status, preoperative diagnostic data, and postoperative hospital course were not.

간 전이를 동반한 위의 간양 선암 1예

권우일,박도중,이혁준,김우호,양한광,최국진,이건욱,Kwon Wooil,Park Do Joong,Lee Hyuk-Joon,Kim Woo Ho,Yang Han-Kwang,Choe Kuk Jin,Lee KuhnUk 대한위암학회 2005 대한위암학회지 Vol.5 No.2

A hepatoid adenocarcinoma of stomach, a subtype of gastric cancr, is characterized by a histologic resemblance to a hepatocellular carcinoma and $\alpha$-feto protein production. Another feature is early metastasis to the liver and lymph nodes, thus revealing a poor prognosis. We report a case of a hepatoid adenocarcinoma of the stomach with liver metastasis. A 52-year-old male visited our hospital with a chief complaint of indigestion. Gastroscopic examination showed a Borrmann type-II lesion on the lesser curvature of the antrum. The CT scan showed a suspected advanced gastric cancer with liver metastasis. The serum AFP level was 123 ng/ml. A radical subtotal gastrectomy and a right hemihepatectomy were performed simultaneously. Pathologic examination confirmed the lesion to be confined to the submucosa. The gastric lesion was a hepatoid adenocarcinoma, and the hepatic lesion was a metastatic adenocarcinoma from the stomach. Therefore, he was classified as having stage IV (T1N1M1) gastric cancer. In cases of a hepatoid adenocarcinoma of the stomach, even patients with early gastric cancer can be staged into the poor prognostic group. 위암의 한 아형인 간양 선암은 조직학적으로 간세포암종과 형태학적으로 유사하며 알파태아단백 생산을 특징으로 한다. 간양 선암의 또 하나의 특징은 간과 림프절로의 조기 전이를 함으로써 불량한 예후를 갖는다는 것이다. 저자들은 간전이를 동반한 위의 간양 선암 1예를 보고하고자 한다. 소화불량을 주소로 내원한 52세 남자 환자는 위내시경 검사상 Borrmann 제2형 병변이 위암이 의심되었다. 환자의 혈청 알파태아단백은 123 ng/ml로 증가되어 있었다. 근치적 위아전절제술과 간우엽절제술을 시행하였고 조직학적 소견상 위의 병변은 점막하층에 국한된 간양 선암이었으며 간의 병변은 위로부터 전이된 선암이었다. 결국 환자는 위암 4기(T1N1M1)로분류되었다. 위의 간양 선암은 조기병변에서도 불량한 예후군으로 분류될 수 있다.

위암 수술의 질 관리

이혁준,양한광,Lee Hyuk-Joon,Yang Han-Kwang 대한위암학회 2005 대한위암학회지 Vol.5 No.2

질 관리란 진료 행위의 표준화 작업과 행위의 다양한 평가를 통해서 더 나은 치료 결과를 얻고자 이루어지는 체계적이고 종합적인 작업이다. 일반적으로 외과 영역의 질 관리는 항암화학치료나 방사선치료에 비해 적용이 어려운 것으로 알려져 있다. 하지만 최근 다기관 전향적 임상시험이 활발히 진행되면서, 두 가지의 수술법을 비교하거나 수술 전후 보조요법의 유용성을 확인하는 임상 연구에서 있어서 수술의 질 관리의 중요성이 점점 더 강조되고 있다. 위암의 경우 몇몇 대규모 전향적 임상시험이 시행되었으나 수술의 질 관리가 만족할 만한 수준으로 유지된 경우는 많지 않다. 유럽에서 시행되었던 D1-D2 림프절 절제술 비교 임상시험은 수술의 질 관리에 많은 노력을 기울인 연구였으나 우리나라의 실정과는 차이가 있는 반면, 현재 일본에서 시행 중인 D2와 D2 및 대동맥 주위림프절 절제술을 비교하는 임상시험에서는 우리에게도 적용 가능한 질 관리 프로그램이 다수 포함되어 있다. 향후 위암 수술에서의 다기관 무작위 전향적 임상시험을 성공적으로 수행하기 위해서는 learning curve 와 연간 증례 수를 고려한 치료자의 선택, 다양한 교육 및 의견 교류를 통한 수술 방법의 표준화, 체계적이고 통일된 전향적 데이터베이스 프로그램의 개발, 표준화된 수술 후 환자 관리 프로그램의 개발, 표준화된 수술 후 환자 관리 프로그램의 개발, 병리 검사 및 병리 기록의 표준화 등이 요구된다. 하지만 지나치게 세세한 표준화 작업 및 너무 많은 감시 프로그램은 환자 및 치료자 대상군 확보를 어렵게 만들고 프로토콜 위반율을 높일 수 있다는 점을 염두에 두어야 할 것이다. Quality assurance may be defined as the complete set of systemic actions that is required to achieve a better treatment result by standardizing treatment and by using various audit programs. In general, application of a quality assurance program in surgery is considered to be more difficult than it is in chemotherapy or radiotherapy. However, recently, the importance of quality assurance in the surgical field has been emphasized in clinical trials comparing different surgical procedures and evaluating the role of postoperative adjuvant therapy. In the case of gastric cancer surgery, excellent quality assurance programs have rarely been applied in most large prospective clinical trials. Although the quality assurance in Dutch trial was conducted very systemically and strictly, the situation is quite different from ours. On the other hand, several quality assurance programs in Japanese trials comparing D2 and D2 plus para-arotic lymph node dissection seem to be applicable to Korean clinical trials. Several factors, including selection of appropriate surgeons based on personal experience and annual number of operations, standardization of surgical procedures by education and consensus, development of a unified database program, application of standardized perioperative management, and standardization of pathologic examination, are required to guarantee a successful multi-institutional prospective clinical trial. In contrast, one needs to realize that protocols that are too strict and sophisticated can make the enrollment of patients and surgeons more difficult and can promote protocol violation during the clinical trials. (J Korean Gastric Cancer Assoc 2005;5:79-88)

전국 위암 환자 진료 현황에 관한 설문조사 결과

대한위암학회 정보전산위원회,양한광,Yang Han-Kwang 대한위암학회 2004 대한위암학회지 Vol.4 No.2

This nationwide survey was conducted to evaluate the current status of clinical practice for gastric cancer patients in Korea. The Information Committee of the Korean Gastric Cancer Association (KGCA) sent questionnaires containing 45 items about the preoperative diagnosis, medical and surgical treatment, and postoperative follow-up for gastric cancer patients to all 298 KGCA members in 108 institutes. Response rates were $32.6\%$ (97/298) for individuals and $59.3\%$ (64/108) for institutes. Most university hospitals responded (response rate of university hospitals: $71.6\%$, 48/67). The preoperative staging work up was performed primarily by abdominal CT, followed by bone scans, abdominal ultrasound, endoscopic ultrasound, and so on. Gastric cancer patients with stages II, III, and IV usually received adjuvant chemotherapy after a curative operation. About half of the surgeons regarded 2 cm as a safe resection margin in early gastric cancer and 5 cm in advanced gastric cancer. More than half of surgeons usually performed a D2 lymph node dissection in early gastric cancer and D2+$\alpha$ lymph node dissection in advanced gastric cancer. About $20\%$ of surgeons performed less invasive surgery and/or function-preserving surgery, such as a pylorus-preserving gastrectomy, a laparoscopic wedge resection, or a laparoscopy-assisted distal gastrectomy.

위장관문합 및 봉합 시 인공 흡수성 단사인 Glycoside-$\varepsilon$- caprolactone-trimethylene Carbonate 혼성중합체의 안정성 및 유용성

이혁준,김윤호,양한광,이건욱,최국진,Lee Hyuk-Joon,Kim Yoon Ho,Yang Han-Kwang,Lee Kuhn Uk,Choe Kuk Jin 대한위암학회 2003 대한위암학회지 Vol.3 No.2

Purpose: Synthetic absorbable monofilaments offer excellent glide characteristics and cause minimal tissue trauma as a result of their smooth monofilament structure and gradual absorption within the healing tissues. For these reasons, these suture materials are commonly used in various surgical fields such as gastroenterology, urology, gynecology, and plastic surgery. The aim of this study was to evaluate the safety and usefulness of a new synthetic absorbable monofilament, Glycoside-..-caprolactone-trimethylene carbonate interpolymer (GCT), in gastrointestinal anastomosis and closure. Materials and Methods: We evaluated 55 gastrointestinal anastomoses and closures using GCT $MONOSYN^{R}$, B. Braun, Germany) in 47 patients who underwent gastric surgery between December 2001 and May 2002 at Seoul National University Hospital. Patient's characteristics, operative procedure, surgeon's opinion of handling properties of GCT, and suture-related complications were analyzed. Results: There were 34 males and 13 females (M:F= 2.6:1) with an average age of 54.2 years old. Forty-five cases of gastrointestinal anastomosis (20 gastrojejunostomies and 25 jejunojejunostomies) and 10 cases of intestinal closure (7 gastrostomy closures and 3 duodenal stump closures) were performed in 41 cases of stomach cancer, three of peptic ulcer disease, two of GIST, and one MALToma. The handling properties of GCT according to the criteria of knot breaking load, knot security, and placing property were always scored with 7 to 9 points (10=excellent, 1=very poor). Two cases of postoperative complications ($3.6\%$) were noted. One was a leak of the gastrojejunostomy site which was successfully managed conservatively, and the other was a stricture of the gastrojejunostomy site which was managed by reoperation (side-to-side jejunojejunostomy). Conclusion: GCT seems to be an applicable suture material for various gastrointestinal anastomoses and closures.

위암에서 국소림프절 전이수에 따른 TNM 병기분류와 UICC TNM 병기분류와의 비교연구

김송철(Song-Chul Kim),양한광(Han-Kwang Yang),김용일(Yong-Il Kim),김진복(Jin-Pok Kim) 대한외과학회 1998 Annals of Surgical Treatment and Research Vol.54 No.6

인체 위암조직에서 Bombesin Family의 Ligand 및 수용체의 발현에 관한 연구

김윤호(Yoon Ho Kim),양한광(Han-Kwang Yang),오승근(Seung Keun Oh) 대한외과학회 2002 Annals of Surgical Treatment and Research(ASRT) Vol.62 No.3

위장관간질종양(GIST)에서 imatinib mesylate를 이용한 표적 치료

이혁준(Hyuk-Joon Lee),양한광(Han-Kwang Yang) 대한종양외과학회 2005 Korean Journal of Clinical Oncology Vol.1 No.2

위장관간질종양(gastrointestinal stromal tumor, GIST)은 위장관에서 발생하는 중배엽 기원 종양 중 가장 흔한 것으로, Interstitial cell of Cajal에서 기원하며 KIT 발현을 그 특징으로 한다. GIST의 유일한 근치적 치료는 수술적 절제이나, 전이성 또는 수술이 불가능한 GIST 환자에서는 항암화학요법이 추천된다. Imatinib mesylate (Glivec®)는 ABL, KIT, PDGFR의 tyrosine kinase 활성을 선택적으로 억제하는 약물이다. Imatinib은 전이성 및 재발성 GIST에서 낮은 독성과 높은 반응률, 전체 생존율의 증가를 보임으로 그 효과가 입증되었다. Imatinib 치료의 초기 용량은 일일 400 ㎎이 추천되며, 높은 반응율에도 불구하고 완전 관해는 매우 드물기 때문에 질병이 진행하거나 환자가 더 이상 투여 받을 수 없을 때까지 계속 투약어야 한다. 현재 수술 후 재발 고위험군에서 보조적 화학요법으로서의 Imatinib의 의의에 대한 제2상 및 제3상 임상시험이 진행 중이다. Imatlnib에 내성을 보이는 경우, 용량 증가 또는 sunitinib 등 새로운 분자표적물질의 적용이 필요할 것으로 생각되나 이에 대해서는 추가적인 연구가 필요한 상태이다. Gastrointestinal stromal tumors (GIST), the most common mesenchymal neoplasm of the gastrointestinal tract, originate from interstitial cell of Cajal, and typically express KIT protein in most cases. Although the only curative treatment for GIST is surgical resection, systemic chemotherapy is recommended in case of metastatic or inoperable disease. Imatinib mesylate (Glivec?) is a small molecule that selectively inhibits ABL, KIT, and PDGFR tyrosine kinase. Many previous studies confirmed that imatinib provides excellent response rate and overall survival rate with acceptable toxicity rate in metastatic or recurrent GIST. 400 ㎎ per day is the currently recommended dose in first-line therapy, and recommended duration of therapy is life-long until disease progression or intolerance. Nowadays, several phase Ⅱ or phase Ⅲ clinical trials are on the way to validate the role of adjuvant treatment of imatinib on GIST after curative resection. In case of the resistance on imatinib, increasing the dose of imatinib or an alternative experimental targeted therapy such as sunitinib can be considered, but more evidence is required to confirm their effectiveness.