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김은희,김철규,이순교,김순덕,이혜옥,권정순,이경미,이민미,심순미,유용만,신종식,강은희,이상일,김병식,오성태,육정환,박수길 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.2
Background : Gastric cancer is the most common malignant tumor in Korea. surgical operation is one of the major treatment modalities for gastric cancer patients. Therefore, gastrectomy is one of the most common procedures in General Surgery. There were variation in length of hospital stay and medical treatment for gastrectomy between three surgeons at Asan Medical Center. Clinical pathways have received considerable attention as a tool for recucing the medical practice variation, increasing the efficiency of care process, and improving the quality of care. The aim of this study was to evaluate the effect of a clinical pathway for gastrectomy in gastric cancer patients. Methods : The clinical pathway for gastrectomy was developed and implemented by a multidisciplinary group in Asan Medical Center. A computerized clinical pathway program was developed and revised after a pilot test. A total of 145 patients underwent gastrectomy by three surgeons at Asan Medical Center. We compared the length of hospital stay, patient satisfaction, and unplanned readmission rate between the pre-pathway group(n=67) and the post-pathway group(n=78). We also investigated the degree of satisfaction among the physicians and nurses who were main end-users of the clinical pathway. Results : The clinical pathway was applied to all target patients. The average length of hospital stay was shortened from 12.7days to 10.6days(p<0.01). The degree of patient satisfaction with the care process changed from 90.3% to 89.2% after the implementation of the clinical pathway, but the difference was of satistically significant(p=0.761). Unplanned readmission rate was 2.9% in the pre-pathway group. More than 90% of physicians and nurses answered that the clinical pathway had been a useful tool in their medical practice. Conclusions : The findings of the study demonstrated that implementation of the clinical pathway for gastrectomy produced substantial reduction in the length of hospital stay while improving the quality of patient outcomes. The computerized clinical pathway program can be used as one of the powerful patient management tools for reducing the practice variations and increasing the efficiency of care process in Korea hospital settings.
Clinicopathological Analysis of Borrmann Type IV Gastric Cancer
Jeong Hwan Yook,Sung Tae Oh,Byung Sik Kim 대한암학회 2005 Cancer Research and Treatment Vol.37 No.2
Purpose: Borrmann type IV gastric cancer is often diagnosed only at an advanced stage, resulting in a prognosis poor. We performed a retrospective study of the clinical characteristics of Borrmann type IV gastric cancer and the prognostic factors affecting the survival rate in such patients.Materials and Methods: Of 4,063 patients with all gastric cancers, 370 (9%) with Borrmann type IV gastric cancer were analyzed.Results: The clinical characteristics of these patients included a higher incidence rate in young females, and higher rates of serosa exposure, metastasis to lymphnodes and early peritoneal dissemination. Of patients presenting with peritoneal seeding, those resected had a higher survival rate than those that were not. A univariate analysis showed that the prognostic factors affecting the survival rate following a curative resection were the location, occupied area and depth of the primary tumor, as well as the presence of lymph node metastasis and the tumor stage. A multivariate analysis indicated that the tumor location and stage were significant independent prognostic factors after a curative resection for Borrmann type IV gastric cancer.Conclusion: In conclusion, the early diagnosis and treatment of patients with Borrmann type IV gastric cancer are essential for the better survival of these patients. Even in patients with advanced tumors, a noncurative palliative resection may improve the prognosis.
Vicryl and PDS Plus Antibacterial 봉합사의 항균력에 대한 생체 외 연구
육정환(Jeong Hwan Yook),성흥섭(Heungsup Sung) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.78 No.1
Purpose: Surgical site infection (SSI) is the most common nosocomial infection in surgical patients, and this accounts for approximately 17% of all hospital-acquired infections. Suture materials are possibly significant sources of SSI. This study aims to evaluate the in vitro antibacterial efficacy of Vicryl and PDS plus antibacterial suture coating with triclosan against bacteria. Methods: Vicryl and PDS plus antibacterial suture coating with and without triclosan were tested for in vitro efficacy against methicillin-susceptible Staphylococcus aureus, methicillin-resistant S. aureus, methicillin-resistant Staphylococcus epidermidis, Escherichia coli by a zone of inhibition assay and test of bacterial adhesion and viability. Results: Vicryl and PDS plus antibacterial suture coating with triclosan demonstrated activity against all tested bacteria in vitro. Evaluations by a zone of inhibition assay and test of bacterial adhesion and viability show the antibacterial activity compared with untreated sutures. Pretreatment of surgical sutures with fetal bovine serum did not diminish antibacterial activity of the triclosan-coated sutures compared with non-coated sutures (P<0.01). Conclusion: Vicryl and PDS plus antibacterial suture reduced in vitro colonization of several strains of bacteria compared with untreated control sutures.
( Min Jeong Song ),( Young Soo Park ),( Ho June Song ),( Se Jeong Park ),( Ji Yong Ahn ),( Kee Don Choi ),( Gin Hyug Lee ),( Hwoon-yong Jung ),( Jeong Hwan Yook ),( Byung Sik Kim ) 대한간학회 2016 Gut and Liver Vol.10 No.5
Background/Aims: Pregnancy-associated gastric cancer is a rare condition. This case-control study was performed to identify the clinicopathological features and prognostic factors of pregnancy-associated gastric cancer. Methods: All consecutive patients who presented to our tertiary referral hospital with pregnancy-associated gastric cancer from 1991 to 2012 were identified. Two age-, sex-, and stagematched controls for each case were also identified from the records. Clinicopathological, gynecological, and oncological outcomes were recorded. Immunohistochemical staining was performed for estrogen receptor, progesterone receptor, epidermal growth factor receptor, human epidermal growth factor receptor, and E-cadherin. Fluorescence in situ hybridization was performed for fibroblast growth factor receptor 2. Results: The median overall survival rates of the pregnancyassociated gastric cancer and control groups were 7.0 months and 15.0 months, respectively (p=0.189). Poor prognostic factors included advanced stage and tumor location in the corpus or the entire stomach but not pregnancy status or loss of E-cadherin. Pregnancy-associated gastric cancer was associated with a longer time from diagnosis to treatment (21 days vs 7 days, p=0.021). The two groups did not differ in the expression of the receptors or E-cadherin. Conclusions: The dismal prognosis of pregnancy-associated gastric cancer may related to the tumor stage and location rather than to pregnancy itself. (Gut Liver 2016;10:731-738)
Biflavonoids from the Leaves of Cephalotaxus koreana Nakai
Yook, Chang-Soo,Jung, Jin-Hwan,Jeong, Jin-Hyun,Nohara, Toshihiro,Chang, Seung-Yeup The Korean Society of Pharmacognosy 2000 Natural Product Sciences Vol.6 No.1
Four biflavonoids were isolated from the leaves of Cephalotaxus koreana. Based on spectroscopic data, the compounds were identified as amentoflavone-7',7",4',4"'-tetramethyl ether, sciadopitysin, ginkgetin and bilobetin, respectively.
정오(Oh Jeong),김병식(Byung Sik Kim),육정환(Jung Hwan Yook),최지은(Ji Eun Choi),김갑중(Kab Jung Kim),오성태(Sung Tae Oh) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.73 No.4
Purpose: The prognosis of advanced gastric cancer is still dismal despite of aggressive surgical treatment. Many investigational approaches such as the use of adjuvant chemotherapy and neoadjuvant chemotherapy with or without radiation therapy have been widely attempted for highly advanced gastric cancer. There are, however, few studies about the use of these types of treatment in Korea. Methods: Between 2001 and 2004, 38 patients with highly advanced gastric cancer underwent preoperative chemotherapy using the DXP (Docetaxel, Xeloda, and Cisplatin) regimen before surgery. An retrospective analysis including clinicopathological features, recurrence, and survival was performed using patient medical records. Results: Twenty-five patients had locally advanced gastric cancer without a distant metastasis, and 13 patients had a distant metastasis or peritoneal metastasis. Patients received the chemotherapy regimen an average of 4.2 times. A partial response and stable disease were found in 28 (73.7%) and 10 (26.3%) patients, respectively, according to the RECIST criteria. Twentyone (84%) of 25 patients without a distant metastasis had a curative resection compared to 6 (46.2%) of 13 patients with a distant metastasis (P=0.024). Four patients (10.5%) had complications with 1 postoperative death. The overall 5 year survival rate was 34% and the median survival duration was 22 months (49%, 34 months for the locally advanced group vs. 0%, 10 months for the distant metastasis group; P<0.001). The only predictor of prognosis of patients as determined by multivariate analysis was the pathological TNM stage. Conclusion: Preoperative chemotherapy can be safely performed without increased postoperative morbidity and mortality. To define the actual benefits for patient survival after preoperative chemotherapy, a large scale randomized prospective control study should be performed.