위절제술 환자의 표준진료지침 개발 및 적용 효과

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.

소화성궤양 환자에 대한 Omeprazole(Losec^(�))의 임상 효과

이종선,이기천,허승식,안정기,윤세진,정현용,이헌영,김영건 최신의학사 1990 最新醫學 Vol.33 No.9

보존적 치료로 회복된 망경색에 의한 급성복증 1예

김정념,이숭환,김정식,김진호,배윤오,박성규,윤상정,한현영,이헌영 충남대학교 의과대학 의학연구소 2003 충남의대잡지 Vol.30 No.1

Omental infarction, the end result of impaired perfusion to the greater omentum, is a rare benign self-limiting clinical entity. The main clinical symptom is non-specific localized abdominal pain with a moderately raised white blood cell and erythrocyte sedimentation rate. These findings often mimic an abdominal surgical emergency. This condition is often misdiagnosed as acute appendicitis or cholecystitis. The characteristic feature of CT scan and ultrasonography provide non-invasive diagnosis in most patients with omental infarction. We report a case of patient whose CT scan showed the characteristic finding of omental infarction. The patient was improved spontaneously only with conservative care.

소화성 궤양에 대한 Nizatidine의 임상효과

안정기,이기천,허승식,이종선,정현용,이헌영,김영건 충남대학교 의과대학 지역사회의학연구소 1990 충남의대잡지 Vol.17 No.1

Nizatidine is a newly introduced potent H2-receptor antagonist of acid secretion with long duration of action. For evaluation of clinical efficancy and safety, twenty one patients with endoscopically proved thirteen gastric ulcers and eight duodenal ulcers were treated with nizatidine 300mg at bed time via per os for 6 weeks. The results were as follows 1. The rate of complete endoscopic healing of duodenal ulcer 92.3% and 87.5% after 6 weeks. The overall healing rate of peptic ulcer was achieved in 89.9% at 6 weeks. 2. Clinical symptoms disappeared in 84.6%, 92.3% and 100% of patients with duodenal ulcer and 75.0%, 87.5% and 87.5% patients with gastric ulcer at 2, 4 and 6 weeks respectively. 3. There were not developed any symptoms and signs suggesting side effect of drug. In conclusion, data from this study suggest that nizatidine 300mg p.o. at sleeping time is effective and safe in treatment of peptic ulcer disease, and is well tolerated on a short-term basis.

내시경으로 확인된 상부소화관 용종의 임상적 고찰

김영건,김병호,성자원,이기천,허승식,이종선,정현용,이헌영 충남대학교 의과대학 지역사회의학연구소 1991 충남의대잡지 Vol.18 No.2

From January 1987 to October 1991, we performed 14,333 cases of upper gastrointestinal endoscopy and diagnosed 527 cases with U.G.I polyp. We assesed these 527 cases and obtained following results: 1) The overall incidence of U.G.I. polyps was 3.6%, and there was no sexual difference. The peak incidence was in 6th decades(32.4%). 2) The U.G.I. polyps were located chiefly at stomach(415 cases, 78.7%), among which antrum occupied antrum 43.5%, body 24.0% and funds 5.1%. And the others were esophagus(6.5%) and duodenum(12.3%). 3) The size of U.G.I. polyp was below 1cm in 72.3%, from 1cm to 1.9cm in 20.7% and above 2cm in 7.0%. According to Yamada' classification, type Ⅰ, Ⅱ, Ⅲ and Ⅳ was 31.9%, 51.3%, 13.7% and 3.0%. 4) Histological nature of U.I.G. polyp were hyperplastic polyp(85.8%), adenomatous polyps(9.3%), carcinomatous polyps(3.3%) and etc. The size of neoplastic polyp such as adenomatous polyps(mean 1.0±0.7cm) and carcinomatous polyps(niean 2.0±1.8) were larger man hyperplastic polyp(mean 0.6±0.4) (p<0.05) 5) The gastric polyps were associated with peptic ulcer(7.5%), gastric cancer(3.2%), other malignancy(3.5%), hepatobiliary disease(5.5%), post subtotal gastrectomy(5.5%). And others(75%) werenot associated with specific disease.

고빌리루빈혈증을 동반한 자가면역성 간염 1례

서영범,김성욱,장재식,강혁주,이중현,윤병구,김욱년,이광헌,이구,유석동,양창헌,이정호,이영현,이창우,서정일 동국대학교 의학연구소 2000 東國醫學 Vol.7 No.-

자가면역성 간염은 대개 만성 경과를 가지며, 혈중 자가면역항체와 혈청 글로불린치의 상승, 그리고 조직학적으로 괴사 염증성 변화를 특징으로 하는 질환으로 아직 정확한 병인이 밝혀져 있지 않은 상태이다. 발병연령은 대개 젊은 영자(15-25세)에서 호발한다. 이 질환은 급성 간염의 임상경과를 보일 수 있으나, 심한 급성 간염이나 전격성 간염으로도 나타날 수 있는데, 이 경우 아주 나쁜 예후를 보인다고 한다. 치료는 자가면역성 간염 임상 경과의 다양성이나 병인, 병리기전의 불확실성에도 불구하고 대개 steroid 치료에 반응하는 것으로 알려져 있으며 대개 80%의 관해율을 나타내며 궁극적으로 간경변으로의 진행을 막을 수 있는 것으로 보인다. 저자들은 58세 남자에서 발생한 급성의 경과를 가지고 심한 황달을 동반한 자가면역성 간염을 경험하였기에 문헌고찰과 함께 보고하는 바이다. Autoimmune hepatitis (AIH) is a chronic necroinflammatory liver disorder of unknown cause associated with circulating autoantibodies and a high serum globulin level. The age of onset of AIH show a peak between the age of 15 and 25 years. AIH can develop and be manifested as acute hepatitis, but severe form of acute hepatitis or fulminant hepatic failure has a poor prognosis. Although AIH is likely to progress from chronic active hepatitis to cirrhosis, steroid therapy can control the disease activity, prolong survival, improve the quality of life , and defer liver transplantation. In the present report we describe a 58-year-old man who admitted because of progressive jaundice and fatigue. He was diagnosed with AIH from laboratory test result showing positivity for antinuclear antibodies, anti-smooth muscle antibodies, and negativity for hepatitis viral markers and from liver biopsy. Steroid therapy, oral administration of prednisolone, was effective in improving the liver function test. Following liver biopsy 6 months after onset shows markedly improved necroinflammatory activity.

TNF-α 유전자형과 방광암과의 관계

정필두,김은정,엄민식,서정원,윤석중,김종석,이상철,김원재 충북대학교 의학연구소 2001 忠北醫大學術誌 Vol.11 No.2

연구목적: TNF-α는 일부 종양의 종양화 과정과 관련이 있는 것으로 알려져 있다. 본 연구는 TNF-α 발현에 영향을 미치는 TNF-α 촉진자 -308 부위의 유전적 다형성이 방광암과 관련이 있는지 유무를 알고자 시행하였다. 대상 및 방법: 유전자 분석을 위하여 환자 113명 및 대조군 109명으로부터 혈액을 채취하여 genomic DNA를 분리한 후 PCR-RFLP 및 direct DNA sequencing을 통하여 TNF-α유전자의 다형성을 조사하여 방광암의 발생, 병기 및 분화도와 비교 검토하였다. 결과: TNF-α 촉진자 -308 부위의 유전형은 대조군에서는 GG형이 83.5%(90례 및 GA형이 16.5%(19례)로 관찰되었으며 AA형은 없었다. 환자군에서는 GG 형이 85.4%(97례), GA형 및 AA형은 각각 13.1%(15례)및 0.8%(1례)에서 관찰되었다. 두 군 모두에서 GG형이 가장 많이 나타났으며 다음으로 GA형을 보이고 AA형은 1례의 방광암 환자에서만 관찰되었다. -308부위의 경우도 두 군 사이에 유전자형의 차이는 없었다(p=0.259) 분화도별 분포를 보면 grade I이 20례, grade II가 49례, grade Ⅲ은 34례였고 병기별로 표재성인 경우가 90례였으며 침윤성은 14례였다. 분화도가 나빠질수록 GA형이 증가하였다(p=0.04). 그러나 병기와 TNF-α promoter -308부위의 유전자형 사이에는 유의한 상관 관계가 없었다(p=0.123). 결론: 방광암 환자의 혈액에서 GA genotype이 관찰되는 경우, 분화도가 나쁠 가능성이 매우 높기 때문에 좀 더 적극적인 치료와 세밀한 추적관찰을 함으로써 방광암으로 인한 사망과 암의 진행을 예방할 수 있을 것으로 기대한다. Purpose : Tumor necrosis factor-alpha (TNF-α) is involved in tumorigenesis of several cancers as an endogenous tumor promoter. The purpose of this study was to investigate whether genetic polymorphism of TNF-α promoter region (-308) was associated with human bladder tumor. Materials and Methods: The DNA from 113 and 109 respective blood samples of bladder tumor Patients and control group was analyzed by PCR-based restriction fragment length polymorphism (RFLP) and direct DNA sequencing methods to characterize the genetic polymorphism of -308 promoter region of the TNF-α gene in bladder tumor patients. We compared the association of bladder tumor with genetic Polymorphism of TNF-α promoter region(-308) in relation to the stage, grade, recurrence and progressio. Results : Eighty-six percents(97/113) of bladder tumor patients and 83.5% (90/109) of control group showed genotype GG at -308 region of TNF-α. Difference in genetic variations of TNF-α promoter (-308) did not exist between bladder tumor patients and control group(p=0.259). Tumor grade was significantly related to the GA genotype (p=0.04). The higher is the grade in bladder tumor, the more frequent was the GA genotype. Tumor stage, recurrence and progression were not significantly associated with genetic polymorphism of TNF-α promoter region (-308). Conclusion: The GA genotype of TNF-a promoter region (-308) had a significant impact on TNF-α production and was related to higher grade tumor compared to GG genotype. TNF-α serum levels in bladder tumor patients were significantly higher than controls. These data suggested that TNF-α might involve the tumorigenesis of the bladder rather than treatment or prevention of bladder tumor.

關羽의 검보와 그 系譜에 관한 小考

李廷植 한국중국문화학회 1998 中國學論叢 Vol.7 No.-

本來在≪三國志≫中的關羽병不像戱曲裏面所描寫的一般, 是唯一偉大的英雄好漢. 依陳壽的≪三國志≫中"剛而自矜", "以短取敗,理數之常也"的句子,對他的評價병不是흔高파. 但是, 後來근劉備, 張飛結拜兄弟之後, 爲了復興漢室, 盡忠而重義氣及節操, 備禮義, 又經過了≪三國演義≫作者的誇張, 而他最後각變成了永遠最受中華民族敬愛的民族英雄了, 甚至於是「護國保民」的「神」的存在了. 比如說在明, 淸時代在全國都市或農村中所建立的「關帝廟」的數字之多, 更不用提同時代一起活躍的劉備, 張飛, 曹操, 孫權等的群雄, 連被稱號 「萬世師表」的孔廟的數字也간不及. 像這樣的情況不局限於國內, 到國外的"華人街"的話, 馬上會發現到「關帝廟」, 而每個家庭裏都有「關帝」, 在早上, 晩上都給拜拜了. 這樣的現象在戱曲界也不例外,叫他的時後, 不叫「關羽」, 而「老爺」,又不叫「關羽戱」, 叫「老爺戱」了. 在這編論文裡爲了了解「關羽熱」, 把著眼點移到傳統戱曲方面來首先考察關羽瞼譜及其由來, 關羽瞼譜的系統, 其次再探討歷代以演關羽出名的人物如,Ⅰ. 被稱呼爲"紅生泰斗"王鴻壽派的關羽及其瞼譜,Ⅱ. 被稱呼爲"紅生鼻祖"的李洪春的關羽及其瞼譜和, Ⅲ. 被稱呼"小老爺"的李萬春的關羽及其瞼譜了. 最後我們可以發現到, 關羽的"面如重棗"근從古代到現在中國人對紅色的觀念依然包含着吉상, 喜愛, 慶祝, 避邪等等的象徵意義, 互通其理一脈相乘了.因此, 一般民衆拜訪「關帝廟」而祈念什마東西,再進一步說, 看到已經神格化的舞臺上"紅瞼"的關羽人家都熱狂或者祈求什마宿願的心情也就不難理解了파.

유리혈관화비골 미세이전과 골유착성 임프란트를 이용한 심미 기능적 편측하악골 결손 재건

이종호,배정식,정현주 大韓顎顔面成形再建外科學會 1995 Maxillofacial Plastic Reconstructive Surgery Vol.17 No.3

In this report, a case is presented in which resected mandible was reconstructed immediately with vascularized bone graft and adjunctive implantation of osseointegrated dental implants. The primary was central odontogenic myxoma of mandible extending from symphysis to the left condylar neck. The hemimandibulectomy defect was restored with free fibular flap. Three months after 1st surgery, the transplant received five IMZ implants. The masticatory function was restored with the implant borne denture. The result including facial appearance was very satisfactory.

영상데이타베이스 구축을 위한 건축설계도면 인식

이연식,신성윤,김정은 群山大學校基礎科學硏究所 1995 基礎科學硏究 Vol.10 No.-

This paper proposes an approach to the vectorization and representation of large-size architectural drawing images. The class of drawings considered here is characterized by instances of symbols, character strings and connections. After horizontal and vertical projection of the scanned gray-scale image, symbols, character strings and connection lines are separated using a few simple yet effective generic drawing properties. The approach is based on a modified run-length image representation on a modified run-length image representation and line- by-line processing scheme with a limited amount of image line stored in memory. Within this approach fast algorithms for transformation of a large-size gray-scale image in vector form are suggested. A hierarchical data structure for the representation of these images in vector form, which stores in compact form all the needed information about connected components, segments, and feature points, is suggested. The process steps for obtaining this data structure are described. The experimental results are also shown.