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.

임피던스 방법을 이용한 뇌혈류량 측정기기의 개발(Ⅰ)

김덕원,김정래,송철규,김정열,남문현 대한의용생체공학회 1989 의공학회지 Vol.10 No.1

In this study, Rheoencephalography(REG) was designed and constructed. Using the constructed instrument cerebral blood flow(CBF) of left and right brain, CBF change by posture, and reproducibility were studied. Followings are important results. Relative CBF could be measured noninvasively and continuously. Since reproducibility of the constructed REG was found to be quite high (4 %), the accuracy of the instrument itself was proved. REG can be easily applied for testing the effect of drugs for the patients with cerebral vessel diseases since it is quite sensitive to the relative changes of CBF. Various cerebral diseases can be diagnosed by analyzing the REG waveforms. The area of restricted cerebral blood vessels can be located by arranging the electrode configuration. Comparative studies with the standard techniques of measuring CBF are needed to verify the accuracy of REG. Further studies on optimal electrode configuration and various artifacts are also necessary.

Kidney Toxicity Induced by 13 Weeks Exposure to the Fruiting Body of Paecilomyces sinclairii in Rats

Jeong, Mi-Hye,Kim, Young-Won,Min, Jeong-Ran,Kwon, Min,Han, Beom-Suk,Kim, Jeong-Gyu,Jeong, Sang-Hee Korean Society of ToxicologyKorea Environmental Mu 2012 Toxicological Research Vol.28 No.3

Paecilomyces sinclairiis (PS) is known as a functional food or human health supplement. However concerns have been raised about its kidney toxicity. This study was performed to investigate the kidney toxicity of PS by 13 week-oral administration to rats. Blood urea nitrogen (BUN), serum creatinine, and kidney damage biomarkers including beta-2-microglobulin (${\beta}2m$), glutathione S-transferase alpha (GST-${\alpha}$), kidney injury molecule 1 (KIM-1), tissue inhibitor of matrix metalloproteinase 1 (TIMP-1), vascular endothelial growth factor (VEGF), calbindin, clusterin, cystatin C, neutrophil gelatinase-associated lipocalin (NGAL) and osteopontin were measured during or after the treatment of PS. BUN, creatinine and kidney damage biomarkers in serum were not changed by PS. However, kidney cell karyomegaly and tubular hypertrophy were observed dose-dependently with higher severity in males. KIM-1, TIMP-1 and osteopontin in kidney and urine were increased dose dependently in male or at the highest dose in female rats. Increased urinary osteopontin by PS was not recovered at 2 weeks of post-exposure in both genders. Cystatin C in kidney was decreased at all treatment groups but inversely increased in urine. The changes in kidney damage biomarkers were more remarkable in male than female rats. These data indicate that the PS may provoke renal cell damage and glomerular filtration dysfunction in rats with histopathological lesions and change of kidney damage biomarkers in kidney or urine. Kidney and urinary KIM-1 and cystatin C were the most marked indicators, while kidney weight, BUN and creatinine and kidney damage biomarkers in serum were not influenced.

동종 골수이식 후 만성 이식편대숙주질환과 동반되어 신증후군으로 발현된 IgA 신병증 1예

정철권,김현수,박준성,정성현,조도연,최진혁,남동기,임호영,김명성,신규태,임현이,김효철 대한조혈모세포이식학회 1999 대한조혈모세포이식학회지 Vol.4 No.2

동종 골수이식 후 발생하는 신기능부전은 원인이 다양하여 감별에 어려움이 있다. 만성 GVHD는 흉선의 기능저하에 따른 면역관용의 실패로 발생되는 자가면역현상에 의해 발생되는 것으로 알려져 있으며 드물게 신장을 침범하여 신증후군을 일으키기도 한다. CaA의 용량을 줄이거나 투약중지 후 발생한 만성 GVHD에 동반된 신증후군의 경우 조기에 신조직검사를 시행하여 감별진단하고 CsA의 용량을 증량하거나 재투약하여 좋은 치료 결과를 보일 것으로 기대된다. 저자들은 문헌고찰을 통해 동종 골수이식 후 발생된 신증후군이 유사한 임상양상을 보이며 발생기전에 만성 GVHD와 자가면역현상이 연관되어 있음을 확인하였으며 동종 골수이식 후 신증후군의 임상양상을 보이는 환자에서 병리조직학적으로 lgA 신병증을 진단하고 이러한 lgA 신병증이 발생기전에 만성 GVHD와 자가 면역현상이 연관되어 있을 가능성을 최초로 확인하였으며 CsA를 이용하여 성공적으로 치료한 경험을 하였기에 보고하는 바이다. Renal insufficiency is occasionally encountered in allogeneic bone marrow transplantation and its cause is difficult to ascertain. Chronic graft-versus-host disease (GVHD) related to thymic dysfunction is immune-mediated and involves autoreactivity of T-lymphocytes derived from donor marrow to recipient's major histocompatibility complex(MHC) minor antigens. The clinical mainifestations of chronic GVHD are similar to those of autoimmune disease but kidney involvement is rare. Few cases of nephrotic syndrome with membranous nephropathy or minimal change nephrotic syndrome have been reported to be associated with chronic GVHD in allogeneic bone marrow transplant recipient especially after cyclosporine A(CsA) withdrawal, and these cases have responded well to CsA. Therefore, it is prudent to differentiate the cause of post-transplant renal insufficiency using renal biopsy and to start CsA in a case of nephrotic syndrome associated with chronic GVHD as early as possible. We report a case who had a massive proteinuria during the post-allogeneic marrow transplantation period. The cause of nephrotic syndrome was diagnosed as IgA nephropathy by renal biopsy. The patient was successfully treated with reintroduction of CsA.

Kidney Toxicity Induced by 13 Weeks Exposure to the Fruiting Body of Paecilomyces sinclairii in Rats

Mihye Jeong,Young-Won Kim,Jeong-Ran Min,Min Kwon,Beom-Suk Han,Jeong-Gyu Kim,Sang-Hee Jeong 한국독성학회 2012 Toxicological Research Vol.28 No.3

Paecilomyces sinclairiis (PS) is known as a functional food or human health supplement. However concerns have been raised about its kidney toxicity. This study was performed to investigate the kidney toxicity of PS by 13 week-oral administration to rats. Blood urea nitrogen (BUN), serum creatinine, and kidney damage biomarkers including beta-2-microglobulin (β2m), glutathione S-transferase alpha (GST-α), kidney injury molecule 1 (KIM-1), tissue inhibitor of matrix metalloproteinase 1 (TIMP-1), vascular endothelial growth factor (VEGF), calbindin, clusterin, cystatin C, neutrophil gelatinase-associated lipocalin (NGAL) and osteopontin were measured during or after the treatment of PS. BUN, creatinine and kidney damage biomarkers in serum were not changed by PS. However, kidney cell karyomegaly and tubular hypertrophy were observed dose-dependently with higher severity in males. KIM-1, TIMP-1 and osteopontin in kidney and urine were increased dose dependently in male or at the highest dose in female rats. Increased urinary osteopontin by PS was not recovered at 2 weeks of post-exposure in both genders. Cystatin C in kidney was decreased at all treatment groups but inversely increased in urine. The changes in kidney damage biomarkers were more remarkable in male than female rats. These data indicate that the PS may provoke renal cell damage and glomerular filtration dysfunction in rats with histopathological lesions and change of kidney damage biomarkers in kidney or urine. Kidney and urinary KIM-1 and cystatin C were the most marked indicators, while kidney weight, BUN and creatinine and kidney damage biomarkers in serum were not influenced.

양측 하악과두 골절에 대한 관혈적 정보술후 나타난 근약화와 시력장애 : 증례보고

정기훈,신용길,김태열,신재명,윤규호,전인성 대한악안면성형재건외과학회 2000 Maxillofacial Plastic Reconstructive Surgery Vol.22 No.6

The condylar fracture show high occurrence rate in the following of symphysis and angle, because it is easy to have concentration of outer pressure due to its long and narrow anatomical shape and mouth opened state when trauma is attacked. For the clinical findings, there are trismus, opening deviation, mal-occlusion and open bite The classification of condylar fracture is varied due to the location of condylar bone fragment, fracture site. There are conservative and surgical methods for treatment modalities. Because of many advantages, conservative method is widely used it has no particular limits of treatment adjustment but the cases of absolutely surgical correction indication are easily found in clinical experience. Although many methods are suggested for treatments of condylar fracture, there are no particular surgical methods for precise reduction due to difficult accessibility in high condylar neck fracture. For precise reduction of condyle, we used Nam's method. However, in Nam's method, because condyle is fixed when once it is kept off externally reduced in avascular state, so complication such as condyle resorption is pointed out as a problem. In our clinic, we obtained some knowledge by treating a patient who had muscle weakness and vision disorder after temporary airway obstruction follownig the both condylar fracure operated using Nam's method, so here we reported the case with a study of documents.

선택중심 교육과정의 운영을 고려한 고등학교 소요교실 산정에 관한 연구

김정규,정주성 대한건축학회 2004 대한건축학회논문집 Vol.20 No.1

This study aims to estimate the number of classrooms to operate optional subject curriculum in high school. The study consists in two parts. First, it analyzes the national level curriculum, the province guidances, and operating programs studied in several high schools to investigate factors affecting the number of classrooms. Secondly, it induces an arithmetic expression to estimate the number of classrooms to operate optional subject curriculum, and verifies the arithmetic expression through timetable simulation. The result of this study will be useful to estimate the scale of high school as the architectural space programing tool.

비소(Arsenic)에 의한 토양 오염과 복원기술

김대연,김정규 고려대학교 2004 생명자원연구 Vol.12 No.-

O_3/활성탄에 의한 고도정수처리에 미치는 기존처리공정의 영향에 관한 연구

김현정,서규태,문병현,이택순 7개 국립대학교 환경연구 논문집 공동발행 위원회 2001 환경연구논문집 Vol.1 No.1

The effect of conventional process, such as coagulation, sedimentation and rapid sand filtration, on O_3/GAC was evaluated for stable operation of the advanced treatment process. Five years long term water quality data was analyzed for a water treatment plant adopting O_3/GAC. Treatment efficiency of unit process in the plant was also monitored for 7 months(from 2000. 11 to 2001. 5) to investigate the pre-treatment effect on the operation of the process. Despite significant seasonal variation of raw water quality, treated water of the plant was good enough to meet drinking water quality standard. However effluent turbidity (1NTU) of sand filter was relatively high compared to the guideline that turbidity of filtered water should be lower than 0.3NTU for the effluent turbidity, 2NTU, of sedimentation tank. It was observed that effluent organic compound of sand filter gave an adverse effect on the running time of GAC filter. This phenomenon could be deduced from the correlation of the effluent water quality of sand filter and GAC in terms of TOC and UV-254. Therefore more sophisticated operation, such as adopting enhanced coagulation, should be given to the conventional process for stable and extended operation of GAC filter to produce safer drinking water even at deteriorated raw water quality.

2002년과 2007년 건강검진 수진자 특성비교

김윤진,김영주,이정규,박현지 부산대학교 병원 암연구소 2009 부산대병원학술지 Vol.- No.25