위암수술 환자에서의 cp 개발과 cp적용에 따른 질 향상 활동에 관한 연구

임은주,황순휘,박도중,하광일,배현주,김형호 한국의료QA학회 2006 한국의료질향상학회지 Vol.13 No.2

Background : In an era of increasing medical costs, safe reduction in postoperative stay has become a major focus to optimize utilization of healthcare resources. The authors aimed to evaluate the clinical significance of the critical pathway(CP) for gastrectomy patients by implementing standardized postoperative management and electronic medical records. Method : From August 2006 to April 2007, critical pathways were introduced to inpatients and outpatients with gastric cancer. 60 consecutive patients undergoing distal gastrectomy were randomly divided into two groups; 30 CP group(A) and 30 non-CP group(B). Simultaneously, we also retrospectively reviewed the records of 438 patients(C:control group) who were able to be enrolled in CP program. We compared group(A) with (B), (C) in terms of hospital stay, complication rate, use of antibiotics and hospital costs. Patient satisfaction was surveyed by questionnaires. Result : There was no significant demographic difference between group(A) and (B). Of 30 patients in group(A), 5 drop-outs and 14 variances occurred. The mean postoperative hospital stays(Laparoscopy-assisted distal gastrectomy: LADG/Open distal gastrectomy: ODG) were 7.6/10.5 days for the group(A), 8.9/12.7 days for the group(B) and 12.6/14.5 days for the group(C) (p=0.02 in LADG). The total hospital cost of group(A) had a tendency to be less than that of group(B) and the amount of hospital cost per day in group(A) was significantly higher than that in group(B). The usage rates of the first generation antibiotics were 73.33%, 63.33%, and 59.2% in group(A), (B), and (C), respectively. Patients’ satisfaction had a tendency to be higher in the CP group than non-CP group. Conclusion : The mean hospital stay in LADG patients was shortened meaningfully and hospital cost per day was enlarged after introduction of clinical pathway. It is necessary to apply a number of patients to the critical pathway and to make an effort to reduce the variation and drop-out rates.

도금사업장의 작업환경의 유해인자 노출수준에 관한 연구

문덕환,도수영,이채관,황용식,선병관,손병철,김대환,이창희,김휘동,이채언 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.5

Objective : For the purpose of preparing the fundamental data and assessing the status of exposure level of chemical substances and physical agents. Methods and Material : Such as noise, two types of dust, four types of metals, seventeen types of organic solvents, and four types of other materials classified by specific chemical substances in 21 metal product plating factories classified by 28 processes. The author determined exposure level on those hazardous materials from Jan. to Dec. 2001. Results : The results were as follows: 1. The exposure level for noise was exceeded to Threshold Limit Value(TLV) in the process of 6 cases of Machining, 5 and 4 cases of pre and post-buffing, and 6 cases of waterdrop-removing, the mean noise level of all of processes was not exceeded to compliance level. 2. The exposure level for dust was not exceeded to TLV at all. 3. The exposure level for Chromium(Cr) was exceeded to TLV in Chromium plating process, metal exposure level including Zinc(Zn), Manganese(Mn), and Lead(Pb) was not exceeded to TLV. 4. The exposure level of toluene in case of organic solvents was exceeded to TLV in 1 case of finishing/cleaning, coating/developing process, respectively. 5. The exposure level of four types of other materials classified by specific chemical substances were not exceeded to TLV. 6. The exposure level for dust and metal including Zn, Mn, and Pb was decreased in comparison with two results of air monitoring performed. There was no difference of the exposure level for Cr, noise, and four types of other materials classified by specific chemical substances, and the exposure level for organic solvents was slightly increased. 7. The exposure level for noise in factories employing more than 21 workers was higher than that for noise in foadtories employing less than 20 workers. The more workers, the lower exposure level in metal including Zn, Mn. The exposure level for Cr was increasing in factories employing more than 51 workers, and the more workers the lower exposure level in organic solvents. Conclusion : According to above results, this study suggests positive work environment managements in processes exceeding exposure limit value as well as continuously consecutive work environment management in processes not exceeding exposure limit value and revealing no chronological difference of exposure level should be needed.

도장작업시 유해인자들의 노출수준과 작업환경관리실태

이세기,문덕환,이채관,황용식,선병관,손병철,김대환,이창희,김휘동,이채언 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.5

Objectives: For the purpose of preparing the fundamental data and assessing the status of exposure level of chemical substances in painting process. Methods and Materials: The author determined the concentration of organic solvents, lead(Pb), Chromium(Cr), and Toluene-2, 4-diisocyanate(TDI) in air of painting process to 90 industries classified by 15 types of manufacturing industry during a period from Jan. 1st 2001 to Dec. 31st 2001. Results: The results were as follows: 1. The geometric mean level of each chemical substance was 0.1706 ppm for exposure index in organic solvents, 0.0019㎎/㎥ for Pb, 0.0024 ㎎/㎥ for Cr, and 0.0004ppm for TDI, respectively. 2. The exposure level of each chemical substances by type of painting was the highest in dipping and brush painting for organic solvent, in spray-painting for TDI, and in spray gun-painting for Pb and Cr, respectively. 3. The exposure level of each chemical substances by type of local ventilation equipment was higher in enclosed and booth type for organic solvents. Cr, and TDI, and in exterior type for Pb, respectively than those of other types. 4. The exposure level of each chemical substances by type of hazardous material arresting media was higher in using water for organic substances, in using bag filter for Pb, TDI, respectively than those of other types. Conclusion: According to above results, this study suggests that the exposure level by type of industry exceeded the exposure level in wooden furniture and metal furniture manufacturing industry for organic solvents and Pb, respectively.

Short-Term Outcomes of Laparoscopic Proximal Gastrectomy With Double-Tract Reconstruction Versus Laparoscopic Total Gastrectomy for Upper Early Gastric Cancer: A KLASS 05 Randomized Clinical Trial

Hwang, Sun-Hwi,Park, Do Joong,Kim, Hyung-Ho,Hyung, Woo Jin,Hur, Hoon,Yang, Han-Kwang,Lee, Hyuk-Joon,Kim, Hyoung-Il,Kong, Seong-Ho,Kim, Young Woo,Lee, Han Hong,Kim, Beom Su,Park, Young-Kyu,Lee, Young-J The Korean Gastric Cancer Association 2022 Journal of gastric cancer Vol.22 No.2

Purpose: Laparoscopic proximal gastrectomy with double-tract reconstruction (LPG-DTR) is a function-preserving procedure performed for treating upper early gastric cancer (EGC). However, few studies have compared the outcomes of LPG-DTR with those of laparoscopic total gastrectomy (LTG). This study aimed at comparing the short-term outcomes of LPG-DTR between LTG and upper EGC. Materials and Methods: For upper-third EGC, a multicenter, prospective, randomized trial was performed to compare those who underwent LPG-DTR with those who underwent LTG. Short-term outcomes, including clinicopathologic results, morbidity, mortality, and postoperative courses, were evaluated using a full analysis set based on the intention-to-treat principle and the per-protocol set. Results: Of the patients, 138 who fulfilled the criteria were randomized to each group. One patient in the LPG-DTR group withdrew consent. Sixty-eight patients underwent LPG-DTR and 69 underwent LTG. The operative time (LPG-DTR=219.4 minutes; LTG=201.8 minutes; P=0.085), estimated blood loss (LPG-DTR=76.0 mL; LTG=66.1 mL; P=0.413), and the morbidity rate (LPG-DTR=23.5%; LTG=17.4%; P=0.373) between the groups were not significantly different. No mortality occurred in either of the study groups. Two weeks post operation, the Visick scores for postprandial symptoms, including reflux symptoms, were not significantly different between the groups (P=0.749). Laboratory findings on postoperative day 5 were not significantly different between the groups. Conclusions: The short-term outcomes of LPG-DTR for upper EGC were comparable to those of LTG.

Local tissue reaction after injection of contrast media on gastric wall of mouse

Sun-Hwi Hwang,Hyung-Ho Kim,Do Joong Park,Ye-Seob Jee,Kyoung Ho Lee,Young Hoon Kim,Hye Seung Lee,Hyuk-Joon Lee,Han-Kwang Yang 대한외과학회 2012 Annals of Surgical Treatment and Research(ASRT) Vol.82 No.2

Purpose: Computed tomography (CT) lymphography is a simple technique of sentinel node navigation but tissue reaction after injection of contrast media has not been reported yet. Methods: Ninety mice used in this study were divided into three groups: lipiodol, iopamidol, and normal saline. The test compounds were given by submucosal injection to the gastric wall of anesthetized mice. The specimens were subjected to histopathological examination. Results: The mean grades of acute inflammatory response after iopamidol and lipiodol injection were significantly higher than control group. However, there was no significant difference between iopamidol and lipiodol injection. The mean grade of chronic inflammatory response and fibrosis showed no differences between groups. The presence or absence of fibrinoid necrosis and mesothelial hyperplasia showed no statistical differences at each time point between groups. The foam cell, which is similar to human signet ring cell carcinoma, were not identified in normal saline and iopamidol group, but were detected by postoperative day 7 in lipiodol group. Conclusion: We conclude that iopamidol and lipiodol when used as a contrast media of CT lymphography is an available material for preoperative sentinel node navigation surgery for gastric cancer with an acceptable incidence of pathological alterations in a mouse model. Our results are potentially useful to clinical (human) application.

위 지방 육종

황순휘(Sun-Hwi Hwang),박도중(Do Joong Park),박영수(Young Soo Park),이경호(Kyoung Ho Lee),김영훈(Young Hoon Kim),이혜승(Hye Seung Lee),이혁준(Hyuk-Joon Lee),김형호(Hyung-Ho Kim),양한광(Han-Kwang Yang),이건욱(Kuhn Uk Lee) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.72 No.5

Liposarcoma is a mesenchymal malignant tumor which occurs most frequently in the limbs, retroperitoneum, and trunk: Although primary liposarcoma may occur anywhere adipose tissue is found, visceral locations are only rarely represented. Moreover, primary gastric liposarcoma is extremely rare. So, only a few cases of primary gastric liposarcoma have been reported in English literature. We describe the case of a 43-year-old woman presenting with melena, epigastric pain, general weakness. Esophagogastroduodenoscopy (EGD) showed a 6×4×3 ㎝ sized-mass which was located on the posterior gastric wall. By endoscopic ultrasonography and abdominal CT scan, we suspected gastric lipoma and performed the laparoscopic transgastric tumor resection by eversion method. Finally, it was confirmed as a gastric liposarcoma pathologically. Herein, we present a case of gastric liposarcoma which was resected by laparoscopic transgastric wedge resection.

Correlations between neuronal loss, decrease of memory, and decrease expression of brain-derived neurotrophic factor in the gerbil hippocampus during normal aging

Hwang, In Koo,Yoo, Ki-Yeon,Jung, Boo-Kyoung,Cho, Jun Hwi,Kim, Do-Hoon,Kang, Tae-Cheon,Kwon, Young-Guen,Kim, Yong-Sun,Won, Moo Ho Elsevier 2006 Experimental neurology Vol.201 No.1

<P><B>Abstract</B></P><P>It is known that the hippocampus has vital functions in learning and memory, behavioral regulation, and activity-dependent synaptic plasticity, and that the hippocampus contains high levels of brain-derived neurotrophic factor (BDNF). In the present study, we followed age-dependent changes of BDNF immunoreactivity and protein level in the gerbil hippocampus to identify the correlation between BDNF and aging. BDNF immunoreactivity and its protein level significantly increased at postnatal month (PM) 12 in the hippocampus and thereafter reduced. At PM 24, BDNF immunoreactivity in the hippocampal CA1 region and dentate gyrus was similar to that in the PM 1 group, whereas BDNF immunoreactivity in the CA2/3 region at PM 24 was higher than that at PM 1. In the PM 24 group, an age-related neuronal loss and the decrease of reference and working memory were observed. In conclusion, our results suggest that observed reduction in BDNF and reference memory may be associated with age-dependent neuronal loss in the hippocampal CA1 region.</P>

두가지 혈류 유발방법에 의한 새로운 심폐소생술(이중 혈류 유발 심폐소생술)장치의 개발

황성오,김현,조준휘,오범진,임종천,최경훈,윤정한,이승환,김영식,이강현,이윤선 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.2

Background: There have been many efforts to augment blood flow during cardiopulmonary resuscitation. These efforts have focused on maximizing the effect of cardiac pump or thoracic pump alone. However, considering that the heart is the biggest blood reservoir and increase of intrathoracic pressure can generate blood flow, simultaneous exploitation of both mechanisms may have synergistic effect. We hypothesized that simultaneous chest constriction in addition to sternal compression by standard CPR may have additive hemodynamic effects by preventing deformation of the chest and increase of intrathoracic pressure. Methods and results: we built a new mechanical device to perform compression and thoracic constriction simultaneously. The device consists of two main elements. Piston in the center is to depress the sternum. Strap is to constrict the thorax circumferentially. Strap is attached to both sides of the piston. When the piston is pushed down, it depresses the sternum and pulls on the thoracic strap. To determine strap width to produce optimal hemodynamic effect, we measured hemodynamic parameters with variable widths of strap in two dogs after induction of ventricular fibrillation. Result of the experiment showed that 10cm wide strap was determined to be most effective. We also determined optimal depth of compression to produce maximal hemodynamic effect with animal experiments using two dogs. Animal experiments showed that the highest aortic pressure could be generated when the stemum was depressed to 5 cm. Cardiopulmonary resusciation using a new device could generate higher systolic aortic pressure, coronary perfusion pressure and end-tidal carbon dioxide tension in comparison with standard cardiopulmonary resuscitation in a pilot animal study using two dogs. Conclusion: New cardiopulmonary resuscitation method using a mechanical device designed by us could perform sternal compression and simultaneous thoracic constriction, and generate better hemodynamic effects than standard cardiopulmonary resuscitation in pilot animal experiments.

저강도 초음파치료의 골절치유 효과

황태선,김종만,이충휘 한국전문물리치료학회 1998 한국전문물리치료학회지 Vol.5 No.3

AbstractNoninvasive low intensity ultrasound has been shown to be an effective means of accelerating bone fracture repair in both animal and clinical studies. The effects of ultrasound stimulation on bone repair after fibular osteotomy were assessed in a rabbit fibular fracture model. Bilateral closed fibular fractures were made in skeletally mature male White Japanese rabbits. In this study, 24 subjects were randomly divided into 2 groups: experimental group 1 (n=12), and experimental group 2 (n=12). Experimental group 1 received 0.875MHz continuous ultrasound and Experimental group 2 was treated with 3 MHz continuous ultrasound. The ultrasound intensity was 50 mW/ciif and treatment time was 10 minutes for every session in both groups. In each rabbit, one fibula served as a control and the other was subjected to ultrasound treatment 5 times per week for 3 weeks. After 3 weeks, rabbits were sacrificed and the ratios of the area between the trabeculae and bone marrow of the fibulae were calculated. At the end of the experimental period, 14 of the 24 rabbits were excluded due to complications from surgery or inadequate fracture status for this study. There was no statistically significant difference in the trabeculae area between experimental leg and control leg in experimental group 1 and experimental group 2 (p>0.05). And there was also no statistic- statistically significant difference between experimental group 1 and experimental group 2 according to ultrasound treatment frequencies, 0.875MHz and 3 MHz (p>0.05). These data suggest that in Japanese white rabbits, low intensity ultrasound stimulation does not facilitate fracture repair nor is there any difference in fracture repair results between ultrasound frequencies, 0.875 MHz and 3 MHz.

심폐소생술 중 심장펌프 이론의 증거로서 대동맥 크기의 변화

황성오,김선만,조준휘,오범진,김성환,강구현,이강현,이승환,윤정한,최경훈 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.1

Background : Although the cardiac pump mechanism and the thoracic pump mechanism have been suggested, the mechanism of blood flow generated by precordial compression in human remains controversial. We hypothesized that, during compression systole, the proximal descending thoracic aorta would be distended by forward blood flow if the heart acts as a pump, and be contracted or unchanged if increased intrathoracic pressure generates blood flow. Methods : Fourteen patients with cardiac arrest underwent transesophageal echocardiography to verify the morphologic changes of the descending thoracic aorta during standard manual cardiopulmonary resuscitation. The aortic dimensions including cross sectional area and diameters at the end of compression and of relaxation were measured proximal to and at the maximal compressing site of the descending thoracic aorta. Results : At the point of maximal compression, deformations of the descending thoracic aorta were observed during compression in all patients and ratio of the longest to shortest diameter of the aorta decreased during compression than relaxation(0.58±0.11, p=0.001). Gross sectional area of the aorta at the maximal compression decreased during compression than relaxation(3.01±1.91 versus 7.26±14.70㎠, p=0.035). Ratio of th longest to shortest diameter of the proximal descending thoracic aorta remained unchanged during compression and relaxation(1.0±0.88 versus 1.0±0.9, p=0.345). Cross sectional area of the proximal descending thoracic aorta increased during compression than relaxation(4.81±2.86 versus 4.29±2.51㎠, p=0.011). Conclusion : Distention of the proximal descending thoracic aorta and deformation of the aorta at the maximal compression during the compression systole suggests that the heart act as a pump during standard manual cardiopulmonary resuscitation in human.