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.

법과학적 응용을 위한 섬유의 동일성에 관한 연구(Ⅰ) : FT-IR, PY-GC에 의한 섬유의 동일성에 관한 연구 A Study on the Identification of Textile by FT-IR & Py-GC

김은호,김명덕,김재균,박하선,장성길,박성우 內務部 國立科學搜査硏究所 2002 國立 科學 搜査 硏究所 年報 Vol.34 No.-

신장이식 환자에서 HCMV 항원혈증 검사의 임상적 유용성

김탁,성흥섭,박관태,김송철,김성한,최상호,김양수,우준희,박수길,한덕종,이상오 대한감염학회 2009 감염과 화학요법 Vol.41 No.2

Background : This study was performed to determine the cut-off value and the predictability of symptomatic human cytomegalovirus (HCMV) infection according to the peak value of HCMV antigenemia assay in kidney transplant recipients. Materials and Methods : We reviewed the results of HCMV antigenemia assay (Chemicon, CA, USA) in patients who received kidney transplantation at our institution from May 2003 through May 2008, and investigated the existence and the type of HCMV infection by the medical record review. Patients who underwent the test only once during the episode or those who received ganciclovir for more than 48hrs before the test were excluded. The receiver-operator characteristic curve was drawn and the point showing maximum likelihood ratio (LR) was chosen as the cut-off value of symptomatic HCMV infection. Results : A total of 689 episodes were screened and 134 episodes were enrolled. Thirty-three (24.6%) episodes were symptomatic HCMV infection, 23 (17.2%) episodes were associated with HCMV syndrome, and 10 (7.5%) episodes were tissue-invasive diseases. The maximum LR was 7.5 (95% confidence interval, 4.014.2) and the cut-off value was 29.5 cells/200,000 WBC. The sensitivity, specificity, Positive predictive value, and negative predictive value were 66.7%, 91.1%, 71.0%, and 89.3%, respectively. Conclusions : The cut-off value of symptomatic HCMV infection by the peak value of HCMV antigenemia assay in our study was similar with previous results, although the sensitivity was relatively low.

개에서 관찰된 모기질세포종의 증례보고

조성환,손화영,김혜성,최종윤,류시윤,박배근,윤원기,홍성혁,김덕환 충남대학교 수의과대학 동물의과학연구소 2002 動物醫科學硏究誌 Vol.10 No.-

Pilomatricoma was histopathologically diagnosed in a 2.5-year-old male Alaskan malamute. The patient was referred to Chungnam National University, Veterinary Medical Teaching Hospital with solitary, firm and well-circumscribed mass at shoulder. Grossly, the mass was dome shaped to tumor like and 10 x 8 x 5㎝ in size. Some lesions had gritty or bony consistency and was chalky when sectioned Histopathologic feature included mumerous clusters of tightly arranged, basaloid cells with evenly distributed chromatin and ghost cells were characterized by a central unstained zone. The ghost cells often become calcified and osseous metaplasia was also present.

정재의 시대적 변천과 전승보급에 관한 연구

김상덕(Kim Sang Duck) 한국체육철학회 1997 움직임의철학 : 한국체육철학회지 Vol.5 No.1

Chong-Jae as a court dance is dedicated to the king. That means contributing talent. It originated grom the shape of court dance music under the control of professional department, and was named 「bang Ark and Hayng Ark」 and 「A-Ark Chong Jae」 has the genre as a dance. In the times of 「Korea」, the respect of Buddism made a present to the king customary, directed to inflew 「Sin Ark of the sung」 and 「Tae Song A-Ark」, and the sting contribute organized The department of court music of the tang, which modified to be in harmony with our people`s emoting, dance and music admired the great achievement of the founding country, prayed the national peace in the early of 「Cho-Sun」 era. So to speak, It developed to make a display of the kings authority. And the completing of 「Hoonmin Jong um」 dirceted Chang Sa, which use 「Korea and Chinese characters in combingation. Since, the early of the 「Cho-Sun」 dynasty, the golden age of the civilization, the dance and music declined, and not reached the level of the first stage. It caused by the much invasion of the Japanese and with the help of the political and economical peace of the king Sook Jong, the court music revived under the rale of the King 「Young Jong」. To the modes ages from the king 「Soon Jae」, there was np dance and music system, introduced 「Chong Jae」, as it is, and became extinct Since the annexation of the Korean and Japan. And, 「Lee Wang Jik」 court dance department renamed court dance department, opened the national classical music institute in 1951. With the designation as a 「Intagible cultural assets」, the modern full-dresses reappearance of 「Chong Jae」 accomplish by 「Kim Chon Heng」 as a 「Chong Jae」 reappearance choregrapher theagh the performance of the national classical music Institute. This work of the reapperarcne done by the national classical music institute must be estimatel affirmatively. As a researcher, I examined the inflow and conservation theroughout the times with the process of historcal changes of 「Chong Jae」, according to the creative Korean dance and the flood of the inflow of foreign culture, I made some conclusion on the pressevation and transmission of 「Chong Jae」. First, the recognition both school education and the institytional system in the national -public organization must direct the chance of various learning in view of the preservation and trancsmission of 「Chong Jae」. Second, the estrangement of court dance on the ceremony of dnace in the dance stage and students dance contest, a group of positive participation must be groped. Third, there is dnace which designation 「intangible cultural assents」 in 「Chong Jae」. Especially, Ovserng the dance of a group 「Chong Jae」, composition dance equipment, I feel sure that It will help the exploitation of various composition, dance, properties and device in the scope of the stage effection in the 「ceremony of the korean creative dance」. In the view of inheriting and tradition the reappearance, reviral, transmiting and spread of 「Chong Jae」 have the meaning as it is. The reappearance and revival must be developed top the arctic value which is in harmony with the present age, consider the internationalization and globalization and Institutional devices are essential to hand it down to poeterity as a research naterials and a concera to cultural art is indispensible.

SS400강판 맞대기용접부의 Out-of-plane 변위측정

차용훈,성백섭,김덕중,김성현,김충환 朝鮮大學校 機械技術硏究所 2002 機械技術硏究 Vol.5 No.1

Currently knowledge of strain in welds has mainly been obtained from strain gaging method which is directly attaching the gage to most of the material. The few non-contact method are still in the early stage. One of the non-contact methods is the use of the laser that has high-level of the accuracy for the measurement, and this laser also has excellent characteristics on which many studies for its applications are focused in the lot of fields. This study is focused on the measurement of the displacement caused by the characteristics and the temperature change of the CO2 welded zone which is used with 3-D ESPI (Electronic Speckle Pattern Interferometry) system that is functionally modified the laser ESPI system. This system employed the SS400 which are mainly used for the steel plate such as general welded structure, bridge, industrial machine and especially using structure of the Absorption Chiller-Heater.

단일공법 복강경하 질식자궁절제술 110예의 고찰 및 다공법과의 비교

박병준 ( Byung Joon Park ),김용욱 ( Yong Wook Kim ),노덕영 ( Duck Yeong Ro ),김태응 ( Tae Eung Kim ),류기성 ( Ki Sung Ryu ),김장흡 ( Jang Heup Kim ) 대한산부인과학회 2010 Obstetrics & Gynecology Science Vol.53 No.7

목적: 통상적인 복강경기구만을 사용한 단일공법 복강경하 질식자궁절제술을 다공법 복강경하 질식자궁절제술과 비교하여 안전성 및 유용성을 평가하고자 하였다. 연구 방법: 2007년 4월부터 2009년 11월까지 인천성모병원에서 자궁근종 또는 자궁샘근증의 질환으로 단일공법 복강경하 질식 자궁절제술을 시행받은 환자 110명과 다공법 복강경하 질식자궁절제술을 시행받은 환자 110명, 총 220명의 환자를 대상으로 하였다. 우리는 모든 수술에서 통상적으로 사용되는 구부러지지 않는 일직선의 복강경기구를 사용하였다. 또한 단일공법 및 다공법 복강경하 질식자궁절제술 둘 다에서 수술자 (Kim, YW)의 이름을 따서 명명한 새로운 질단부 봉합 방법인 김씨 질구개 현수법 (Kim`s Vaginal Vault Suspension Method)을 사용하였다. 결과: 환자 나이, 수술 시간, 자궁의 무게, 혈색소 수치의 변화, 수혈 빈도, 수술 후 발열에서 두 군 간에 유의한 차이를 보이지 않았다. 환자들의 평균 나이는 46.7±7.0세(단일공법)와 45.5±6.3세(다공법)이었다. 평균 수술 시간은 87.2±21.0분(단일공법)과 83.3±20.3분(다공법), 평균 자궁의 무게는 261.4±139.7 g(단일공법)과 257.8±132.9 g(다공법), 평균 혈색소 수치의 변화는 1.1±0.7 g/dL(단일공법)와 1.2±0.6 g/dL(다공법)이었다. 두 군 모두에서 수술 중 장 또는 요로의 손상은 없었다. 두 군 모두에서 각각 한 건의 개복수술로의 전환이 있었다. 단일공법을 시행한 군에서 입원 기간이 유의하게 짧았다(2.6±0.6일 [단일공법], 3.3±0.7일 [다공법], P<0.05). 결론: 통상적으로 사용하는 구부러지지 않는 일직선의 복강경기구를 이용한 단일공법 복강경하 질식자궁절제술은 다공법 복강경하 질식자궁절제술에 대한 안전하고 유용한 대체 수술이 될 수 있다. Objective: To evaluate the safety and feasibility of single-port access laparoscopically assisted vaginal hysterectomy (SPA-LAVH) using conventional laparoscopic instruments compared to multi-port access laparoscopically assisted vaginal hysterectomy (MPA-LAVH). Methods: We reviewed the medical records of 220 patients with uterine leiomyoma or adenomyosis who underwent 110 SPA-LAVH and 110 MPA-LAVH in Incheon St. Mary`s Hospital between April 2007 and November 2009. We performed SPA-LAVH with conventional rigid straight laparoscopic instruments in all cases. We also performed a new vaginal cuff closure method, Kim`s Vaginal Vault Suspension Method, named after the operator (Kim, YW) in both SPA-LAVH and MPA-LAVH. Results: There was no significant difference in patients` age, operating time, uterine weight, hemoglobin change, frequency of blood transfusion, and incidence of postoperative fever between the two groups. The patients` mean age was 46.1±7.0 years (SPA-LAVH) and 45.5±6.3 years (MPA-LAVH). The mean operating time was 87.2±21.0 minutes (SPA-LAVH) and 83.3±20.3 minutes (MPA-LAVH). The mean uterine weight was 261.4±139.7 g (SPA-LAVH) and 257.8±132.9 g (MPA-LAVH). The mean hemoglobin change was 1.1±0.7 g/dL (SPA-LAVH) and 1.2±0.6 g/dL (MPA-LAVH). Neither bowel injury nor urinary tract injury occurred during the operation in the two groups. One of the SPA-LAVH and one of the MPA-LAVH cases were converted to abdominal total hysterectomy. The mean hospital stay time was shorter with SPA-LAVH (2.6±0.6 days [SPA-LAVH] and 3.3±0.7 days [MPA-LAVH], P<0.05). Conclusion: SPA-LAVH using conventional rigid straight laparoscopic instruments can be offered as a safe and feasible alternative to MPA-LAVH.

인체 유방암종에서 Cyclic-Dependent Kinase Inhibitor, p27^Kip1 발현의 의의

송상용,김덕환,서연림,고영혜,김대식,남석진,양정현 대한병리학회 1998 Journal of Pathology and Translational Medicine Vol.32 No.12

아임계 및 초임계수하의 p-Xylene 의 무촉매 부분 산화반응에서 반응조건이 Terephthalic acid 의 선택성에 미치는 영향

김영래,김재덕,임종성,이윤우,이성철 한국화학공학회 2003 Korean Chemical Engineering Research(HWAHAK KONGHA Vol.41 No.1

아임계와 초임계수 매체하에서 p-xylene을 과산화수소에 의해 무촉매로 부분 산화시켜 terephthalic acid(TPA)를 제조하는가능성을 실험적으로 검토하였다. 회분식 반응실험을 통해 p-xylene의 새로운 산화 분해 경로를 제시하였다. 반응 시작 후 20분이 경과하였을 때 p-xylene의 전화율은 아임계수 조건에서 89.0% 이상이었고, 초임계수 조건에서는 99.0% 이상으로 온도가 높아질수록 증가하였다. TPA의 선택성은 초임계수 조건보다는 아임계수 조건에서 더 높았으며, 특히 온도 300 ℃, 압력 220 bar, 과산화수소 주입비 50%일 때 TPA수율은 29.0%로 최대값을 나타내었다. 또한 TPA 선택성에 미치는 압력의 영향은 초임계수보다는 아임계수 조건에서 더 큰 것으로 나타났다. The possibility of manufacturing the terephthalic acid(TPA) by partial oxidation of p-xylene without a catalyst in subcritical and supercritical water medium was investigated experimentally. The effects of reaction condition such as reaction temperature, pressure and hydrogen peroxide feed ratio on the conversion of p-xylene and the selectivity of TPA produced were investigated in batch reactor and new oxidation reaction pathway of p-xylene was proposed. Conversion of p-xylene was about 89.0% in subcritical condition and increased with the temperature increasing, over 99.0% in supercritical condition after 20 minutes from the start of reaction. The selectivity of TPA in subcritical conditions was higher than in supercritical conditions and the maximum value was 29.0% at 300 ℃, 220 bar, 50% H_2O_2 feed ratio. The pressure effect on TPA selectivity was higher at subcritical water condition than at the supercritical condition.

燒死

金基德,金相鉉 大韓法醫學會 1983 대한법의학회지 Vol.7 No.1-2

Death by fire is defined to asphyxial death due to the combination of burn injury, carbon monoxide poisoning and hypoxia, but it differs from burn injury in nature. Not rarely a victim by dry heat may have been overcome by fumes, which usually contain carbon monoxide, produced by the incomplete combustion of wood or paint etc. In consequence, the victim's collapse prevent his escape from the fire or, on some occasions, inhalation of fumes may cause death from carbon monoxide poisoning. But destruction of tissue by the application of dry or moist heat, producing a burn, is usually the result of contact with a naked flame, the heated elements of an electric fire or scalding. The range of damage due to scalding or dry heat is from a negligible but actually painful redding of the skin to gross incineration not only of the soft parts but also of bone., of which the cause of death by burn injury may be the complications of burn injury or systemic disturbances. Therefore, the authors discussed the autopsy finding and medicolegal aspects of burn injury and death by fire.