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김성환,황성오,이강현,조준휘,강구현,문중범,이승환,윤정한,최경훈,김영식 대한응급의학회 2000 대한응급의학회지 Vol.11 No.3
Background: The aim of this study was to determine whether the conventional subcostal approach is suitable for emergency pericardiocentesis in patients with cardiac tamponade or impending cardiac tamponade. Methods: This study was a prospective, observational study conducted at the emergency department of a tertiary hospital, Patients who had symptomatic pericardial effusion and who needed emergency pericardiocentesis in the emergency department were included in this study. We measured the epicardium-to-pericardium distance at the subcostal, parasternal, and apical area with two-dimensional echocardiography to determine the appropriate puncture site for pericardiocentesis. An epicardium-to-pericardium distance of more than 1.0 cm was considered as the primary safety factor in determining the Puncture site for pericardiocentesis. The skin-to-pericardium distance was considered as secondary safety factor. Results: Ninety-five consecutive patients(55 males and 40 females; total mean age: 53 year old) with cardiac tamponade or impending cardiac tamponade were enrolled in this study. The puncture site for pericardiocentesis, as determined by echocardiography, was the subcostal area in 43 patients(45%), the apical area in 40 patients(42%), the left parasternal area In 11 patients(12%), and the right parastemal area in one patient(1%). Pericardiocentesis failed in 2 patients(2%) with the subcostal approach and in one patient(1%) with the apical approach. The average epicardium-to-pericardium distance was 31 ±21 mm in patients with the subcostal approach and 21±8 mm in patients with other approaches. There were no differences in the amount of pericardial fluid and in the intraperical pressure among patient groups according to puncture site. There were two procedure related complications: a puncture of the right ventricle with the subcostal approach and a ventricular tachycardia with the apical approach.
모 컴퓨터 회사 근로자 건강증진 사업 전개를 위한 수요조사
임현우,안병용,최환석,박정일,김경수,이강숙,김정아,구정완 가톨릭대학산업의학쎈타 산업의학연구소 1997 韓國의 産業醫學 Vol.36 No.4
Before conducting the health promotion program, we surveyed the health risk appraisal(HRA) of 210 workers (186 men and 24 women) in a computer company, for the need assessment, selection of target population, priority setting, and as a standard for comparision after performing the program. The smokers were 115(88.6%), and drinkers (over 1 bottle of Soju per week) were 91(44.8%) in men. Entire women and 148(78.0%) men never or irregularly exercise. Type A personality were 73(39.2%) in men, 8(33.3%) in women, and 26(14.0%) of men and 6(25.0%) of women were high stress risk group. 53(25.2%) of men and 2(8.3%) of women were obese (BMI ≥25kg/m²), and workers who consumed exess of total calory compared with recommendation were 142(76.3%) in men and 18(75%) of women. By the health risk appraisal, it was suggested that smoking cessation program, drinking counselling, exercise prescription, stress management, and weight control program should be conducted effectively for the high risk group.
Postoperative Radiation for Soft Tissue Sarcoma
Kang,Yong-Koo,Kim,Hyoung-Min,Bahk,Won-Jong,Lee,Seong-Koo,Kim,Yun-Sil,Kim,Jung-Mang,Moon,Myung-Sang,Woo,Young-yun,Chang,Jee-Young,Yoon,Se-Chul,Song,Seok-Whan 가톨릭중앙의료원 가톨릭암센터 1994 암심포지움 Vol.- No.2
To evaluate the role of radiation and chemotherapy after limb-saving operation in the management of soft tissue sarcoma, the authors analysed retrospectively 33 patients treated in Department of Orthopaedic Surgery and Radiation Therapy, Catholic University Medical College, in terms of survival rate, local recurrence and prognostic factors. The sex distribution was 16 males and 17 females. The age distribution ranged from 16 to 81 year old with mean age of 48. The follow-up period ranged from 1 year to 10 years with average of 5.5 years. The histologic diagnoses were 9 liposarcoma(27.2%), 8 MFH(24.2%), 7 unclassifiable(21.2%), 3 rhabdomyosarcoma(9.1%), and 3 fibrosarcoma(9.1%) in orders. While marginal and intralesional margins were gained in 24 patients(72.2%), wide and radical margins were obtained only in 9 patients(27.3%). On postoperative 3 weeks, local irradiation of 5000-7000 cGy was delivered to all patients by shrinking field technique for 5-8 weeks. Of 33 patients, 16(45.5%) patients were recieved adjuvant chemotherapy in combination of adriamycin, cyclophosphamide & vicristine, or VP16 & ifosfamide based on histologic type and obtained surgical margin. The survival rates at 2 years and 5 years were 58% and 37% respectively. Local recurrences occured in 15 patients(45.5%) at average 16 months after operation. In addition, the authors considered surgical margin, presence of local recurrence and tumor size as a significant prognostic factors.
Kang, Soo-Jin,Kim, Young-Hak,Lee, June-Goo,Kang, Do-Yoon,Lee, Pil Hyung,Ahn, Jung-Min,Park, Duk-Woo,Lee, Seung-Whan,Lee, Cheol Whan,Park, Seong-Wook,Park, Seung-Jung,Koo, Hyun Jung,Yun, Sung-Cheol,Jun Elsevier 2019 The American journal of cardiology Vol.123 No.5
<P>Although decision-making for revascularization is based on the extent of ischemic myocardium, the prognostic implication of supplying myocardial territories has not yet been studied. To evaluate the clinical impact of the coronary artery-based myocardial segmentation (CAMS)-derived myocardial volume subtended to the poststenotic segment, and to determine clinically relevant coronary lesions, coronary computed tomography angiography, invasive coronary angiography, and preprocedure fractional flow reserve (FFR) data were analyzed in 664 deferred lesions (in 577 patients) and 401 treated lesions (in 369 patients) with drug-eluting stent implantation, respectively. Using CAMS method, the myocardial volume subtended to a stenotic coronary segment (V<SUB>sub</SUB>) was assessed. The primary composites included target vessel-related major adverse cardiac event (MACE) including cardiac death, myocardial infarction, and target vessel revascularization over 3 years. Independent predictors of 3-year MACE in deferred lesions were V<SUB>sub</SUB> (adjusted hazard ratio [HR] 1.02), FFR (adjusted HR per 0.1 = 0.60), and distal reference luminal diameter (adjusted HR 2.04, all p < 0.05). A V<SUB>sub</SUB> ≥ 36.2cc was predictive of MACE in deferred lesions with a sensitivity 72% and a specificity 67% (area under curve 0.71, 95% confidence interval 0.67 to 0.74, p < 0.001). V<SUB>sub</SUB> was not associated with target vessel-related MACE. For the prediction of FFR < 0.80, the area under curve of V<SUB>sub</SUB>/MLD<SUP>4</SUP> > 6.3 was greater than those of angiographic diameter stenosis (0.78 vs 0.69) and minimal luminal diameter (0.78 vs 0.71), (all p < 0.05). CAMS-derived V<SUB>sub</SUB> predicted 3-year clinical outcomes in untreated coronary lesions, and improved the diagnostic performance of angiography-derived parameters to identify ischemia-producing lesions.</P>
레이저 박피술의 피부면적 감소효과와 레이저 punch out 병변의 치유에 대한 실험적 연구
강동희,윤을식,구상환,안덕선,박승하 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.3
An experimental study was designed to analyze the surface reduction effect of ultrapulse carbon dioxide laser on the skin of guinea pigs receiving laser resurfacing. Two squares of skin measuring 3x3 ㎠ were designed on each side of the abdomen of guinea pigs(n=10). Five animals received laser resurfacing on their abdomen at energy of 250mJ/5 watt, and five other animals received 500 mJ/5 watt. On each animal, the left side square was treated with one pass of a CO2 laser, and the right side q=square was treated with two passes using a C.P.G. scanner. The size of the resurfacing area was determined by celluloid overlays at 1,2,3,4 and 6 weeks. Immediately following laser resurfacing, the area was decreased to 69%(left side) and 56%(right side) of the designed area in the 250 mJ/5 watt group, and 59% and 40% in the 500mJ/5 watt group. After 6 weeks, the resurfaced area had been reduced to 70% and 56% of the designed area in the 250mJ/5 watt group, and 60% and 40% in the 500mJ/5 watt group. As a result, the effect of surface reduction by CO2 laser resurfacing increased at a higher power and when more passes of the ultrapulse carbon dioxide laser were applied. The laser treated skin continued to maintain its contracted dimensions. These findings suggest that ultrapulse carbon dioxide laser may be an effective treatment method for rhytides. Another experiment was performed on multiple punch-out lesions on guinea pig skin(n=2) with 1,2,3 mm collimated hand pieces for the purpose of determining a new laser treatment method. After 4 weeks, on gross and histological examination, there were no differences in the healing of multiple punch-out lesions and the healing of punch-out lesions was complete without any scarring. These findings suggest that the laser punch-out method can be used for the treatment of acne scars.
성장성 두개골 골절 : 증례보고 A Case Report
강연구,정훈,이상평,최기환,여형태,이정길 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.10
소아 연령층, 특히 3세 이하에서 비개방성 두부 외상과 관련된 두개골의 주요 이개성 골절이 있는 경우 규칙적인 추적조사를 통하여 성장성 두개골 골절이 발견될 경우 조기에 수술적 치료로 교정함으로써 점차 진행될 수 있는 뇌조직 연화와 손상을 방지하여야 할 것이며 특히 두개성형은 특이한 경우가 아니면 반드시 자가골을 이용하는 것이 옳을 것으로 사료된다. The authors report a case of growing fracture of the skull. also called as leptomeningeal cyst. in a young boy who presented with symptoms of skull defect. headache. and pulsating mass on right posterior parietal area. Successful duroplasty and cranioplasty with autogenous bone were performed resulting in disappearance of all symtoms. The most significant factor contributing to the growing fracture is an underlying dura tear. A brief review of the relevant literature is also presented.