피하매몰 중심정맥포트 설치술:천자위치와 시술방법에 따른 비교

신병석,안문상,Shin, Byung-Suck,Ahn, Moon-Sang 대한영상의학회 2003 대한영상의학회지 Vol.49 No.3

목적: 피하매몰 정맥포트 삽입시 설치경로와 방법에 따른 결과와 합병증을 알아보고자 한다. 대상과 방법:2001년 4월부터 2002년 10월까지 피하매몰 중심정맥포트를 삽입하였던 95명의 환자,103개의 피하매몰 정맥포트를 대상으로 하였다.모든 예에서 항암요법을 실시하기 위해서 일체형(n=39)과 분리형 (n=64)의 정맥포트를 삽입하였다. 천자는 좌측 쇄골하정맥(n=35), 우측 쇄골하정맥 (n=5),좌측 내경정맥 (n=9),우측 내경정맥 (n=54)에서 시행하였다. 설치경로와 방법에 따른 포트의 사용기간과 합병증을 분석하였다. 결과: 모든 예에서 피하매몰 정맥포트를 성공적으로 설치를 하였다.도관의 삽입 기간은 8-554일(평균 159일, 총 17,872일)이었다. 시술과 관련된 초기합병증으로 일시적인 폐동맥 공기색전 (n=1),소량혈종(n=1)과 일체형의 포트사용시 도관의 위치이상 (n=2)이 발생하였다. 후기합병증으로 도관의 이동 (n=5),포트기능부전 (n=3), 도관폐쇄(n=1)와 감염 (n=11)이 발생하였고 이중 15예(14.5%)에서 포트를 제거하였다. 도관의 이동이 있던 예는 모두 쇄골하정맥을 천자한 경우이며 내경정맥은 발생하지 않았다 (13%,p=.008).감염은 10.7%(0.61 per1000 catheter days)에서 발생하였다. 도관과 연관된 중심정맥 혈전증의 발생은 없었다. 결론: 피하매몰 포트의 삽입은 안전하게 시행할 수 있으며 쇄골하정맥보다는 우측 내경정맥을 천자위치로 선택하는 것이 합병증 발생이 적으며 포트는 분리형을 사용하는 것이 시술시 보다 편리한 것으로 보인다. 시술 후 장기적으로 사용하기 위해서는 포트에 대한 적절한 관리가 필요하다. Purpose: To evaluate the results and complications of placement of implantable port according to approach routes and methods. Materials and Methods: Between April 2001 and October 2002, a total of 103 implantable chemoport was placed in 95 patients for chemotherapy using preconnected type (n=39) and attachable type (n=64). Puncture sites were left subclavian vein (n=35), right subclavian vein (n=5), left internal jugular vein (n=9), right internal jugular vein (n=54). We evaluated duration of catheterization days, complications according to approach routes and methods. Results: Implantable chemoport was placed successfully in all cases. Duration of catheterization ranged from 8 to 554 days(mean 159, total 17,872 catheter days). Procedure related complications occurred transient pulmonary air embolism (n=1), small hematoma (n=1) and malposition in using preconnected type (n=2). Late complications occurred catheter migration (n=5), catheter malfunction (n=3), occlusion (n=1) and infection (n=11). Among them 15 chemoport was removed (14.5%). Catheter migration was occured via subclavian vein in all cases (13%, p=.008). Infection developed in 10.7% of patients(0.61 per 1000 catheter days). There were no catheter-related central vein thrombosis. Conclusion: Implantation of chemoport is a safe procedure. Choice of right internal jugular vein than subclavian vein for puncture site has less complications. And selection of attachable type of chemoport is convenient than preconnected type. Adequate care of chemoport is essential for long patency.

Nationwide Epidemiologic Study of Abdominal Aortic Aneurysms in Korea: A Cross-Sectional Study Using National Health Insurance Review and Assessment Service Data

최찬중,Sanghyun Ahn,Sang-il Min,안문상,하종원,Hyung-Jin Yoon,Rina So,Sung Hyouk Choi,Seung-Kee Min 대한혈관외과학회 2019 Vascular Specialist International Vol.35 No.4

Purpose: The prevalence and treatment patterns of abdominal aortic aneurysm (AAA) vary according to ethnicity and region. This study analyzed nationwide data on the epidemiology, practice patterns, and mortality rates of AAA in Korea. Materials and Methods: Data from patients treated for AAA from 2012 to 2016 were extracted from the Korean Health Insurance Review and Assessment (HIRA) database. Results: A total of 30,766 patients in Korea had treatment codes for AAA and 2,618 patients were treated for ruptured AAA. Of the 6,356 patients treated surgically, 1,849 and 4,507 underwent open surgical aneurysmal repairs (OSAR) or endovascular aneurysmal repairs (EVAR), respectively. The number of surgical treatments performed annually for AAA increased from 1,129 cases in 2012 to 1,501 cases in 2016. The number of EVAR cases increased from 753 to 1,109 during these five years, while the number of OSAR cases remained similar, at 376 and 392, respectively. The 30-day mortality rates after EVAR and OSAR were 4.2% and 10.6%, respectively. The mortality rates were significantly higher in patients with hypertension, dyslipidemia, chronic renal disease, diabetes mellitus, and congestive heart failure. There were significant differences in the prevalence, proportion of EVAR, and mortality rates according to the regional area. Conclusion: The prevalence of AAA and the proportion of EVAR in Korea increased in the past 5 years, while the rupture rate and the proportion of OSAR remained similar. To minimize mortality and regional discrepancies, nationwide registry and treatment standardization are needed.

담도 낭선종과 낭선암

서경석(Kung Suk Suh),안문상(Moon Sang Ahn),김선희(Sun Whe Kim),이건욱(Kuhn Uk Lee),박영현(Yong Hyun Park),김수태(Sun Whe Kim) 대한외과학회 1996 Annals of Surgical Treatment and Research Vol.50 No.3

대학수업에서 팀 기반 학습과 플립러닝에 관한 메타분석

이혜진(Lee, HyeJin),안문상(Ahn, Moonsang),이진구(Lee, JinGu) 학습자중심교과교육학회 2018 학습자중심교과교육연구 Vol.18 No.21

본 연구는 학습자 중심 교육방법으로 알려져 있는 팀 기반 학습과 플립러닝의 학습효과를 메타분석을 통하여 알아봄으로써 향후 4차 산업혁명에 대비한 국내 대학교육 변화에 대한 계량적 근거를 제공하는데 목적을 두었다. 이를 위해 2008년부터 2017년 12월까지 국내 대학생을 대상으로 국내 학술논문 40편, 학위논문 8편, 총 48편이 최종 선정 후 179개의 효과크기를 산출·분석하였다. 연구 결과 전통적 강의식 수업보다 팀 기반 학습은 0.703, 플립러닝은 0.593의 효과크기를 보였으며(p=0.000), 역량에 따른 학습별 효과크기를 비교한 결과 팀 기반 학습이 인지 역량 0.737, 비인지 역량 0.606으로 통계적 차이는 없었으나 효과크기가 더 컸다. 하위변인별 팀 기반 학습과 플립러닝 간의 차이에 대한 메타ANOVA를 시행한 결과 팀 기반 학습이 플립러 닝에 비하여 인지 역량의 학업성취도(p=0.033)와 문제해결력(p=0.037)이 큰 효과크기를 보였고, 비인지 역량의 학업만족도(p=0.011)가 통계적으로 유의하게 큰 효과크기를 보여 역량 영역에 따른 학습효과의 차이가 존재함을 확인할 수 있었다. 교육 차수에 대한 메타회귀분석 결과 플립러닝에서 교육 차수가 증가할수록 교육 효과가 증가 하였으며(p=0.003), 학업만족도도 증가함을 확인하였다(p=0.036). 또한, 전공 과정 학생들에서 팀 기반 학습의 효과크기가 0.629로 플립러닝의 효과크기 0.452에 비하여더 효과적인 학습법이였다(P=0.011). 이러한 연구 결과를 바탕으로 향후 국내 팀 기반 학습과 플립러닝의 실행을 위한 시사점을 제안하였다. This study was intended to provide a quantitative basis for the change of Korean uni versity education in preparation for the fourth industrial revolution by presenting the lea rning effect of team-based learning (TBL) and flipped learning (FL) known as a way of learner-led education. Meta-analysis was carried out by collecting papers on the effectiv eness of the two educational methods for university students in Korea from 2008 to Dec ember 2017. A total of 48 papers (40 published papers and 8 domestic dissertations) wer e finalized. 179 effect sizes(ES) of TBL and FL were calculated and analyzed. The ES of TBL and FL were 0.703 and 0.593, respectively, compared with traditional lecture clas s(p=0.000). Cognitive and non-cognitive competence and sub-categories were analyzed. Although TBL had a larger effect size with a cognitive capacity of 0.737 and a non-cog nitive capacity of 0.606 than FL, there was no statistical difference. TBL showed statisti cally significantly higher ES than that of FL in academic achievement(p=0.033) and prob lem solving ability(p=0.037) of the cognitive domain and academic satisfaction(p=0.011) o f the non-cognitive domain. Therefore it was confirmed that there was a difference in le arning effect according to competence area. As a result of meta-regression analysis, it was confirmed that ES of educational effect(p=0.003) and academic satisfaction(p=0.036) increased with the number of education session in FL. In the majors, the effect size of TBL was 0.629, which was a more effective learning method than FL with effect size of 0.452(p=0.011). Based on these results, we suggest implications for future FL and TBL in Korea.

마우스 간의 허혈-재관류 손상에 대한 Haematococcus 추출물의 효과

윤익진(Ik-Jin Yun),안문상(Moon Sang Ahn),김동철(Dong-Chul Kim),유병일(Byeung-Il You),이건국(Gun Kuk Lee),하종원(Jongwon Ha),김상준(Sang Joon Kim) 한국간담췌외과학회 2004 한국간담췌외과학회지 Vol.8 No.3

신 이식 직후 신장 스캔 소견과 이식신 장기 생존의 관계

소영(Young So),이강욱(Kang Wook Lee),신영태(Young Tai Shin),안문상(Moon Sang Ahn),배진선(Jin Sun Bae),설종구(Chong Koo Sul),정인목(In Mok Jung) 대한핵의학회 2001 핵의학 분자영상 Vol.35 No.4

N/A Purpose: We investigated the possibility of early postoperative Tc-99m DTPA scintigraphy in predicting long-term renal transplant survival. Materials and Methods: 64 living donor (LD) grafts were divided into two groups according to the graft function on early post-operative renal scintigraphy. Survival analysis was performed using Kaplan-Meier method and Cox proportional hazard model. Chi-square test was performed to evaluate the difference in the frequency of acute rejection. Results: Cumulative renal transplant survival was decreased in 11 patients with abnormal renal scintigraphy, but it was not statistically significant. Decreased graft function on early post-operative renal scintigraphy was not a predictor of long-term graft survival. The frequency of acute rejection was higher in abnormal scintigraphy group, and the difference was statistically significant. Conclusion: Decreased graft function on early post-operative renal scintigraphy has no direct effect on long-term renal transplant survival in LD transplantation. But it may have an indirect effect through increasing the frequency of acute rejection. (Korean J Nucl Med 200135-251-257)

혈액투석을 위한 동정맥루 형성술 후 기능 부전 시 구조 요법

이창민(Chang Min Lee),신병석(Byung Seok Shin),안문상(Moonsang Ahn) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.5

Purpose: Salvage procedures for a dysfunctional arteriovenous fistula (AVF) are defined as operation or percutaneous balloon angioplasty (PTA) for the AVF is inadequate for performing hemodialysis. This retrospective study was performed in order to identify the appropriate salvage treatment modality. Methods: From April 2001 to October 2007, 132 salvage procedures in 100 patients were performed. We analyzed the overall cumulative patency rates of both the procedures and we compared them according to the type of primary AVF and the site and distribution of the stenoses. Results: Fifty eight patients underwent operation, and 74 patients underwent PTA. The initial success rate was 77.59% for operation and 83.78% for PTA. The one year cumulative patency rates of operation and PTA were 46.11% and 21.62%, respectively (P=0.00). For the patients whose AVF had been created using autogenous vein, the one year cumulative patency rates of operation and PTA were 49.72% and 21.15%, respectively (P=0.04). According to the location and distribution of the stenoses, 56 patients (64.4%) with an autogenous AVF had juxta-anastomotic lesion. Among them, 23 patients underwent operation and 33 patients underwent PTA. The 1 year cumulative patency rates for these patients were 66.63% and 12.12%, respectively (P=0.00). For the treatment of the diffuse and multiple stenoses of the autogenous vein, PTA (n=14) showed a better patency rate than that of operation (P=0.00). Conclusion: Salvage therapy for a dysfunctional fistula prolonged their life span. Operation was superior to PTA for a juxta-anastomotic lesion of an autogenous AVF, but PTA had benefit over operation for the cases with diffuse and multiple stenoses.

피하매몰 중심정맥포트 설치술

김용훈(Yong Hun Kim),신병석(Byung Suck Shin),안문상(Moonsang Ahn) 대한외과학회 2004 Annals of Surgical Treatment and Research Vol.67 No.6

선천성 담도 폐쇄증에 대한 부분 간이식

김수태(Soo Tae Kim),김건표(Keon Pyo Kim),이건욱(Kuhn Uk Lee),김상준(Sang Joon Kim),윤여규(Yeo Kyu Yoon),윤효영(Hyo Young Yoon),안문상(Moon Sang Ahn),김우기(Woo Ki Kim),박귀원(Kwi Won Park),조마해(Ma Hae Cho),김성권(Suhng Gwon Kim),이효 대한외과학회 1994 Annals of Surgical Treatment and Research Vol.47 No.2

직장 결장암의 간전이 환자에서 VEGF-A, C, D 발현의 비교연구

전광식(Kwang-Sik Chun),이경하(Kyung-Ha Lee),송인상(In-Sang Song),김지연(Ji-Yeon Kim),김제룡(Je-Ryong Kim),안문상(Moon-Sang Ahn),이상일(Sang-Il Lee),박종현(Jong-Hyun Park),최송이(Song-E Choi),강대영(Dae-Young Kang),송규상(Kyu-Sang Son 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.76 No.5

Purpose: We aimed to investigate the correlations between expressions of angiogenic cytokines VEGF-A, C, D of primary colorectal cancer and liver metastasis. Methods: We examined paraffin-embedded primary colorectal cancer tissue from 45 patients who had liver resection due to colorectal liver metastasis (metastasis group) and 37 patients who had surgical resection due to colorectal cancer only (control group). In the control group, local recurrence and distant metastasis had not occurred. Immunohistochemical staining for VEGF-A, C and D was performed. We analysed the correlations between expression of VEGF-A, C and D in primary colorectal cancer tissues and clinicopathologic parameters. Results: VEGF-A expressions of primary colorectal carcinoma were not different between the two groups. VEGF-C was more frequently expressed in the metastasis group (P=0.008) but VEGF-D was more expressed in the control group (P=0.003). Patients with VEGF-C negative and VEGF-D positive expression were predominant in the control group (P=0.020). Tumor location, T stage, lymph node metastasis and tumor differentiation were not related with the expressions of VEGF-A, C, D but only preoperative CEA was positively correlated with VEGF-A and C expression. Conclusion: Expressions of VEGF-C in primary tumor were more frequent in metastatic colorectal cancer and expressions of VEGF-D were more frequent in nonmetastatic colorectal cancer. More large-scale prospective studies for VEGF-C and D expression in colorectal cancer are necessary.