혈관질환 정보관리 시스템

김동익,김덕경,허세호,이병붕,김용신,김은숙,문지영,도영수,신성욱,김동수,김만태,진재욱,김용신 대한혈관외과학회 2002 Vascular Specialist International Vol.18 No.1

As medical technology progresses rapidly, there is a rise in the average age along with the Korean dietary lifestyle becoming more westernized, which leads to an increase in the number of vascular disease patients in Korea. Thus, we need to manage the medical information of a disease systematically in order to diagnose and treat constructively. However, since there has been no standardized method of man agement to date, a great deal of information could not be properly utilized nor studied. Therefore, the departments of Cardiology, Radiology and Neurology of Samsung Seoul Hospital recently got together to develop an information management system called the Vascular Data System. This program was developed to be run on win98 O/S, upper Pentium Ⅲ, and upper 128 MB Memory, and its source code is Dephi 4.0. It was configured for the user to set the configurations as well as do a variety of search and analysis. If this program were to be updated continuously, it may be used extensively as well as in various parts of clinical research activities.

Surgical technique for single-port laparoscopy in huge ovarian tumors: SW Kim`s technique and comparison to laparotomy

( Jeong Sook Kim ),( In Ok Lee ),( Kyung Jin Eoh ),( Young Shin Chung ),( Inha Lee ),( Jung-yun Lee ),( Eun Ji Nam ),( Sunghoon Kim ),( Young Tae Kim ),( Sang Wun Kim ) 대한산부인과학회 2017 Obstetrics & Gynecology Science Vol.60 No.2

Objective This study aimed to introduce a method to remove huge ovarian tumors (≥15 cm) intact with single-port laparoscopic surgery (SPLS) using SW Kim`s technique and to compare the surgical outcomes with those of laparotomy. Methods Medical records were retrospectively reviewed for patients who underwent either SPLS (n=21) with SW Kim`s technique using a specially designed 30×30-cm2-sized 3XL LapBag or laparotomy (n=22) for a huge ovarian tumor from December 2008 to May 2016. Perioperative surgical outcomes were compared. Results In 19/21 (90.5%) patients, SPLS was successfully performed without any tumor spillage or conversion to multi-port laparoscopy or laparotomy. There was no significant difference in patient characteristics, including tumor diameter and total operation time, between both groups. The postoperative hospital stay was significantly shorter for the SPLS group than for the laparotomy group (median, 2 [1 to 5] vs. 4 [3 to 17] days; P<0.001). The number of postoperative general diet build-up days was also significantly shorter for the SPLS group (median, 1 [1 to 4] vs. 3 [2 to 16] days; P<0.001). Immediate post-operative pain score was lower in the SPLS group (median, 2.0 [0 to 8] vs. 4.0 [0 to 8]; P=0.045). Patient-controlled anesthesia was used less in the SPLS group (61.9% vs. 100%). Conclusion SPLS was successful in removing most large ovarian tumors without rupture and showed quicker recovery and less immediate post-operative pain in comparison to laparotomy. SPLS using SW Kim`s technique could be a feasible solution to removing huge ovarian tumors.

내관지압이 슬관절 전치환술 받은 노인 환자의 오심, 구토 및 통증에 미치는 효과

유제복 ( Je Bog Yoo ),장희정 ( Hee Jung Jang ),나은희 ( Eun Hee Na ),김선영 ( Sun Young Kim ),신동수 ( Dong Soo Shin ) 경희대학교 동서의학연구소 2011 동서간호학연구지 Vol.17 No.2

지압은 수직압, 지속압, 조화압으로 경혈을 찾은 다음 치료하는 사람의 체중을 실어서 위에서 아래로 누르는 방법으로 어깨에 불필요한 힘을 뺀 상태에서 자연스럽게 상체의 체중을 손가락에 집중을 시켜 수직으로 경혈을 보통 3-4초 정도 지속적으로 눌러 주는것을 말한다(East-west nursing research institute, 2000; Kim, 1999). 내관지압의 오심· 구토 경감 효과를 검증한 연구를 살펴보면, Alsaid 등(1997)이 수술 후 오심· 구토 감소에 효과가 있다고 보고하였고, Ming 등(2002)은 기능적 내시경 부비동 수술에 지압이 효과가 있다고 하였으며, Apfel 등(1999)은 항암화학요법을 받는 유방암 환자에게 지압이 오심과 구토에 유의한 차이가 있다고 보고하였다. Kim. 2003). Kim (2003)의 연구결과 내관지압이 항암화학요법을 받는 폐암 환자의 오심· 구토에 미치는 영향을 연구한 결과, 실험군에서 제2일과 3일에 오심 정도를 감소시키는 효과를 검증한 바 있다. 수술 환자의 자가 통증 조절기 사용은 최근 널리 적용되고 있는 통증완화를 위한 방법으로 자가 통증 조절기는 통증 완화를 위한 치료 효과는 높지만 오심· 구토는 대부분의 수술 후 자가 통증 조절기를 사용하는 환자들이 경험하는 심각한 불편감으로, 자가 통증조절기(PCA) 사용을 중단하게 되는 원인이 되기도 한다(Lee, 2006). 수술 후 오심, 구토는 통증보다 더욱 힘든 것으로 보고되고 있어, 이를 경감시켜 주기 위한 다양한 간호중재 전략의 개발이 요구된다Song & Shin, 1988). 본 연구는 슬관절 수술 환자의 자가 통증 조절기 사용 후 오심· 구토의 완화를 위해 내관지압을 적용하여 그 효과를 검증함으로써 비 침습적이고 독자적인 간호중재로서 발전시키기 위해 시도되었다. 본 연구 결과에서 내관지압 제공 후 24시간에 구토영역과 오심·구토 전체 영역에서 유의한 차이가 있었는데, 이는 Lee (2008)의 중이수술 대상자에게 손목밴드 내관지압을 적용한 결과 마취 종료후 24시간에 오심· 구토의 전체영역에서 유의한 차이가 나타났다는 결과와 일치하였다. 그러나 본 연구에서는 오심 영역은 유의미한 차이를 나타내지 못하여 Kim (2003)의 연구에서 항암화학요법주기 제2일 오심불편감이 실험군과 대조군 간에 통계적으로 유의한 차이를 보였다는 결과와 일치하지 않는 결과를 나타내었다. 이는 대상자의 차이에 의한 것으로 수술 환자와 항암요법대상자의 차이에서 비롯된 것으로 본다. Shin (2002)의 연구에서는 지압교육실험군에서 항암화학요법제투여 2일, 3일, 4일, 5일째 오심· 구토 정도가 유의미하게 감소하였다. 본 연구에서는 내관지압 제공 후 12시간에서 유의미하게 구토영역에서 감소를 나타내기 시작하였다. 이는 대상자가 다르기 때문으로 판단되며 항암요법을 실시하고 있는 대상자보다 고관절치환술 후자가통증조절기를 보유하고 있는 대상자의 오심· 구토 정도가 상대적으로 항암 환자보다 낮은 정도이기 때문으로 본다. Lee (2002)의 연구결과 오심 정도는 제3일째는 유의미한 차이가 있었으나 구토정 도에서는 유의미한 차이를 나타내지 않았다. 본 연구결과와는 차이를 나타내었다. 역시 항암요법을 받는 난소암 환자가 대상자이기 때문에 대상자의 차이로 인한 결과라고 본다. 따라서 앞으로 연구 시에는 동일대상자에 대한 반복연구가 필요함을 시사할 뿐 아니라 최초 효과발현 시기에 대해 다양한 대상자별 반복연구가 필요함을 알 수 있었다. 본 연구의 결과에서 내관지압 제공 후 24시간 시점에서 두 군 간의 오심· 구토 전체 점수는 유의미하게 낮았고 특히 구토 횟수, 구토불편감, 구토 양은 통계적으로 낮아 유의한 차이가 있었다. 그러나 Lee (2008)의 연구에서는 마취종료 후 24시간에 오심· 구토 전체 점수에서 유의미하게 차이가 났다는 결과와는 일치하였으나 세부 하위영역에서 유의미한 영역은 차이가 있다. 즉, Lee (2008)는 특히 오심에서 유의미한 차이를 나타내어 본 연구결과와 일치하지는 않았다. 이는 대상자의 수술의 심각성 정도에 따라 차이를 나타낸 것으로 보인다. Shin (2002)의 연구에서 항암화학요법을 받은 위암 환자에게 내관지압이 하위영역 구토 횟수 감소에 유의한 효과를 나타냈다는 결과와는 일치하였으며 Kim 등(2007)의 연구와도 일치하였다. 이는 지압 제공 후 12시간보다는 24시간에 효과가 큰 것은 시간이 지남에 따라 지압의 효과가 축적되어 나타나는 것이라 본다. Kwon(2011)의 결과 갑상선절제술 환자에게 손목밴드를 이용한 내관지압을 적용하였을 때 시간이 경과함에 따라 오심· 구토 점수가 감소하였다는 결과가 있었고 Kim 등(2010)의 결과에서는 시간에 따라 오심감소가 유의미하게 있었으므로 앞으로도 시간이 경과함에 따라오심· 구토의 감소효과를 계속해서 연구할 필요가 있다. Aidah 등(2002)의 연구결과 24-48시간에 구토의 부작용이 가장 심하게 나타난다는 연구결과가 있었는데 이때 지압을 통해 구토영역이 유의미하게 낮은 점수를 나타낸 것은 대조군은 구토의 부작용이 지속되지만 실험군은 지압의 효과로 구토의 부작용을 최소화하였기 때문이라 볼 수 있다. 그래서 본 연구의 실험군에서도 24시간에 가장 구토영역의 유의미하게 낮은 점수를 나타낸 것으로 본다. 본 연구결과는 24시간 시점에서 집중적으로 오심· 구토를 중재할 수 있는 간호 중재의 요구도가 있다는 것을 나타내는 증거라고 본다. 그러므로 앞으로는 내관(P6)지압을 24시간 이후 48시간에도 계속 적용한 후 오심· 구토 정도를 확인하는 반복 연구가 필요하다. 내관지압의 통증감소효과에 대한 가설을 세웠으나 본 연구결과 통증에는 효과가 나타나지 않았음을 보였다. 지압이 통증 감소에 영향을 미친다는 연구결과와 일치하지 않는 것을 보였다. Ju (2010)의 연구결과 경혈지압마사지가 요통 환자의 통증감소에 효과적이었다고 보고하였으나 이는 8주간의 장시간을 두고 효과를 검증한 것이었다. Shin (2004)은 자궁 적출술 환자의 통증 자가조절교육과 함께 내관지압을 실시한 실험군에서 통증감소효과가 있었다고 보고한 것과도 일치하지 않는 결과를 나타내었다. 이는 본 연구에서 이미 대상자 스스로 통증치료를 위해 PCEA를 사용하고 있으므로 통증에 대해서는 스스로 조절을 하는 부분이 더 영향을 미쳤을 것으로 본다. 그러나 앞으로의 연구에서는 PCEA를 착용하고 있으므로 이를 통한 통증약물 사용량을 함께 측정함으로써 통증 정도를 좀 더 정확하고 광범위하게 측정하여 통증 정도의 효과를 검증하는 것이 필요하다고 본다. 이상에서 논의한 바와 같이 본 연구는 수술 후 자가 통증 조절기사용 환자의 오심 및 구토, 통증 완화에 지압을 이용한 간호중재가 부분적으로 오심· 구토 감소에 효과를 나타낸다는 것을 검증하였으므로 임상에서 내관(P6)지압을 간호중재의 하나로서 적극 활용할 것을 제안한다. Purpose: Patient-controlled epidural analgesia (PCEA) is an effective method for controlling post surgical pain. However, it is associated with adverse drug reactions such as nausea and vomiting. In this, study we tested the effects of Nei-Guan (P6) acupressure on PCEA-associated nausea, vomiting, and pain in geriatric patients after total knee replacement arthroplasty (TKRA). Methods: Ninety-nine patients who had TKRA for the first time were randomly assigned to either, experiment group (n=50) or control groups (n=49). All patients received PCEA immediately after surgery, but acupressure on Nei-Guan (P6) point was applied to experiment group only. Ten minutes of finger acupressure on Nei-Guan (P6) acupressure point was applied twice with 15 minute-interval in the experiment group. The incidence of nausea, vomiting, and retching as well as pain intensity were assessed at 12 and 24 hours after surgery. Nausea, and vomiting were assessed by Index of Nausea, Vomiting and Retching (INVR) questionnaire. Pain intensity was measured with frequency of analgesics. Results: Vomiting both was significantly different between two groups at 12 hours (t=-2.18, p=0.03) and 24 hours (t=-2.64, p=0.01) after surgery. Total scores of nausea, vomiting and retching in experimental group was significantly lower than control group 24hours after surgery (t=- 2.18, p=0.03). However, pain was not different between two groups. Conclusion: Nei-Guan (P6) acupressure may be considered as an effective nursing intervention to decrease PCEA-associated nausea and vomiting in older patients after TKRA.

만성 견비통에 대한 동씨침 치료의 무작위 대조군의 임상 연구

김찬영,권나현,신예지,남동우,김건형,김종인,최도영,이윤호,이재동 WHO COLLABORATING CENTRE FOR TRADITIONAL MEDICINE 2007 東西醫學硏究所 論文集 Vol.2007 No.-

Objectives : To observe the effect of acupuncture treatment in chronic shoulder pain patients. Methods : 36 voluntary patients were randomly assigned to an acupuncture treatment group(E GrouP, n=18) and a control group(C GrouP, n=18). The E Group patients received acupuncture treatment on LI_(15), TE_(14), GB_(21) and Master Dong's acupuncture points, Shin-gwan and Gyun-joong, twice a week for four weeks. The C Group patients received no treatment. All patients in both groups were instructed to practise self exercise in their daily lives. Evaluations were made at baseline and after four weeks of study. The Constant Shoulder Assessment(CSA), Shoulder Pain and Disability Index(SPADI) and the patient's subjective pain was measured by Visual Analogue Scale(VAS). The obtained data was analyzed. Results '. The E Group showed significant(p<0.05) improvement in CSA, SPADI and VAS after four weeks of treatment. The C Group showed significant(p<0.05) improvement in CSA, but the change of SPADI and VAS was insignificant(P>0.05). CSA and SPADI of E Group significantly(p<0.05) improved compared to the C GrouP, but the difference of VAS change in the two groups was insignificant(p>0.05). Conclusions : Four weeks of acupuncture treatment significantly improved CSA, SPADI and VAS. The improvement of CSA and SPADI was significant(p<0.05) compared to untreated patients.

Impact of lifestyle factors on trends in lipid profiles among Korean adolescents: the Korea National Health and Nutrition Examination Surveys study, 1998 and 2010 Shin-Hye

Kim, Shin-Hye,Song, Young-Hwan,Park, Sangshin,Park, Mi-Jung The Korean Pediatric Society 2016 Clinical and Experimental Pediatrics (CEP) Vol.59 No.2

Purpose: Only a few studies have explored nationwide trends in lipid profiles among Asian adolescents. We aimed to assess trends in lipid profiles and the associated lifestyle factors among Korean children. Methods: We analyzed data for 2,094 adolescents who were aged 10-18 years and had participated in the Korea National Health and Nutrition Examination Surveys in 1998 and 2010. Results: During 1998-2010, the prevalence of obesity significantly increased in boys, but no changes were observed in girls. Over this period, there was a small but significant decrease in the mean lowdensity lipoprotein (LDL)-cholesterol level in boys (1998, 87.5 mg/dL; 2010, 83.6 mg/dL; P=0.019) and mean triglyceride levels in girls (1998, 90.8 mg/dL; 2010, 85.8 mg/dL; P=0.020). There were no significant changes in the prevalence of dyslipidemia in boys, but a modest decrease was noted in girls (1998, 25.1%; 2010, 18.3%; P=0.052). During the study period, the prevalence of breakfast skipping decreased, whereas that of regular exercise increased in both groups. Daily total energy intake did not change between these years. In multivariable logistic regression analyses, breakfast skipping was associated with increased risk of hyper-LDL-cholesterolemia in boys (odds ratio [OR], 5.77) and hypertriglyceridemia (OR, 2.27) in girls. Regular exercise was associated with decreased risk of hypo-HDL-cholesterolemia (OR, 0.40) in boys. Conclusion: Although the prevalence of obesity in boys increased, favorable or constant trends in lipid profiles were observed among Korean adolescents during 1998-2010. Decrease in breakfast skipping and increase in regular exercise may have contributed to these trends.

참당귀의 흰쥐 4-Vessel Occlusion 전뇌허혈에 대한 신경방어효과

김영옥,하니나,부영민,박선영,박주영,유영법,신준식,안덕균,김호철 대한본초학회 2002 大韓本草學會誌 Vol.17 No.2

Objectives : Angelicae Radix, the root of Angelica gigas N_AKAI (Umbelliferae) , which has been used to nourish the blood(補血), regulate menstruation(調經), relieve pain and promote bowel movements(崩漏) and activate blood circulation for the treatment of fatigue, headache, constipation and blood troubles in traditional Korean medicine. It's flavour and channel tropism is sweet(甘), pungent(辛), warm(溫), acting on the lung, heart and spleen(肺, 心, 脾). The purpose of study we report here was to determine the neuroprotective effect of Angelica gigas on global ischemia induced by 4-vessel occlusion in Wistar rats. Methods : Angelica gigas extracts was lyphilized after extraction with 85% methanol. We induced 4-VO for 10 minutes and reperfused again. The number of CA1 pyramidal neurons were counted after 7 days of reperfusion under the cresyl violet staining. Results : The results showed that Angelica gigas had significantly neuroprotective effects (100, 250 and 500mg/kg of AR extracts, p<0.001) compared with control group. Each neuroprotective ratio was about 66.1, 79.3 and 78.6% respectively. Immunohistochemical data partially explained the protective effects of Angelica gigas via attenuation of COX-2 induction in hippocampus. Conclusion : Angelica gigas gas neuroprotective effects on the global ischemia induced by 4-vessel occlusion in Wistar rats and the attenuation of COX-2 induction is thought to be its possible mechanism.

흉통의 양상에 따라 분류한 불안정형 협심증 환자의 임상적 소견의 비교

김명수,김성구,정호석,온영근,신원용,김철현,최태명,현민수,권영주 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.1

Background and aims : The clinical syndrome unstable angina pectoris that encompasses a variety of symptoms and clincal presentations of transient episode of myocardial ischemia, was devided to several subgroups. Also, it has variable pathophysiologic factors to cause myocardial ischemia. According to clincal presentation, coronary angiographic finding and prognostic factor, the result of unstable angina pectoris is variable. In fact, there were a few data reported on the prognosis of wide spectrum of patients with unstable angina. However, the precise risk of subgroups according to classitication has not been established because it was difficult to compare between studies. We classified unstable angina pectoris by clinical nature of chest pain, and performed to establish and compare the clinical presentations, coronary angiographic findings, treatement and prognosis of patients with unstable angina within subgroups of classification. Methods : Retrospenctive data for 164 unstable angina pectoris patients admitted to the Internal Cardiology Division of Soon Chun Hyang University Hospital from May 1996 to July 1999 was analyzed. The patients were classified into one of the following categories: Class I, new onset of severe angina; Class II, acceleration of previous chronic stable angina; Class III, angina at rest. Clinical presentations, echocardiographic findings, coronary angiographic findings, treatment and prognosis were compared. Results : From the total 164 patients, the subjects of classes were as follows : Class I, 46 cases (28.1%); Class II, 74 cases (45.1%); Class III, 44 cases (26.8%). In view of age distribution, the 7th decade had the highest incidence, and then, 6th, 8th decades were followed. There was no baseline differences among the 3 classes with respect to gender, number of risk factors. Significantly, class II showed more severe findings in abnormal Q wave 15 cases (20.8%), total occclusive lesion 10 cases (20.8%) and three vessel coronary disease 11 cases (22.9%) than other classes. The change of ST segment was significantly apparent (p<0.02) among class I 28 cases (60.8%), class III 26 cases (59.0%), comparing with class II 30 cases (40.5%). Class III had the higher incidence of one vessel coronary artery disease than class I and III. The heparin treatment was performed in 99 cases (60.1%). The incidence of nonfatal myocardial infarction was much more in class I and III, each 4 cases (8.7%, 9.8%) than in class II 1 cases (1.4%). In-Hospital death was occurred in class I and II, each 1 case. Conclusion : The patients with the acclerated angina from chronic stable angina had more severe coronary artery disease than other classes, but they had better in-hospital prognosis.

신경회로망에 의한 용접 결함 종류의 정량적인 자동인식 시스템 개발에 관한 연구

김재열,김영석,김병현,유신,김훈조,정진홍 한국공작기계학회 1997 한국생산제조학회지 Vol.6 No.1

A neural network approach has been developed to determine the depth of a surface breaking crack in a steel plate from ultrasonic backscattering data. The network is trained by the use of feedforward three-layered network together with a back-scattering algorithm for error correction. The signal used for crack insonification is a mode converted 70˚ transverse wave. A numerical analysis of back scattered field is carried out based on elastic wave theory, by the use of the boundary element method. The numerical data are calibrated by comparison with experimental data. The numerical analysis provides synthetic data for the training of the network. The training data have been calculated for cracks with specified increments of the crack depth. The performance of the network has been tested on other synthetic data and experimental data which are different form the training data.

특발성 경련질환으로 오인된 원발성 부갑상선기능저하증 1례

신성하,최정영,김준기,고영춘,조상욱,김순호,임중규 全南大醫大 2001 전남의대학술지 Vol.37 No.1

편광현미경에 의한 형태와 구성성분에 의한 토양의 비교분석에 관한연구(Ⅱ)

김은호,김재균,김명덕,신윤열,장성길,박성우,김영만 內務部 國立科學搜査硏究所 2001 國立 科學 搜査 硏究所 年報 Vol.33 No.-