Prevention of medical malpractice and disputes through analysis of lawsuits related to coronary angiography and intervention

Cheol Won Hyeon,Won Lee,So Yoon Kim,Ji Yong Park,Su Hwan Shin 대한내과학회 2020 The Korean Journal of Internal Medicine Vol.35 No.3

Background/Aims: Possible fatal complications arising from coronary angiography (CAG), percutaneous coronary intervention (PCI), and coronary artery disease itself, are likely to cause medical disputes. Presenting the current status and reasons for judgments given in lawsuits related to CAG/PCI, this study aimed to identify ways to prevent unnecessary disputes and medical malpractice suits related to CAG/PCI through lawsuit analysis. Methods: A total of 13 cases (20 judgments) found in the Supreme Court of Korea’s Written Judgment Management System from 1998 to 2017 were analyzed. Results: Coronary artery injury was the most common causative complication that led to lawsuits (n = 6, 46%). Six cases (46%) were ruled in favor of the plaintiff for violation of duty of care (n = 4) and duty of explanation (n = 2), respectively. Cases that violated duty of care included two errors in intra-procedure device manipulation, one in pre-procedure diagnosis, and one in management of post-procedure complication. Lack of explanation regarding the risk of complications was pointed out in both cases that violated duty of explanation. The average awarded amount for the damages was 114,436,064 Korean won. Conclusions: Physicians need not fear unfair judgments so long as they follow standard of care because the Court consistently looked at the probability, the foreseeability, and the evidence. Therefore, maintaining standard of care is important. Besides, specific, detailed, and comprehensible explanations, including the risk of complications in addition to the necessity of procedures, are important to ensure the patient clearly understands the possible risk of adverse outcomes.

원문 : 크레아틴-중탄산나트륨의 복합투여가 암-에르고미터 운동수행력에 미치는 영향

이철원 ( Cheol Won Lee ) 한국운동생리학회(구 한국운동과학회) 2014 운동과학 Vol.23 No.3

이철원. 크레아틴-중탄산나트륨의 복합투여가 암-에르고미터 운동수행력에 미치는 영향. 운동과학, 제23권 제3호. 257-266 2014. 본 연구는 크레아틴, 중탄산나트륨, 그리고 크레아틴과 중탄산나트륨의 복합투여가 암-에르고미터(arm-ergometer)를 이용한 상지 근기능에 미치는 효과를 알아보기 위해 경기도 소재 Y대학교 체육계열 남·여학생 17명을 대상으로 실시하였다. 무선추출법을 통해 크레아틴 투여집단(n=7), 중탄산나트륨 투여집단(n=5), 크레아틴과 중탄산나트륨의 복합투여집단(n=5), 총 3 집단으로 나누어 암-에르고미터를 이용한 상지 근기능 사전검사(pre-test) 후 집단별 로딩(loading)이 완료된 5일 후 사후검사(post-test)를 동일하게 실시하였다. 자료처리는 통계패키지 SPSS Ver. 12.0을 이용하여 모든 변인의 측정결과를 평균과 표준편차로 산출하고, 집단 및 시기 차이에 대한 주효과검정과 집단과 상호작용효과를 알아보기 위해 반복측정에 의한 이원변량분석 (Two-way repeated measured ANOVA)을 실시하였으며, 모든 통계적 유의수준은 p<.05로 설정하였다. 본 연구의 결과 암-에르고미터를 통한 검사 항목에서 최고 파워, 피로지수, 체중당 피크파워, 안정시 젖산농도 등에서 시기에 따른 유의한 차를 나타내었으나, 집단 간 유의한 차이는 나타나지 않았다. 결론적으로, 크레아틴과 중탄산나트륨 그리고 크레아틴과 중탄산나트륨의 복합투여는 암-에르고미터를 이용한 상지 운동수행력에 긍정적인 영향을 미치는 것으로 나타났으나, 복합투여의 우수성은 나타나지 않았다. Lee, Cheol-Won. The Effect of Combined Creatine and Sodium Bicarbonate Supplementation on Arm Ergometer Performance. Exercise Science. 23(3): 257-266, 2014. The purpose of this study was to assess the effects of creatine, sodium bicarbonate and combined creatine and sodium bicarbonate supplementation on upper limbs with arm-ergometer. Seventeen students majoring in physical education were randomly assigned to 3 groups [creatine (n=7), sodium bicarbonate (n=5), creatine & sodium bicarbonate (n=5)]. Pre-test consisted of muscular function of upper limbs with arm-ergometer and after 5 days later for creatine and sodium bicarbonate loading, post-test was processed with the same way as pre-test. Statistical analysis was performed by two-way repeated measured ANOVA for intervention. Significance was accepted at p<.05. The following results were obtained from this study. Peak power, fatigue index, peak power/kg and peak attainment time of arm-ergometer test were significantly (p<.05) increased by time but no difference among the groups. In conclusion, creatine, sodium bicarbonate and combined creatine & sodium bicarbonate supplementation favorably affected muscular function of upper limbs with arm-ergometer but there were no significant difference among the groups.

알레르기 환자에서 한방 이외의 대체 요법의 사용 현황에 대한 다기관 조사

이현정 ( Hyun Jung Lee ),이재현 ( Jae Hyun Lee ),이용원 ( Yong Won Lee ),김철우 ( Cheol Woo Kim ),동헌종 ( Hun Jong Dhong ),박해심 ( Hae Sim Park ),조영주 ( Young Joo Cho ),조진희 ( Jin Hee Cho ),조상헌 ( Sang Heon Cho ),편복양 ( 대한내과학회 2011 대한내과학회지 Vol.80 No.1

Background/Aims: The use of unproven complementary/alternative medicine (CAM) to treat allergies is popular in Korea. We conducted a multicenter survey of the current use of CAM other than herbal medication in Korean allergy patients. Methods: This study enrolled 510 adults with allergic diseases, including asthma, allergic rhinitis, atopic dermatitis, and chronic urticaria, from ten hospitals. They underwent a structured questionnaire interview and clinical assessment of the prevalence, motivation, costs, and subjective assessment of CAM. Results: Of the patients, 16.7% used at least one type of CAM to treat their allergic diseases. Common types of CAM were diet (48.6%), aroma therapy (23.8%), massage (14.3%), breathing exercises (7.6%), baths (5.7%), and mind control (5.7%). The therapeutic effects of CAM included improved in patients using mind control (50%), diet (50%), breathing exercises (75%), and baths (33.3%), but worse in patients using aroma therapy (28%), and massage (26.7%). About 36.4% of the patients used CAM more than four times per year, and the average cost per CAM user was 370,000 won/year. The main reason for trying CAM was `hope to improve my constitution`. Conclusions: CAM is used widely for treating allergic diseases in Korea. Detailed knowledge of CAM and patient education are important. Further studies of the clinical efficacy of CAM are needed. (Korean J Med 2011;80:68-77)

소음인(少陰人) 태음병(太陰病) 심하비증(心下?證)의 병증약리(病證藥理) 고찰

서영광,이지원,이준희,최원철,이의주,고병희,Seo, Young-Kwang,Lee, Ji-Won,Lee, Jun-Hee,Choi, Won-Cheol,Lee, Eui-Ju,Kho, Byung-Hee 사상체질의학회 2010 사상체질의학회지 Vol.22 No.3

1. Objective: Gastric Stuffiness (心下?證) in the Soeumin Taeeum symptomatology (少陰人 太陰病) in Sasang Constitutional Medicine shows an interesting evolutionary process. Originally found in the texts of Sanghanlun (傷寒論), the perspectives regarding the symptoms of Gastric Stuffiness were expanded by many medical scholars and Lee Jema. To comprehend the Jema's concept of Taeeum symptomatology and utilize his prescription clinically, it deserves to study on the Gastric Stuffiness in Donguisuseowon (東醫壽世保元). 2. Methods: Many texts including Sanghanlun (傷寒論) and Dongeuibogam (東醫寶鑑) were reviewed in order to track the evolutionary process concerning the symptoms of Gastric Stuffiness. Also, Lee Jema's works including the different versions of Donguisuseowon (東醫壽世保元) were reviewed to examine the development of Lee's concepts regarding the Gastric Stuffiness in the Soeumin Taeeum symptomatology. 3. Results and Conclusions: 1) Most of the previous concepts on Gastric Stuffiness were generally similar to those found in Sanghanlun, especially in that they addressed Yang deficiency of the middle triple energizeer as the central pathogenic process. 2) Lee Jema's views on the epigastric discomfort in the Soeumin Taeeum symptomatology evoloved over time and culminated in the finalized pathology and therapeutics appearing in his last work, the Shinchuk version of Donguisuseowon (東醫壽世保元). 3) 4 kinds of prescription which invented by Lee Jema to treat the Gastric Stuffiness in the Soeumin Taeeum symptomatology can be matched to the prescription of Sanghanlun respectively. However through evolutionary process of Jema's prescriptions, the indication of them expanded: not only to treat Gastric Stuffiness but to diverse symptoms of Soeumin.

Clinical outcomes of neoadjuvant chemoradiotherapy followed by total mesorectal excision in locally advanced rectal cancer with mesorectal fascia involvement

Lee Jeong Ha,Kim Nalee,Yu Jeong Il,유규상,Park Hee Chul,Lee Woo Yong,윤성현,Kim Hee Cheol,Cho Yong Beom,허정욱,박윤아,신정경,Park Joon Oh,Kim Seung Tae,Park Young Suk,Lee Jeeyun,Kang Won Ki 대한방사선종양학회 2024 대한방사선종양학회지 Vol.42 No.2

Purpose: For the treatment of locally advanced rectal cancer (LARC), research on primary lesions with mesorectal fascia (MRF) involvement is lacking. This study analyzed the clinical outcomes and efficacy of dose-escalated neoadjuvant concurrent chemoradiotherapy (NCRT) to patients with LARC involving MRF.Materials and Methods: We retrospectively reviewed 301 patients who were diagnosed with LARC involving MRF and underwent NCRT followed by total mesorectal excision (TME). Patients who received radiotherapy (RT) doses of ≤50.4 Gy were defined as the non-boost group, while ≥54.0 Gy as the boost group. Pathological tumor response and survival outcomes, including intrapelvic recurrence-free survival (IPRFS), distant metastases-free survival (DMFS) and overall survival (OS), were analyzed.Results: A total of 269 patients (89.4%) achieved a negative pathological circumferential resection margin and 104 (34.6%) had good pathological tumor regression grades. With a median follow-up of 32.4 months, IPRFS, DMFS, and OS rates at 5-years were 88.6%, 78.0%, and 91.2%, respectively. In the subgroup analysis by RT dose, the boost group included more advanced clinical stages of patients. For the non-boost group and boost group, 5-year IPRFS rates were 90.3% and 87.0% (p = 0.242), 5-year DMFS rates were 82.0% and 71.3% (p = 0.105), and 5-year OS rates were 93.0% and 80.6% (p = 0.439), respectively. Treatment related toxicity was comparable between the two groups (p = 0.211).Conclusion: Although this retrospective study failed to confirm the efficacy of dose-escalated NCRT, favorable IPRFS and pathological complete response was achieved with NCRT followed by TME. Further studies combining patient customized RT dose with systemic therapies are needed.

Series-Stacked Ripple-Free Resonant DC/DC Converter for Low Voltage Fuel-Cell Applications

Cheol-Hwan Kim,Gyeong-Seop Lim,Joo-Han Park,Muhammad Umer Amjad,Minsung Kim,Sang-Won Lee 전력전자학회 2023 ICPE(ISPE)논문집 Vol.2023 No.-

This paper presents series-stacked ripple-free resonant dc/dc converter for low voltage fuel-cell applications. By connecting two active voltage doublers in series, the proposed circuit achieved very high-voltage gain. Without using extra input inductors, active-clamped push-pull circuit operating with fixed duty-ratio at 0.5 generate the ripple-free input current; this trait extends the lifetime of the fuel-cell. The active power components are turned on and off with soft switching. A 1-kW prototype of the proposed converter is implemented and tested to verify the theoretical analysis.

Ruptured Intracranial Aneurysm in a 45-day-old Infant

Lee, Jae-Won,Rim, Dae-Cheol,Ahn, Sung-Ki The Korean Neurosurgical Society 2005 Journal of Korean neurosurgical society Vol.38 No.4

The incidence of intracranial aneurysms in childhood is rare, especially in infancy. We report a case of a 45-day-old girl who presented with seizure due to a ruptured large saccular aneurysm of the middle cerebral artery[MCA] with subsequent subarachnoid, intracerebral and intraventricular hemorrhage. The baby has enjoyed an excellent clinical outcome after surgical management. The clinical features of the case and review of the literature are presented.

Advances in Molecular Imaging Strategies for <i> In Vivo</i> Tracking of Immune Cells

Lee, Ho Won,Gangadaran, Prakash,Kalimuthu, Senthilkumar,Ahn, Byeong-Cheol Hindawi Publishing Corporation 2016 BioMed research international Vol.2016 No.-

<P>Tracking of immune cells<I> in vivo</I> is a crucial tool for development and optimization of cell-based therapy. Techniques for tracking immune cells have been applied widely for understanding the intrinsic behavior of immune cells and include non-radiation-based techniques such as optical imaging and magnetic resonance imaging (MRI), radiation-based techniques such as computerized tomography (CT), and nuclear imaging including single photon emission computerized tomography (SPECT) and positron emission tomography (PET). Each modality has its own strengths and limitations. To overcome the limitations of each modality, multimodal imaging techniques involving two or more imaging modalities are actively applied. Multimodal techniques allow integration of the strengths of individual modalities. In this review, we discuss the strengths and limitations of currently available preclinical<I> in vivo</I> immune cell tracking techniques and summarize the value of immune cell tracking in the development and optimization of immune cell therapy for various diseases.</P>

Case Report : Anaphylaxis with angioedema by rocuronium during induction of general anesthesia

( Won Ju Jeong ),( Woon Young Kim ),( Joo Hyung Son ),( Yoon Sook Lee ),( Jae Hwan Kim ),( Young Cheol Park ) 대한마취과학회 2010 Korean Journal of Anesthesiology Vol.58 No.4

Perioperative anaphylaxis is characterized by severe respiratory and cardiovascular manifestations. Correct management of anaphylaxis during anaesthesia requires a multidisciplinary approach with prompt recognition and treatment of the acute event by the attending anesthesiologist. A 34-year-old woman was scheduled to undergo endo venous laser therapy of varicose veins. She had no history of allergies and had never undergone general anesthesia. General anesthesia was induced with propofol and rocuronium bromide. Approximately three minutes after rocuronium administration, hypotension and tachycardia developed and angioedema around the eyelids and skin rashes and urticaria appeared. The patient received ephedrine and hydrocortisone with hydration. After achieving stable vital signs and symptom relief, surgery was performed without complications. A postoperative skin dermal test performed to identify the agent responsible revealed a positive skin test for rocuronium. (Korean J Anesthesiol 2010; 58: 391-395)

A Study on Synthetic Failure-finding Method for Electrical and Thermal Degradation of Polymer Insulator by Surface Discharge

Lee, Kang-Won,Jang, Dong-Uk,Park, Cheol-Hyun The Korean Institute of Electrical and Electronic 2007 Transactions on Electrical and Electronic Material Vol.8 No.3

Polymer insulators are used widely in variable fields for high voltage insulation and separating people from high voltage charging parts for safety and also supporting overhead power line in electric railway. But it may be broken down by tracking path resulting from continuous surface discharge. This paper has investigated synthetically both the characteristics of electrical aging using precision CT(current transformer) and the thermal aging using thermography method. Electrical aging was analyzed for time-frequency region and thermal aging was illustrated by image processing method. This synthetic method may be an appropriate one to evaluate the surface degradation of polymer insulator.