Poster Session : PS 0831 ; Upper GI Tract : Clinical Factors to Predict Angiographically Detectable Non-Variceal Upper Gastrointestinal Bleeding in Patients Refractory to Endoscopic Treatment

( Tae Hwan Ha ),( Tae Hoon Oh ),( Sung In Yu ),( Min Kim ),( Jong Wook Kim ),( Won Ki Bae ),( Jae Hyung Kim ),( Seung Suk Baek ),( Mi Jin Ryu ),( Ye Na Choi ),( Ji Young Park ),( Eileen L Yoon ),( Tae 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Non-variceal upper GI bleeding (NVUGIB) is a common medical problem that has signifi cant association with morbidity and mortality. Angiographic detection and subsequent transarterial embolization (TAE) is a primary treatment option when medical and endoscopic treatments fail. We investigated clinical factors that could affect the success of the angiographic detection and prognosis after TAE in patients with NVUGIB refractory to endoscopic therapy. Methods: A retrospective analysis of the clinical data was done in patients with failed endoscopic treatment who underwent angiography for the treatment of acute NVUGIB between May 2002 and May 2013. Patients were divided into detection or non-detection groups according to the presence of bleeding stigmata in angiographic fi nding. Rebleeding defi ned as subsequent bleeding event within 7 days and mortality within 30days were analyzed as outcome parameters after TAE following detection in angiography. Results: A total 45 patients 37 (male, mean age, 65.9±14.9 years) were analyzed and classifi ed as a detection group (n=25, 55.5%) and non-detection group (n=20, 44.6%). Peptic ulcers were the most common cause of refractory NVUGIB. Larger transfusion amount (5.7±3.9 unit vs. 3.5±2.8 unit; P=0.03), prolonged aPTT level (34.2±17.3 sec vs. 21.8±13.8 sec; P=0.01) and short time interval between last endoscopy and angiography (17.5±25.9 hours vs. 34.3±59.5 hours; P=0.04) were found to be signifi cant factors for predicting angiographic detection. TAE was performed in all patients detected in angiography. Rebleeding (44%) was significantly associated with higher Rockall score (8.3±1.5 vs. 6.6±2.4; P=0.046) and mortality (12%) was signifi cantly associated with higher Rockall score (9.3±0.6 vs. 7.1±2.2; P=0.002) and higher level of BUN (55.3±47.4 vs. 27.6±17.4; P=0.01). Conclusions: Clinical characteristics associated with angiographic detection in patients with NVUGIB refractory to endoscopic therapy were severe bleeding, bleeding tendency and early angiographic intervention. The Rockall score is useful parameter for predicting rebleeding and mortality after TAE.

서울의 Penicillinase Producing Neisseria Gonorrhoeae 발생빈도(1996)

김재홍,황동규,전재홍,김윤석,김중환,김용준,이창균,임동진,김현수,조창근,김경문,박상훈,전우형,김희성,이호정,차명수,김갑형,김형석,김석우,황지환,박병순,권오상,이민수,송기훈,성소영,이인섭,부태성 대한화학요법학회 1999 대한화학요법학회지 Vol.17 No.2

Background : In recent years, gonorrhea has been panedemic and remains one of the most commom STDs in the world, especially in developing countries. Objective & Methods: For the detection of a more effective therapeutic regimen and assessing the prevalence of PPNG, we have been trying to study the patients who have visited the VD Clinic of Choong-Ku Public Health Center in Seoul since 1980 by means of the chromogenic cephalosporin method. Results: In 1996, 139 strains of N. gonorrhoeae were isolated, among which 53(39.0%) were PPNG. Conclusion: Our results suggests that after a peak of 74.3% in 1993, the prevalence of PPNG in Seoul is gradually declining.

비혈연간 동종조혈모세포이식의 단일기관성적 : Single Center Experience

김유진,김동욱,이석,이동건,박윤희,김희제,김태규,민우성,김춘추 대한조혈모세포이식학회 2003 대한조혈모세포이식학회지 Vol.8 No.2

연구배경: 비혈연간 조혈모세포이식은 HLA체계에 대한 이해의 증진과 새로운 검사법의 개발, 그리고 기증자 수의 증가에 힘입어 최근 빠르게 증가하고 있다. 방법: 가톨릭조혈모세포이식센터에서 1995년 10월부터 2001년 12월까지 비혈연간 이식을 받은 138명의 성인 환자를 대상으로 후향적 분석을 하였다. 결과: 질환별로 만성골수성백혈병 66예, 급성림프구성백혈병 23예, 급성골수성백혈병 16예, 재생불량성빈혈 21예, 골수이형성증후군 9예, 비호지킨림프종 2예, 그리고 발작성야간혈색소뇨증이 1예였다. 일차 생차부전은 분석가능한 136예 중 4예(2.9%)에서 발생하였다. Ⅱ도 이상의 급성이식편대숙주병의 발생률은 48.1%였고, 만성이식편대숙주병은 49.5%였다. 재발 이외의 사망원인 중 가장 높은 빈도를 보인 것은 폐렴으로, 독성사망 64예 중 36예(52.3%)에서 관찰 되었다. 만성골수성백혈병의 경우(n=66), 무병생존율, 재발률, 비재발성 사망률이 각각 45.7%, 11.4%, 49.2%였다. 무병생존율은 표준위험군이 고위험군에 비해 통계적으로 유의하게 높았다(50.3% vs 32.0%, p=0.03). 급성림프구성백혈병의 경우(n=23), 무병생존율, 재발률, 비재발성 사망률이 각각 30.0%와 49.4%, 44.8%였던 반면, 급성골수성백혈병에서는(n=16) 28.6%, 39.4%, 52.9%였다. 이들 급성백혈병에서는 표준위험군에 비해 고위험군에서 재발률과 비재발성 사망이 모두 높게 관찰되었다. 중증재생불량성빈혈의 경우(n=21), 무병생존율과 비재발성 사망이 37.3%와 62.7%였다. 결론: 본 연구의 결과 비혈연간 이식은 HLA적합 형제가 없는 혈액질환 환자들에게 유용한 치료법의 하나임을 알 수 있었다. 낮은 병기에서의 조기 이식과 분자생물학적 방법을 사용한 HLA 적합도의 개선이 이식관련 사망을 최소화시켜 비혈연간 이식의 효과를 더욱 확대시킬 수 있을 것으로 생각된다. Background: Unrelated allogeneic stem cell transplantation (U-SCT) is recently on a increasing trend supported by better understanding of HLA system, development of new HLA typing, and increase of donor pool. Methods: We retrospectively analyzed 138 adult patients who underwent U-SCT between October 1995 and December 2001 at Catholic Hematopoietic Stem Cell Transplantation Center. Results: Diagnoses were chronic myeloid leukemia (CML, n=66), acute lymphoblastic leukemia (ALL, n=23), acute myeloid leukemia (AML, n=16), severe aplastic anemia (SAA, n=21), myelodysplastic syndrome (MDS, n=9), non-Hodgkin lymphoma (NHL, n=2), and paroxysmal nocturnal hemoglobinuria (PNH, n=1). Primary engraftment failure was observed in 4 (2.9%) of 136 evaluable patients. Acute GVHD (≥grade II) occurred in 48.1% and chronic GVHD occurred in 49.5%. The most common cause of death other than relapse was pneumonia, which occurred 36 (52.3%) of 64 toxic deaths. In CML, disease-free survival (DFS), relapse rate, and non-relapse mortality (NRM) was 45.7%, 11.4%, and 49.2%. DFS of the standard-risk group (SR) was significantly better than that of high- risk group (HR) (50.3% vs 32.0%, P=0.03). In ALL, DFS, relapse rate, and NRM was 30.0%, 49.4%, and 44.8%, whereas corresponding figures for AML were 28.6%, 39.4%, and 52.9%. NRM and relapse rate were higher in HR compared to SR in acute leukemia. In SAA, DFS and NRM was 37.3% and 62.7%. Conclusion: We concluded that U-SCT is a feasible therapeutic option for patients lacking a HLA-matched sibling donor. Transplantation at earlier phase of disease with more accurate HLA matching by molecular typing can minimize treatment-related toxicity and could extend the benefit of U-SCT.

장기간 항갑상선제 투여 후 임의 중단 뒤 재복용시 발생한 무과립구증 1 예

김승만;김태영;박수영;배영환;서영경 정은주;김태균;권민정;박정현;이순희 인제대학교 2011 仁濟醫學 Vol.32 No.-

Agranulocytosis, one of the major side effects of antithyroid a gents, probably occurs in less than 0.25% of cases treated with antithyroid agents. It usually occurs within the first several weeks or months after the initiation of therapy, when drug dosage is higher. Most reported cases of agranulocytosis have occurred during the first 3 months of therapy. We describe here a rare case that did not experience the side effect for 6 years of antithyroid agent treatment but presented with agranulocytosis in one month after re-exposure. It suggests that the major side effect such as agranulocytosis can occur in patients who had undergone prior uneventful antithyroid drug therapy.

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.

Effect of Forging Type on the Deformation Heterogeneities in Multi‑Axial Diagonal Forged AA1100

Min‑Seong Kim,Sang‑Chul Kwon,Sun‑Tae Kim,Seong Lee,Hyo‑Tae Jeong,Shi‑Hoon Choi 대한금속·재료학회 2019 METALS AND MATERIALS International Vol.25 No.3

The present study investigated the effects that different types of forging exert on the deformation heterogeneities developedin AA1100 during multi-axial diagonal forging. To measure the deformation heterogeneities of deformed workpieces, thevalues for hardness and Kernel average misorientation were measured at the center section following each forging process. Type-D forging that consists of diagonal forging and return-diagonal forging was relatively advantageous compared withType-P forging that includes plane forging and return-plane forging for minimizing the non-uniformity of deformationdeveloped in workpieces. The effective strain developed in a workpiece during the 2 types of forging was simulated using3-D FEA. FEA revealed that the positions and degrees of occurrence for soft and hard-zones in workpieces vary greatlydepending on the forging type. Type-D forging was relatively advantageous compared with Type-P forging for minimizingthe non-uniformity of effective strain developed in workpieces.

서울의 Penicillinase Producing Neisseria gonorrhoeae 발생빈도(1997)

김재홍,문득곤,김정수,김용준,임동진,박상훈,김희성,이민수,송기훈,김갑형,김형석,성소영,이인섭,김석우,황지환,조창근,김경문,부태성 대한화학요법학회 2000 대한화학요법학회지 Vol.18 No.3

Background : In recent years, gonorrhea has been pandemic and remains one of the most common STDs in the world, especially in developing countries. Objective & Methods : For the detection of a more effective therapeutic regimen and assessing the prevalence of PPNG, we have been trying to study the patients who have visited the Venereal Disease Clinic of Choong-Ku Public Health Center in Seoul since 1980 by means of the chromogenic cephalosporin method. Results : In 1997. 99 strains of N. gonorrhoeae were isolated, among which 45(45.5%) were PPNG. Conclusion : The prevalence of PPNG in Seoul, which had been decreased to 39% in 1996 after a peak of 74.3% in 1993, is increased to 45.5% in 1997.

Nanocrystalline silicon films deposited with a modulated hydrogen dilution ratio by catalytic CVD at 200 ℃

Tae-Hwan Kim,Kyoung-Min Lee,Jae-dam Hwang,Wan-Shick Hong 한국물리학회 2009 Current Applied Physics Vol.9 No.2

Nanocrystalline silicon (nc-Si) thin films that are deposited at low-temperatures (<200 ℃) often contain an incubation layer as thick as 10 nm. This incubation layer deteriorates performance of electronic devices, such as bottom-gate thin-film transistors, fabricated from the nc-Si film. We found that the crystallinity of the nc-Si films could be improved by adding a large quantity of hydrogen to the source gas. However, the hydrogen dilution degraded the deposition rate. We attempted a modulation of the hydrogen dilution ratio in a catalytic chemical vapor deposition (Cat-CVD) system to achieve both a minimal incubation layer and high throughput. We obtained an incubation-layer thickness of 3 nm and were able to grow a 200-nm-thick film in 18 min. Nanocrystalline silicon (nc-Si) thin films that are deposited at low-temperatures (<200 ℃) often contain an incubation layer as thick as 10 nm. This incubation layer deteriorates performance of electronic devices, such as bottom-gate thin-film transistors, fabricated from the nc-Si film. We found that the crystallinity of the nc-Si films could be improved by adding a large quantity of hydrogen to the source gas. However, the hydrogen dilution degraded the deposition rate. We attempted a modulation of the hydrogen dilution ratio in a catalytic chemical vapor deposition (Cat-CVD) system to achieve both a minimal incubation layer and high throughput. We obtained an incubation-layer thickness of 3 nm and were able to grow a 200-nm-thick film in 18 min.

글래스 아이오노머 이장재와 복합레진간의 결합강도에 관한 연구

김민희,정태성,김신 大韓小兒齒科學會 1999 大韓小兒齒科學會誌 Vol.26 No.3

본 연구는 현재 널리 쓰이고 있는 sandwich technique을 임상에 적용함에 있어서,GIC 이장재에 대한 이중중합형 레진과 비교적 근래에 소개된 compomer의 결합력을 측정하여 기존의 광중합형, 화학중합형 복합레진과 비교하고, 가장 우수한 결합력을 보이는 glass ionomer composite resin의 조합을 밝혀내고자 시도되었다. 이장용 재료로는, 광중합형인 GIC Vitrebond와 화학중합형인 GIC인 Ketac-fil을 사용하였으며,이 두가지의 이장재에 대해,광중합형 복합 레진인 Z-100,화학중합형 복합 레진인 Clearfil, compomer인 Dyract,그리고 이중중합형 복합 레진인 Bis-core를 축조하여 각 군당 10개씩, 총 80개의 시편을 제작하였다. 제작된 시편은 37℃의 증류수에 24시간동안 보관한 후,full load scale 50Kg,cross-head speed 1mm/min 조건의 만능 시험기에서 그 전단결합강도를 측정하였으며 실험결과는 student t-test로 검정하였다.본 연구의 결과는 다음과 같다. 1.Vitrebond를 이장재로 사용한 경우,Z-100이 가장 낮은 결합강도를 보였으며,나머지 세 재료는 결합력의 차이를 보이지 않았다(P<0.05). 2.Ketac-fil을 이장재로 사용한 경우,Clearfil이 가장 높은 결합강도를 보였고,Dyract, Bis-core가 중등도의 결합강도를,Z-100이 가장 낮은 결합강도를 보였다(P<0.05). 3.Clearfild은 Vitrebond 상방에서는 타 재료들과 비슷한 결합강도를 보였으나, Ketac-fil 상방에서는 가장 높은 결합강도를 보임으로써, GIC 이장재 종류에 따른 결합력의 차이를 보였으나 (P<0.05),나머지 세 재료의 경우에는 차이를 보이지 않았다(P>0.05). 4.Vitrebond를 사용할 때보다 Ketac-fil을 이장재로 사용할 때, 상부에 축조되는 복합레진의 종류에 따른 결합력의 차이가 더 크게 나타났다(P<0.05). For the purpose of providing suggestions in selection of filling materials used in `sandwich technique',the bone strengths between glass ionomer cement bases and composite resins were invetigated and compared. For lining materials,`Vitrebond' and '`Ketac-fil' were used.Using these two as bases,10 of each following resins were built up of the top ;Z-100(light curing resin),Clear-fil(chemical curing resin),Bis-core(dual cure resin),Dyract(compomer),therfore 10 specimens of each group and total of 80 specimens were made. After storing specimens in 37℃ deionized water for 24 hours,the shear bond strengths were measured under universal testing machine with 50 kg of full load scale and 1mm/min of crosshead speed and obtained the results as follows: 1.Over Vitrebond base,Z-100 showed the lowest bond strength but the other three did not show any difference in bond strength. 2.Over Ketac-fil base,Clear-fil showed the highest bond strength followed by Dyract,Bis-core,and Z-100 showed the lowest bond strengths. 3.Whereas Clear-fil showed the similar bond strengths on the Vitrebond base as other resins,it showed the highest bond strength on Ketac-fil base,which showed some difference in bond strength by differing GIC bases. 4.The bond strengths between base materials and composite resin showed a stronger resin-dependence tendency in cases with Ketac-fil bases rather than with Vitrebond bases.

급성심근경색후 발생한 심실중격결손 2례

김태희,이재호,김애란,허민영,문치숙,정수룡,김대경,김두일,김동수 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.4

Ventricular septal defect remains an infrequent but devastating complication of acute MI. Approximately 1∼3% of cases of acute myocardial infarction are complicated by ventricular septal rupture in the prethrombolytic era and the incidence has decreased to 0.2% with reperfusion therapy. This mechanical complication usually occurs within the first 10 to 14 days when necrotic tissue is most abundant and the collateral coronary circulation is not well developed. This lesion is generally associated with complete coronary obstruction rather than severe stenosis. Rupture of the ventricular septum is a severe mechanical complication of acute myocardial infarction, usually resulting in death unless surgical repair is performed. The bad prognosis of this event within the first 2 weeks indicates the need for early surgical rapair. This complication is more frequent after the first acute myocardial infarction in the elderly and secondary to a transmural myocardial infarction. We report two cases of ventricular septal rupture after acute myocardial infarction.