말기환자 관리에 대한 의사들의 태도

최윤선,김장욱,신승욱,이영미,이태호,홍명호 가톨릭대학교 가톨릭대학교 간호대학 호스피스 교육연구소 1998 호스피스논집 Vol.3 No.-

Background : Nowadays, it is possible to prolong the life. And to improve the quality of life of the dying patients, they need to receive not only the physical, pscychological, social and spiritual care but also comprehensive and continuous care. Also, doctors have to consider many ethical issues especially in the dying patients. The purpose of this study is to analyze the doctors' attitude of those ethical issues and emphasize the importance of hospice. Methods : During September 1996, doctors who worked for a university hospital participated in this study by responding to the pre-made questionnaire. It dealt with the most suffering pain, the preferred death place, the use of life maintaining equipments, the application of cardiopulmonary resuscitation(CPR) to terminal patients and the doctors' experience and attitude euthanasia. Results : ① The most suffering symptom in dying patients was pain(60.0%). ② The death place was recommended by doctors was home(58.8%) and hospital (15.4%) in order. ③ 56.9% of doctors answered 'the life maintaining equipments isn't needed', 29.2% of doctors answered' according to the case', and 'needed' was 12.3%. ④ The application of CPR to the terminal patients, without the DNR chart, the only 15.4% of doctors answered "Do not CPR." But with the DNR chart, the percents of 'Do not CPR' was increased to 69.2%. The resident group did more CPR than specialist group(p<0.01). ⑤ The 50.8% of doctors agreed with the passive euthanasia. Conclusions : Many doctors follow the family member's opinion in the ethical issues of the dying patients. Euthanasia is forbidden by the law in Korea, but many doctors agree with the passive euthanasia. Hospice can solve the debating ethical issues including the euthanasia.

3분 및 4분 상완골근위부 골절에서의 외반형 및 내반형에 따른 임상적 비교

최창혁,권굉우,김신근,이상욱,신동규,이승진 대한골절학회 2002 대한골절학회지 Vol.15 No.4

목 적 : 수술적으로 치료한 3분, 4분 상완골 근위부 골절을 외반형과 내반형으로 재분류하여 임상적 결과를 비교하고자 하였다. 대상 및 방법 : Neer 분류상 3분, 4분 상완골근위부 골절로 분류된 21례에 대해 수술적 치료를 시행하고 12개월 이상 추시된 증례를 대상으로, 골절부위의 각형성, 상완골두의 방향성, 그리고 우세 전위결절의 양상에 따라 외반형과 내반형으로 재분류하여 UCLA shoulder rating scale에 따른 기능적 평가를 시행하였다. 결 과 : 단순 방사선 소견을 기준으로 Neer의 3, 4분 상완골 근위부골절을 외반형과 내반형 및 각각의 아형(subtype)으로 분류할 수 있었다. 견관절 반치환술을 시술한 2례를 제외하고 분석한 각 그룹의 UCLA 기능적 평가는 외반형에서 양호 이상의 결과가 9례중 8례(89%), 내반형에서 10례중 4례(40%)로 외반형에서 더 우수한 임상적 경과를 보였다. 결 론 : 상완골 근위부 골절에서 골두의 방향성은 골절의 각형성 및 우세 전위결절의 양상과 높은 상관관계를 가졌으며, 내반형의 경우 혈행과 신경장애가 좀더 빈번하고 예후도 불량한 것으로 나타났고, 이러한 경우 수술시 도달 방법, 연부조직 상태에 대한 평가가 더욱 신중하게 고려되어야 할 것으로 생각되었다. Purpose : We reclassified three-and four-part proximal humerus fracture by Neer's classification into valgus & varus type, and compared the results of these groups. Materials & methods : 21 cases classified as three- and four-part fracture in Neer's classifiation were treated surgically and followed for 12 months. We reclassified the 21 cases vlagus and varus type fractures, according to angulation of fractures, facing of humeral head, and dominant displaced tuberosity. Functional evaluation was done by UCLA shoulder rating scale. Results : Neer's three- and four-part proximal humerus fractures could be reclassified based on angulation, facing of humeral head, and dominant tuberosity displacement. The functional results according to UCLA shoulder rating scale were good or excellent in 8 of 9 cases of valgus type(89%), and at 4 in cases of varus type(40%). The clinical result of the valgus type was better than that of the varus type. Conclusion : Based on reclassification system of proximal humerus fractures, clinical results and radiographic findings including angulation, facing of head and domonant tuberosity displacement showed close relationship. Neurovascular complication were more frequent in the varus type. Therefore, careful evaluation including surgical approach and soft tissue status should be considered in the varus type of complex proximal humerus fracture.

혈중 콜레스테롤과 음독자실시도

최승필,권태욱,황주일,김세경 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

Objective: Several studies suggest that a low cholesterol concentration is associated with a greater than normal risk of mortality from suicide. The authors sought to determine whether a low cholesterol level is associated with a history of serious suicide attempts among drug ingested ED patients. Method: serum cholesterol levels of attempted suicide of 89 patients, aged 20-72 years, were obtained from the ED admission biochemical profiles. Results: The seriousness of suicide attempt was associated with low serum cholesterol concentration in all age subgroups. Conclusions: Low cholesterol concentration should be futher investigated as a potential biological marker of suicide risk.

협심증 환자에서 경피적 관동맥 확장술 후의 QT간격분산(QT Dispersion)의 변화

최일준,이일수,이상곤,홍명기,박성욱,박승정,김유호 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.9

발작성상심실성 빈맥환자에서 Adenosine과 Verapamil의 치료효과

최성욱,오진호,김승호 大韓應急醫學會 1998 대한응급의학회지 Vol.9 No.3

Background. According to the 1992 version of ACLS guideline, adenosine is recommended as the first line drug for the treatment of paroxysmal supraventricular tachycardia(PSVT). But adenosine is not used frequently in our country, despite currently proven effect and safety. Therefore we tried to compare the efficacy and safety of adenosine with verapamil for the treatment for PSVT. Materials and Methods. We prospectively reviewed charts of PSVT patients admitted to YongDong Severance Hospital from Jan. 1995 to Dec. 1996. These patients were randomly divided into two groups. The first group was given 6mg of adenosine initially , and another 12mg was given within 5minutes if first dose failed. The other group was given 5mg of verapamil initially, and if failed, 10mg was given within 10minutes. The results were analyzed by Chi-square test and student- t method Results. In converting PSVT to normal rhythm, adenosine and verapamil showed similar results and there was no difference between the two groups in frequency of side effects, but serious arrhythmia such as ventricular fibrillation and ventricular tachycardia was not seen in the adenosine group. Conclusion. Adenosine not only showed comparable effect and safety, but also had shorter action time than verapamil. Therefore we recommand sdenosine, as a safe and effective first line drug for PSVT.

특발성 좌심실빈맥(Idiopathic Left Ventricular Tachycardia)의 성공적인 전극도자절제술을 위해 단극전기도(Unipolar Electrogram)가 유용한가?

최기준,남기병,강덕현,홍명기,송재관,김재중,박성욱,박승정,박종훈,김유호 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.4

UML을 이용한 송전선로 보호계전기 정정프로그램 분석/설계

吳泰旭,崔勉松,李承宰 明知大學校 産業技術硏究所 2004 産業技術硏究所論文集 Vol.23 No.-

PROSET2000 that is integrated protective management system had developed and used in order to automate the setting process of protective relays in transmission system protection. PROSET2000 have database for relay setting and automated for relay setting program within. This paper proposed PCM current differential relay setting program point of Object Oriented Programming paradigm using Unified Modeling Language about additional relay in PROSET2000. Nevertheless each relay uses same current differential but setting method is different. This paper discribed different thing about setting method of each relay and evaluated more effective and corrective relay setting program using UML.

여성호르몬대체요법을 받는 폐경 후 여성에서의 혈청 C-reactive Protein 수치 변화

황승욱,최국명 제주대학교 생명과학연구소 2002 제주생명과학연구 Vol.5 No.6

연구배경: 폐경 후 여성에서 여성호르몬 대체요법 치료는 관상동맥질환의 위험을 감소시킨다고 알려져 있지만 최근 발표된 연구에서는 기존에 관상동맥질환을 갖고 있는 폐경 후 여성에서 1년 내의 관상동맥질환의 위험이 증가했다가 시간경과에 따라 위험이 감수한다는 사실을 보여 주었다. 한편 혈청 C-reactive protein(CRP)의 등가는 광상동백질환의 독립적인 위험인자로 인정되고 있다. 이에 저자들은 여성호르몬 대체요법을 받는 폐경 후 여성을 대상으로 여성호르몬 대체요법이 혈청 CRP 수치의 변화와 관련성이 있는가를 알아보기 위해 본 연구를 시행하였다. 방법: 1995년 5월 1일부터 2001년 5월 31일까지 일개대학병원 건강증진센터에서 1년 정도의 간격으로 연속 3회 이상 건강검진을 받은 여성 188명 중에서 의무기록 열람과 전화조사를 통해 40세 이상 70세 미만으로 일개대학병원 가정의학과에서 처음으로 폐경 후 여성호르몬 대체요법을 받기 시작한 여성 40면을 대상으로 연도별로 혈중 CRP 수치의 변화를 분석하였다. 결과: 여성호르몬 대체요법 후의 혈중 CRP 농도는 고혈압 군에서 1년후의 CRP의 증가가 있었으나(P<0.05). 2년 후에는 기저수치에 비해 의미 있는 차이가 없었다. 비고혈압 군에서는 1년 후와 2년 후 모두 의미 있는 차이가 없었다. 결론: 본 연구에서는 특히 고혈압이 있으면서 폐경 후 여성호르몬대체요법을 받는 여성에서 시간적 경과에 따라 혈중 CRP 수치가 단기적으로 증가하였다가 점차 감소하는 경향을 보였다. Background: It was known that postmenopausal estrogen replacement therapy(ESP) decreased the risk of coronary heart disease. A recent study reported that the risk of coronary heart disease had a pattern of increase and decrease during ERT in postmenopausal women with coronary disease. The increase of Serum C reactive protein level was accepted as an independent risk factor of coronary heart disease. In this study, we tried to analyze the relationship between ERT in postmenopausal women and the change of CRP level. Methods: The study population was composed of 40 postmenopausal women who first started HRT in Health Promotion Center of University Hospital from May 5, 1995 to May 31, 2001. We checked their CRP level yearly. Results: In the group composed of postmenopausal women with hypertension, there was significant increase of CRP level(P<0.05) in 1 year ERT. But CRP level in 2 year after ERT was not significantly different from baseline level. In the group composed of postmenopausal women without hypertension. CRP level was not significantly changed 1 year after nor 2 year after. Conclusions: In this study, the CRP level showed the pattern of short-term increase and then decrease with time trend in postmenopausal women with hypertension.

안와골절의 외과적 접근에 대한 증례보고

민승기,이은택,오승환,이동근,고세욱,송종민,최성림 대한악안면성형재건외과학회 2002 Maxillofacial Plastic Reconstructive Surgery Vol.24 No.3

The Orbital fracture which is often combined with midface fracture can cause decreased visual acuity, limitation of eyeball movement, diplopia, enophthalmos, etc. Traumatic orbital fracture causes change of orbital volume, results in diplopia and enophthalmos thus, accurate repositioning of displaced bone and reconstruction of orbital defect with autogenous materials(cranial, rib, iliac bone, cartilage and fascia lata) or alloplastic materials(gelatin film, polyglactin mesh, methylmethacrylate, Teflon, silicone, Supermid, hydroxyapatite and metal). The key point of reconstruction of orbit is accurate repositioning of displaced orbital floor, lateral, medial orbital wall and sufficient bonegraft in anatomical defect. As this cases, we obtained good results through transconjunctival and coronal approach who were required orbital reconstruction. Also, we accurately diagnosed orbital fracture with C.T., 3D model and good result for orbital reconstruction with sufficient parietal block bone graft during average 16.8 months follow-up.

이중관 기포탑에서의 비뉴튼류의 기-액간 물질이동

한승환,김상렬,최재욱,최일곤 東亞大學校 1991 東亞論叢 Vol.28 No.1

The effect of draught tube dimension, properties of CMC aqueous solution and gas velocity on the gas holdup, ??, and the volumetric liquidphase masstransfer coefficient, ??, in a bubble column with draught tube were measured in highly viscous-pseudo plastic carboxymethylcellulose aqueous solution. The results were as follows : 1. ?? and ?? increase with increasing gas velocity and decrease with increasing concentration of CMC aqueous solution. 2. ?? and ?? increase with being enlarged diameter ratio of draught tube but specially ?? decreases to some degree in the CMC concentration of 0.05∼0.7wt%. 3. Correlations among various parameters having an influence on ?? and ?? were expressed by Eq. (16) and Eq. (17), respectively. ??