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.

정상 관동맥을 가진 심장 점액종 환자에서 발생한 급성 심근 경색증 1예

이정민,이현승,전은정,윤호중,정욱성,오용석,김철민,김재형,최규보,홍순조,이교영,심상인 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.9

하시모트 갑상선염과 동반된 갑상선 MALT 림프종(MALToma) 1 예

김영선,이태영,한찬희,유명희,김철희,변동원,진소영,남일송,류은상,홍기영,윤석기,서교일 대한내과학회 2001 대한내과학회지 Vol.61 No.3

Primary thyroid lymphomas constitute of up to 5% of all thyroid malignancies. Recently, mucosa-associated lymphoid tissue (MALT) lymphoma are relatively recognized as a B cell subset of non-Hodgkin's lymphoma. MALT-lymphomas are thought to develop from acquired lymphocytic tissue during the course of a chronic inflammatory or autoimmune process. In the thyroid , which is normally devoid of lymphocytic tissue, chronic autoimmune thyroiditis (Hashimoto's disease) has been associated with an increased risk of lymphoma, including MALT type. The clinical presentations include the enlarging of the neck mass, dysphagia, hoarsenes and choking or cold thyroid nodule. We report a case of MALToma of the thyroid accompanied by Hashimoto's thyroiditis with a review of the literature.(Korean J Med 61:281-285, 2001)

말 기생충성 동맥염 2예

신태균,김승호,배종희,이두식,임윤규,이수길 濟州大學校 農科大學 動物科學硏究所 1992 動物科學論叢 Vol.7 No.1

Two cases of verminous arteritis were chosen for this case. These horses were originally submitted for necropsy in the Cheju horse race. Case 1 : At necropy, there was increased ascite, thickened ab-dominal aorta at junction of cranial mesenteric artery. In the aorta, there was a long thrombus embed-ded with strongylus vulgaris larvae. Some larvae were also firmly attached in the aortic intima Histologically, there was infiltration of neutropliils, eosinophils, and macrophages in the tunica media. At the junction of thrombus and arterial intima, there was proliferation of vessels. Case 2 : At necropsy, there was thickened abdominal aorta, which showed typical verminous arteritis with thrombus. Histologically, ceseous tissues with haematopoietic tissue was recognized in the aortic wall.

유방암과 섬유선종의 방사선학적 소견 : 유방 단순촬영술과 유방 초음파검사 소견의 비교 연구 Studies on mammographic and ultrasonographic findings evaluation

임한혁,최득린,고은석,이혜경,임철완,이상진,홍현숙,최교창,김영화,박재성 순천향의학연구소 1997 Journal of Soonchunhyang Medical Science Vol.3 No.2

Purpose : To evaluate the utility of mammography and ultrasonography in study of morphologic differential diagnosis between malignant and benign mass. Materials and Methods : Average age of patients with breast cancer was 48.4 year-old, and that of fibroadenoma was 29.4 year-old. The equipments used for examination were MF-159 high frequency mammography(Bennet Co.) and Acoustic image 5200S. We evaluated mammographic findings about breast parenchymal pattern, calcification, margin and size of the mass associated tumor nature, and ultrasonographic findings about shape, height and width, internal homogenicity and echo pattern, wall contour, boundary echo, and posterior shadow in breast mass. Thirty-seven of mammographic findings and 34 cases of ultrasonogreaphic findings in pathologically proven breast cancer and 34 case of mammographic findings and 71 cases of ultrasonographic findings in breast fibroadenoma were reviewed retrospectively. Results : In mammographic study, the parenchymal patterns of breast cancer according to Wolfe classification were NI(16.2%), PI(24.3%), P@(37.8%), and DY(21.6%) and those in fibroadenoma were NI(3.1%), Pl(11.7%), P2(35.2%),and DY(50%). Mammographic findings about presence of calcification were as follows; only calcification(16.2%), only mass(51.3%), and mass with calcification(32.5%) in breast cancer, and only mass(91.2%), mass with calcification(8.8%) in fibroadenoma. The features of mass margins were classified as ill-defined margin(45.9%), well-defined(5.4%), and well-defined with partial spiculation(48.6%) in breast cancer and ill-defined(20.5%), well-defined(73.5%), and well-defined with partial spiculation(5.8%) in fibroadenoma. The mass were grouped by size; 1-2cm(37.8%), 2-4cm(45.9%), and 4-6cm(16.3%) in breast cancer and 1-2cm(79.4%), 2-4cm(17.6%), and 4-6cm (3.0%) in fibroadenoma. On ultrasonographic study, the shape of masses in breast cancer were lobulated(82.3%),oval(14.7%), and round(3.0%),and those in fibroadenoma were lobulated(14.0%), oval(57.7%), and round(18.3%). The cases that the height was longer than width were 32.3% in breast cancer and 0% in fibroadenoma. The findings about homogenecity and echo patterns were as follows; hypoechoic(52.9%) and mixed(47.1%) in breast cancer and hypoechoic(2.8%), hypoechoic(63.4%), and mixed(33.8%) in fibroadenoma. The margin of masses were smooth in 85.9% of fibroadenoma, and irregular in 73.6% of breast cancer. The boundary echoes of masses and decreased posterior echo shadow were seen only in 61.8% and 55.9% of breast cancer, respectively. Conclusion: The margin and calcifications are more clearly delineated on mammography but breast cancer and fibroadenoma, both are more commonly developed in dense parenchymal pattern(P2+DY),and there findings are easily obscured in mammography. So ultrasoography is very useful in these masses evaluation, especially amoung young patients.

Detection of Novel Coronavirus on the Surface of Environmental Materials Contaminated by COVID-19 Patients in the Republic of Korea

Lee Sang-Eun,Lee Deog-Yong,Lee Wook-Gyo,Kang ByeongHak,Jang Yoon Suk,Ryu Boyeong,Lee SeungJae,Bahk Hyunjung,Lee Eungyu 질병관리본부 2020 Osong Public Health and Research Persptectives Vol.11 No.3

This study aimed to determine the presence of SARS-CoV-2 on surfaces frequently touched by COVID-19 patients, and assess the scope of contamination and transmissibility in facilities where the outbreaks occurred. In the course of this epidemiological investigation, a total of 80 environmental specimens were collected from 6 hospitals (68 specimens) and 2 “mass facilities” (6 specimens from a rehabilitation center and 6 specimens from an apartment building complex). Specific reverse transcriptase-polymerase chain reaction targeting of RNA-dependent RNA polymerase, and envelope genes, were used to identify the presence of this novel coronavirus. The 68 specimens from 6 hospitals (A, B, C, D, E, and G), where prior disinfection/cleaning had been performed before environmental sampling, tested negative for SARS-CoV-2. However, 2 out of 12 specimens (16.7%) from 2 “mass facilities” (F and H), where prior disinfection/cleaning had not taken place, were positive for SARS-CoV-2 RNA polymerase, and envelope genes. These results suggest that prompt disinfection and cleaning of potentially contaminated surfaces is an effective infection control measure. By inactivating SARS-CoV-2 with disinfection/cleaning the infectivity and transmission of the virus is blocked. This investigation of environmental sampling may help in the understanding of risk assessment of the COVID-19 outbreak in “mass facilities” and provide guidance in using effective disinfectants on contaminated surfaces.

Depth and combined infection is important predictor of lower extremity amputations in hospitalized diabetic foot ulcer patients

( Eun-gyo Jeong ),( Sung Shim Cho ),( Sang-hoon Lee ),( Kang-min Lee ),( Seo-kyung Woo ),( Yoongoo Kang ),( Jae-seung Yun ),( Seon-ah Cha ),( Yoon-jung Kim ),( Yu-bae Ahn ),( Seung-hyun Ko ),( Jung-mi 대한내과학회 2018 The Korean Journal of Internal Medicine Vol.33 No.5

Background/Aims: As the prevalence of diabetes mellitus and its complications increase rapidly, diabetic foot ulcers (DFUs), which are a major diabetic complication, are expected to increase. For prevention and effective treatment, it is important to understand the clinical course of DFUs. The aim of this study was to investigate the natural course and predictors of amputation in patients with DFUs who required hospitalization Methods: A total of 209 patients with type 2 diabetes, aged 30 to 85 years, who visited emergency department or needed hospitalization due to DFUs were consecutively enrolled from May 2012 to January 2016, by retrospective medical record review. The main outcome was lower extremity amputation (LEA). Results: Among 192 patients who completed follow-up, 113 patients (58.9%) required LEAs. Compared to patients without amputation, baseline levels of white blood cell counts and C-reactive protein were higher in patients with amputation. In addition, bone and joint involvement was more frequently observed in patients with amputation. Multivariable regression analysis revealed that combined infection (odds ratio [OR], 11.39; 95% confidence interval [CI], 2.55 to 50.93; p = 0.001) and bone or joint involvement (OR, 3.74; 95% CI, 1.10 to 12.70; p = 0.035) were significantly associated with an increased risk of LEA. Conclusions: The depth of the wound and combined infection of DFU, rather than the extent of the wound, were significant prognostic factors of LEAs in patients with type 2 diabetes.

Morphological Characteristics of Ginseng Leaves in High-Temperature Injury Resistant and Susceptible Lines of Panax ginseng Meyer

Lee, Joon-Soo,Lee, Kyung-Hwan,Lee, Sung-Sik,Kim, Eun-Soo,Ahn, In-Ok,In, Jun-Gyo The Korean Society of Ginseng 2011 Journal of Ginseng Research Vol.35 No.4

Plant leaf cuticle is related to the prevention of moisture loss, transpiration, and diffusion of light reflection. The purpose of this study was to examine the morphological characteristics of ginseng leaves in ginseng plants resistant and susceptible to hightemperature injury (HTI) to be related with the leaf-burning. For the HTI resistant lines Yunpoong, high-temperature injury resistance (HTIR) 1, HTIR 2, and HTIR 3, and the HTI-susceptible line Chunpoong, the cuticle densities were 53.0%, 46.2%, 44.9%, 48.0%, and 17.0%; the adaxial leaf cuticle layers were 141.3, 119.7, 119.7, 159.4, and 85.0 nm in thickness; the abaxial leaf cuticle layers were 153.6, 165.8, 157.9, 199.6, and 119.4 nm in thickness; and the stomtal lengths were 21.7, 32.4, 29.4, 30.9, and $21.8{\mu}m$, respectively. All of these aspects suggest that HTI resistant lines have higher cuticle density, thickicker adaxial and abaxial leaf cuticle layers, and longer of stomta length than the HTI-susceptible line, protecting leaves from moisture loss and excessive transpiration under high temperatures to be resistant against the leaf-burning.

Recovery of Lactic Acid from Fermentation Broth by the Two-Stage Process of Nanofiltration and Water-Splitting Electrodialysis

Lee, Eun-Gyo,Kang, Sang-Hyeon,Kim, Hyun-Han,Chang, Yong-Keun The Korean Society for Biotechnology and Bioengine 2006 Biotechnology and Bioprocess Engineering Vol.11 No.4

A two-stage process of nanofiltration and water-splitting electrodialysis was investigated for lactic acid recovery from fermentation broth. In this process, sodium lactate is isolated from fermentation broth in the first stage of nanofiltration by using an NTR-729HF membrane, and then is converted to lactic acid in the second stage by water-splitting electrodialysis. To determine the optimal operating conditions for nanofiltration, the effects of pressure, lactate concentration, pH, and known added impurities were studied. Lactate rejection was less than 5%, magnesium rejection approximated 45%, and calcium rejection was at 40%. In subsequent water-splitting electrodialysis, both the sodium lactate conversion to lactic acid and sodium hydroxide recovery, were about 95%, with a power requirement of $0.9{\sim}1.0\; kWh$ per kg of lactate.

Analysis on the Color Reproduction of Near Infrared Absorbing Lenses and Tinted Lenses

Gyo-Eun Lee,Jae-Yeon Pyo,Min-Chul Kim,Bon-Yeop Koo,Hang-Seok Lee,Ki-Choong Mah 대한시과학회 2020 대한시과학회지 Vol.22 No.1

목적 : 근적외선 차단렌즈의 색 왜곡을 평가하기 위하여 객관적 및 주관적 측색 결과를 분석하였다. 방법 : Colorchecker Classic의 15번(Red), 16번(Yellow) 및 14번(Green) 색표를 가상신호등으로 설정하여 객관적 측색을 실시하였다. 객관적 평가를 위하여 디지털 카메라에 각 렌즈를 장착한 후 가상신호등을 촬영하였 다. 본래 색상과 렌즈 장착 후 측정된 색을 CIE 1976 L*a*b* 색도좌표로 표시하였고, 좌표간 거리 값인 ΔE* ab를 산출하여 색 왜곡도를 비교 분석하였다. 32명을 대상으로 주관적 평가를 실시하였다. 교통신호등의 관찰된 색을 한국 색채 표준 디지털팔레트에서 선택하도록 하여 본래 색상과 비교하였다. 결과 : 객관적 평가에서, 황색 및 녹색 가상신호등의 색왜곡은 근적외선 차단렌즈 착용 시 가장 작은 것으로 나 타났다. 근적외선 차단렌즈에 의한 적색 가상신호등의 색왜곡은 녹색렌즈보다 크지만 갈색, 회색 및 청색렌즈에 비교하여 더 적은 것으로 나타났다. 주관적 평가에서, 적색 신호등을 주시했을 때 근적외선 차단렌즈에 의한 색왜곡은 갈색렌즈와 비교하여 더 많았으며, 청색 및 녹색렌즈 착용과 유사하였고, 회색렌즈 착용보다 적은 것으로 나타났다. 결론 : 근적외선 차단렌즈의 색왜곡은 다른 렌즈와 비교하여 객관적 평가에서 가장 낮았으나, 주관적 평가에서는 유의한 차이가 없었다. 근적외선 차단렌즈의 주관적 색 재현성을 정량적으로 조사할 수 있는 추가적인 연구가 필요할 것으로 생각된다. Purpose : To compare the objective and subjective colorimetry so as to evaluate the color accuracy of the near infrared absorbing lenses(IR lenses). Methods : The 15#(Red), 16#(Yellow) and 17#(Green) of the Colorchecker Classiccolor charts were set as virtual traffic signals for measuring objective colorimetry. The objective colorimetry of virtual traffic signals were measured by digital camera attached each test lenses. The original color and measured color by each test lens were represented by CIE 1976 L*a*b* color coordinates, and the color distortion were analyzed by ΔE* ab of the distance between color coordinates of the original and colorimetric color. 32 subjects were participated to the subjective colorimetry. The observed colors of traffic signals were selected from the Korean color standard digital palette, and compared with the original color. Results : In the objective colorimetry, the color distortion of yellow and green virtual traffic signals by near infrared absorbing lenses was found to be the smallest among the test lenses. The color distortion of red virtual traffic signals by near infrared absorbing lenses was greater than the green lens, but less compared to the brown, gray, and blue lenses. In the subjective colorimetry, the color distortion by near infrared absorbing lenses was more than that of brown lenses, similar to blue and green lenses, and less than that of gray lenses. Conclusion : The color distortion of the near infrared absorbing lenses was the smallest in the objective colorimetry compared to other test lenses, but there was no significant difference in the subjective colorimetry. It is considered that further studies are to be necessary to investigate quantitatively the subjective color distortion of near infrared absorbing lenses.