Intrahepatic sarcomatous cholangiocarchinoma 1예

금민애,장혁재,곽진호,김지훈,김지훈,한명식 대한외과학회 2009 대한외과학회 학술대회 초록집 Vol.2009 No.11

1-1 : Clinical Effect of Altered Lipid Emulsion Composition Containing Fish Oil in Post-Operative Patients

금민애,홍석경,한호성,윤동섭,서정민,윤익진 한국정맥경장영양학회 2013 한국정맥경장영양학회 학술대회집 Vol.2013 No.-

Introduction: Omega-3 fatty acids have been shown to decrease inflammatory responses after trauma and surgery resulting in reduction of morbidity and mortality in postoperative patients. The ￥ø-6:￥ø-3 polyunsaturated fatty acid (PUFA) ratio in parenteral nutrition (PN) also influences the immune-modulation during the postoperative inflammatory period. The aim of this study was to evaluated the optimal ratio of PUFA in postoperative patients following abdominal surgery. Methods: In a prospective, randomized, open-labeled, comparative, multicenter, phase 3 clinical study, we compared the safety and efficacy of a 21.:1 ration of ￥ø-6:￥ø-3 fatty acid to 2.5:1 in postoperative patients requiring PN (Table 1). These products are iso-energetic and iso-nitrogenic except lipid emulsion composition sepecially ratio of ￥ø-6:￥ø-3 fatty acid. 54 patients were assigned to receive PN with Combiflex Omega peripheral (CFO, low ratio group, n=28) or SMOFKabiven peripheral(KAB, high ratio group, n=26) for 3 days after abdominal surgery. Safety and efficacy were monitored daily with laboratory parameters, vital signs and adverse event from operation day (day 0) till the end of study (day 4). Results: Total cholesterol (TC) and low density lipoprotein-cholesterol (LDL-C) levels have been less changed significantly in the low ratio group (3±18 vs.16±23 mg/dl, p=0.027 for TC, 4±12 vs. 12±18 mg/dl, p=0.026 for LDL-C) compared to high ratio group in postoperative patients. Other laboratory parameters and adverse events did not show satatistically significant differences between the groups. Conclusion: Th lipid emulsion containing low ratio of ￥ø-6:￥ø-3 fatty acid was comparable with high ratio of ￥ø-6:￥ø-3 about safety and efficacy and also had advantages regard to lipid metabolism aspect in postoperative patients requiring PN.

Clinicopathologic Factors Affecting Recurrence after Curative Surgery for Stage I Colorectal Cancer

금민애,임석병,Sun A Kim,Yong Sik Yoon,Chan Wook Kim,유창식,김진천 대한대장항문학회 2012 Annals of Coloproctolgy Vol.28 No.1

Purpose: The objective of the current study was to identify the clinicopathological risk factors affecting recurrence after a curative resection for stage I colorectal cancer. Methods: We retrospectively studied 434 patients who underwent a curative resection for stage I colorectal cancer between January 1999 and December 2004. Postoperative oral chemotherapy was performed in 189 patients (45.3%). The following prognostic factors were correlated with recurrence: age, gender, preoperative carcinoembryonic antigen level, location of tumor, T stage, size of tumor, histologic differentiation, growth pattern, and lymphovascular invasion. The median follow-up duration was 65 months. Results: The overall recurrence rate was 4.6% (20/434). The median time to recurrence was 33 months. Two-thirds of the recurrence occurred more than two years after surgery. Risk factors associated with recurrence were rectal cancer (P =0.009), T2 stage (P = 0.010), and infiltrative growth pattern (P = 0.020). A Cox proportional hazards regression analysis demonstrated that the infiltrative growth pattern was an independent predictor for recurrence. Tumor cell budding was observed in all pathologic reviews with recurrence. Conclusion: Long-term follow-up is necessary for stage I colorectal patients with high risk factors like rectal cancer, T2stage, and infiltrative growth pattern.

기계환기

금민애 대한외과학회 2023 대한외과학회 학술대회 초록집 Vol.2023 No.5

건삭 파열에 의한 외상성 삼천판 역류: 증례보고

금민애 ( Min Ae Keum ),노효근 ( Hyo Keun No ),선병주 ( Byung Joo Sun ),홍석경 ( Suk Kyung Hong ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.2

Traumatic tricuspid regurgitation is a rare complication of blunt chest trauma caused by chordal rupture, anterior papillary muscle rupture and anterior leaflet tear. Since clinical symptoms are vague, early diagnosis is difficult and some patient exhibit symptoms of right heart failure. Right heart failure has been the traditional indication for surgical treatment, such as tricuspid valve replacement. Recently, early detection using transthoracic echocardiography and surgical treatment, like valve repair, prior to overt right heart failure have been shown to better prognosis. We report a case of traumatic tricuspid regurgitation with chordal rupture in patient due to traffic accident. [ J Trauma Inj 2015; 28: 67-70 ]

Mangled Trauma 환자에서의 치료방법에 따른 삶의 질 비교

김준영,정윤중,금민애,권수경,홍석경 대한외상중환자외과학회 2019 Journal of Acute Care Surgery Vol.9 No.1

Purpose: Mangled injury is defined as severe injury, including three or more tissues such as bones, nerves, vessels, muscles, and tendons in the upper or lower extremities. The choice of treatment results in different cosmetic and functional outcomes for mangled injury. In this study, we estimated patients’ quality of life after treatment with the future intention of having patients make proper decisions at the time of injury.Methods: Twenty patients were treated at Asan Medical Center from January, 2009 to November, 2011, and 11 patients were included who agreed with the questionnaire. We used 36-item short form health survey (SF-36) for estimating quality of life after treatments.Results: Subjective satisfaction of cosmetic and functional aspects was higher in the reconstruction group than in the amputation group. However, in the estimation of specified satisfaction using SF-36, the amputation group was more satisfied than the reconstruction group. Conclusion: Among the many treatment considerations at the time of injury, expected cosmetic and functional outcomes were important parts determining the decision. In our study, the amputation group showed a better satisfaction level. This result could help patients make more appropriate decisions in the case of mangled injury.

외상환자에서 전신 전산화 단층촬영의 역할

선현우,홍석경,금민애,백종관,이정선,이충욱 대한외상중환자외과학회 2016 Journal of Acute Care Surgery Vol.6 No.1

Purpose: To assess the effects of whole-body computed tomography (WBCT) on severely injured trauma patients. Methods: After the installation of a WBCT scanner, we compared 48 patients who underwent the WBCT (WBCT cohort) with 40 patients prior to the WBCT (pre-WBCT cohort). We evaluated the number of CT, radiation exposure, time interval to decision and clinical outcomes such as length of intensive care unit stay, ventilation period, and acute kidney injury rates. Results: In the WBCT cohort, the number of CT scans was significantly less (3.5 times) than in the pre-WBCT cohort (5.5 times; p<0.001). The radiation exposure was significantly lower in the WBCT cohort (24.5 mSv) than in the pre-WBCT cohort (31.3 mSv; p=0.040). The amount of radio-contrast used differed between the groups, but not significantly. Although there were fewer acute kidney injuries in the WBCT cohort (27.1%) than in pre-WBCT cohort (37.5%; p=0.296), especially severe injuries (stage 3 Acute Kidney Injury [AKI] Network: 17.5% in pre-WBCT vs. 6.3% in WBCT; p=0.059), the difference did not reach statistical significance. The hospital length of stay was significantly shorter in the WBCT cohort (21.42 days) than in the pre-WBCT cohort (32.38 days, p=0.019). However, there were no significant differences in the time interval to decision, intensive care unit stay, ventilation days, and mortality.Conclusion: The WBCT decreased the number of CT scans and subsequent less use of radio-contrast amount. It also tended to reduce severe AKI. (J Acute Care Surg 2016;6:18-22)

중증 외상환자의 병원 간 이송에 지상 이송의 효용과 Mobile Trauma Unit의 효과에 대한 연구

변은애,경규혁,김성집,금민애,박성균,김지훈 대한외상중환자외과학회 2019 Journal of Acute Care Surgery Vol.9 No.1

Purpose: The author’s trauma center implemented Mobile Trauma Units (MTU), which are ground transportation automobiles constructed with advanced medical equipment, in an attempt to improve the survival rate of severe trauma patients. The purpose of this study was to examine the efficacy of MTU as a means of inter-hospital transfer of patients in urban environments.Methods: Patients with an injury severity score (ISS) of 16 or more were enrolled in this study. The participants must also be patients who were transferred with the MTU in the 18 months between January 2017 and June 2018. To assess the survival probability, the revised trauma score (RTS), trauma and injury severity score (TRISS), and w-score were used as the outcome indices.Results: Forty-four (86.3%) of the severe trauma patients with an ISS of 16 or more were male and 7 (13.7%) were female. The number of patients from the territory were 32 (62.7%), and patients from the others were 19 (37.3%). All the patients received their injury from blunt force trauma. The average time of from the scene of the accident to the trauma center was 176 minutes. In 13 deaths, 10 (76.9%) of the RTS values were below 4 points. Among the 51 patients, TRISS was more than 0.5 in 32 patients (62.7%). The w-score was 13.25 and the actual survival rate of a patient was 74.50%.Conclusion: Ground transportation automobiles that use MTU for severe trauma patients in urban areas are more economically beneficial and more efficient. The survival rate while using MTU was also shown to be higher than that of medical helicopter transfers.

The Effect of Systematic Approach to Tracheostomy Care in Patients Transferred from the Surgical Intensive Care Unit to General Ward

정윤중,김영환,경규혁,금민애,김태현,마대성,홍석경 대한중환자의학회 2019 Acute and Critical Care Vol.34 No.1

외상환자의 치료에서 외상 전문간호사 도입 결과

정윤중 ( Yooun Joong Jung ),김영환 ( Young Hwan Kim ),김태현 ( Tae Hyun Kim ),금민애 ( Min Ae Keum ),마대성 ( Dae Sung Ma ),경규혁 ( Kyu Hyouck Kyoung ),김정재 ( Jung Jae Kim ),홍석경 ( Suk Kyung Hong ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.4

Purpose: Ongoing treatment and care, as well as initial stabilization, are required for trauma patients. With increasing number of sickest trauma patients and shortage of surgeons, the need for advanced practice nurse to provide and coordinate trauma care has been greater. The purpose of this study is to analyze the effect of hiring a trauma clinical nurse specialist and its influence on the treatment of trauma patients. Methods: Based on the employment of the clinical nurse specialist in December 2010, the patients were divided into two groups: patients admitted from January 1, 2010 to November 30, 2010 and patients admitted from December 1, 2010 to December 31, 2011. Retrospectively, data were collected using electronic medical records. The general characteristics, clinical courses, and ICU re-admission rates, collaboration (transfers to other departments and collaborative surgery) were compared. Results: To have a clinical nurse specialist on the trauma team resulted in a statistically significant reductions in the length of general ward hospital stay (p<0.05), the ICU re-admission rate, (p<0.03), the lead-time before transfer to other departments (p<0.05). Conclusion: The clinical nurse specialist, as a professional practitioner, improved the quality of treatment through early detection and management of problems. In addition, as a coordinator, the clinical nurse specialist maintained a cooperative relationship with multi-disciplinary medical personnel. The trauma clinical nurse spe-cialist contributed to the treatment of trauma patients positively through a decrease in ICU re-admission rate and length of hospital stay. (J Trauma Inj 2012;25:254-260)