응급센터에서의 수혈치료

조영덕,최성혁,윤영훈,김정윤,박상민,임채승 대한수혈학회 2013 大韓輸血學會誌 Vol.24 No.1

Background:Most patients requiring transfusion are admitted to the general ward; however, the number of patients visiting the emergency department for transfusion is increasing. In this study, we reviewed the transfusion therapies that are performed in the emergency department and analyzed their status. Methods:We conducted a retrospective review of the charts of patients who visited the emergency department in our hospital for transfusion therapy from October 1, 2008 to October 30, 2012. We collected and analyzed general information on the patients and divided them into groups according to the number and kind of blood products they received. Results:A total of 4,497 patients visited the emergency department for transfusion therapy during the study period. Among 4,497 patients, 2,925 patients were enrolled in the study and 1,572 patients were excluded. Out of 2,925 patients, there were 1,745 male patients (59.66%) and 1,180 female patients (40.34%), mean age was 61.24 (±17.49); 2,340 patients (80.00%) were admitted, 364 (12.45%) discharged, 44 (1.50%) expired, and 177 (6.05%) were transferred. The most common cause for transfusion was upper and lower gastrointestinal bleeding (928, 32%), followed by trauma (548, 19%), malignancy (376, 13%), anemia (294, 10%), infection (281, 10%), and gynecologic (137, 5%) respectively. Conclusion:Performance of transfusion therapy in the emergency department is not uncommon; therefore, proper protocols by cause of bleeding will be required for prevention of unnecessary complication that may occur during transfusion therapy. 배경: 수혈을 필요로 하는 대부분의 환자들은일반 병동으로 입원하나 최근에는 수혈 치료를위하여 응급센터를 방문하는 환자들의 수가 늘어가고 있다. 이 연구에서는 응급센터에서 수혈치료를 받은 환자들의 현황에 대한 조사 및 분석을하고자 한다. 방법: 본 연구자들은 2008년 10월 1일부터 2012 년 10월 30일까지 수혈치료를 위하여 본원 응급센터를 방문한 환자들의 차트를 후향적 연구로검토하였다. 환자들의 일반적 자료들을 수집했으며 수혈치료의 수와 종류에 따라 여러 그룹으로나눈 후 결과를 분석하였다. 결과: 연구 기간 동안 총 4,497명의 환자가 수혈치료를 받았으며 그 중 1,572명이 제외되고2,925명이 연구에 포함됐다. 총 대상 중 남자1,745명(59.66%), 여자 1,180명(40.34%), 평균나이61.24세(±17.49)였으며 2,340명(80.00%)이 입원, 364명(12.45%)이 귀가, 44명(1.50%)이 사망, 177 명(6.05%)이 전원 조치되었다. 수혈치료를 받은가장 흔한 원인은 위장관 출혈(928명, 32%)이었으며 그 뒤로 외상(548명, 19%), 종양(376명,13%), 빈혈(294명, 10%), 감염(281명, 10%) 그리고 산부인과적 출혈(137명, 5%) 등이었다. 결론: 응급센터에서 수혈치료는 쉽게 접할 수있으며 각각의 원인에 적합한 수혈치료 방법이치료 중 발생할 수 있는 합병증 예방을 위하여 필요할 것이다.

Simple Maturation of Direct-Converted Hepatocytes Derived from Fibroblasts

조영덕,윤상태,강교진,김요한,이승범,서대관,류기영,정재민,최동호 한국조직공학과 재생의학회 2017 조직공학과 재생의학 Vol.14 No.5

Target cells differentiation techniques from stem cells are developed rapidly. Recently, direct conversion techniques are introduced in various categories. Unlike pluripotent stem cells, this technique enables direct differentiation into the other cell types such as neurons, cardiomyocytes, insulin-producing cells, and hepatocytes without going through the pluripotent stage. However, the function of these converted cells reserve an immature phenotype. Therefore, we modified the culture conditions of mouse direct converted hepatocytes (miHeps) to mature fetal characteristics, such as higher AFP and lower albumin (ALB) expression than primary hepatocytes. First, we generate miHeps from mouse embryonic fibroblasts (MEFs) with two transcription factors HNF4a and Foxa3. These cells indicate typical epithelial morphology and express hepatic proteins. To mature hepatic function, DMSO is treated during culture time for more than 7 days. After maturation, miHeps showed features of maturation such as exhibiting typical hepatocyte-like morphology, increased up-regulated ALB and CYP enzyme gene expression, down-regulated AFP expressions, and acquired hepatic function over time. Thus, our data provides a simple method to mature direct converted hepatocytes functionally and these cells enable them to move closer to generating functional hepatocytes.

애매한 담도협착의 평가: 내시경 진단

조영덕 대한췌담도학회 2012 대한췌담도학회지 Vol.17 No.1

Noninvasive techniques including transabdominal US, CT, and magnetic resonance imaging (MRI) are extremely sensitive for detecting bile duct dilation. However, these techniques are less accurate for determination of the underlying cause when a mass lesion is not identified. Recent advances in endoscopic techniques have improved our ability to differentiate between benign and malignant lesions. IDUS, using an endoscopic approach, has the potential to aid in separating benign and malignant biliary lesions. EUS is used to assist in differentiating between benign and malignant strictures or in the staging of cholangiocarcinoma. Tissue sampling under EUS guidance should improve the diagnostic rate, depending of the origin of the stenosis. EUS-guided FNA is being used to diagnose and stage cholangiocarcinoma. This procedure is safe, and effective in evaluating proximal biliary strictures. When used in combination with ERCP, it helps distinguish benign from malignant strictures, and facilitates a definitive diagnosis by increasing tissue yield. Direct visualization of biliary mucosa using a peroral or percutaneous transhepatic cholangioscopy also helps separate benign from malignant biliary strictures.

2002 년도 춘계학술대회 - 심포지엄 2 / 소화기질환과 삶의 질 : 만성 췌장염 환자의 삶의 질

조영덕 대한소화기학회 2002 대한소화기학회 춘계학술대회 Vol.2002 No.-

기관지 천식환자의 기관지 폐포세척 세포의 H2O2 형성능

조영덕,조주영,김현태,어수택,정연태,김용훈,박춘식 대한천식알레르기학회 1991 천식 및 알레르기 Vol.11 No.4

It is now becoming clear that asthma is a chronic inflammatory disease, involving many interacting cells. Although there may be several ways of initiating these inflammatory response, the precise relationship between damage of airway epithelium and bronchial hyperresponsiveness in patients with bronchial asthma is still not certain Bronchial hyperreactivity, which is the characteristic parameter for diagnosis of bronchial asthma, was reported to be determined by the degree of bronchial damage, inhalation of platelet activating factor produce bronchoconstriction in normal and asthamtic subjects and desensitization to PAF-induced bronchoconstriction by repeated inhalation of PAF To search for the role of bronchoalveolar lavage cells in development of bronchial hyperreactivity through generation of H,O, and desensitization of these cell to PAF, we measured the H,O, generation by bronchoalveolar lavage cell in 16 bronchial asthmatic patients and in 21 normal subjects, The results were as follows, 1. The generation of H,O, by bronchoalveolar lavage cells were higher in patients with bronchial asthma than that of control group. 2. The generation of H,O, to PAF-stimulus was not responed in asthmatic patients but that was increased significantly(p<0.05) in control group, 3, the generation of basal H,O, increased proportionally with the number of eosinophils in bronchalveolar lavage fluid. 4. The number of epithelial cells in bron- choalveolar lavage fluid increased proportionally with generaton of H,O, In conclusion, bronchoalveolar lavage cells including eosinophils might be have a role in development of bronchial hyperreactivity through the damage of ciliated epitheilum by the generation of H,O, and these cells were desensitized to PAF in asthmatic patients.

수술이 불가능한 간문부 담관암 환자에서의 광역동 치료 효과

조영덕 대한췌담도학회 2005 대한췌담도학회지 Vol.10 No.2

비록 광역동 치료가 고식적이고 담즙 배액관 삽입과 병행하여 시행하고 있으나 시술과 관련된 뚜렷한 합병증이 없고 반복적 시술이 가능하면 여러 연구에서 삶의 질 및 생존률의 향상이 있어 수술이 불가능한 담관암환자에서 광역동 치료는 뚜렷한 이득이 있는 것은 사실이다. 담관암의 특징이 담도를 따라 종양이 확산되는 특징이 있어 원격성 전이가 없는 Bismuth 3형, 4형에서 광역동 치료는 유용하며 신체적 또는 고령으로 인해 수술을 시행할 수 없는 Bismuth 1, 2형 그리고 하부 담관암환자에서도 광역동치료를 병행하는 것은 유용할 것으로 생각한다. 그러나 좀 더 많은 증례 수에서 전향적 비교 연구 및 장기간 추적 관찰이 광역동 치료의 역할을 규명하는데 필요할 것으로 생각한다.

전혈과 혈청에서의 칼륨 이상소견 검사의 차이

조영덕,최성혁,윤영훈,박상민,김정윤,임채승 대한수혈학회 2012 大韓輸血學會誌 Vol.23 No.2

Background:Potassium, the most common cation in the intracellular space, plays a critical role in our physiology. Potassium imbalance may cause life-threatening problems, ranging from general weakness to cardiac arrest due to ventricular fibrillation. For emergency physicians, detection of such derangement within a short period of time is of critical importance. In this study, we wanted to determine whether analysis of whole blood samples can be used as a screening tool for potassium imbalance by comparative analysis of whole blood and serum samples. Methods:Two samples were drawn from 227 patients. The whole blood sample was taken from the radial artery and contained in a commercially available arterial blood collection syringe with a lithium-heparin coating. The serum sample was contained in a commercially available vacuum bottle in a non-additive silicone coated tube and transported to the laboratory. The study population was divided into three groups, patients with normal whole blood potassium, patients with decreased whole blood potassium, and patients with elevated whole blood potassium. Potassium levels for each group were coupled with serum potassium levels and compared. Results:No significant difference in potassium values was observed between whole blood and serum samples (P<0.05). Strong associations were observed among the three groups (normal range, hypokalemia, and hyperkalemia group). Compared to the normal group (r=0.851), the hyperkalemia group showed a stronger association between variables (r=0.897), and the hypokalemia group showed a weaker association (r=0.760). Their correlation coefficients were highly significant (P<0.05). Conclusion:Our study illustrates that point-of-care testing using whole blood with whole blood can be a reliable screening tool when treating patients with suspicious potassium abnormality, especially in hyperkalemia patients.

전문가 인터뷰를 통한 건설 프로젝트 설계 및 시공단계의 BIM 적용현황 및 개선전략 분석

조영덕,이주성,김재준 한국CDE학회 2021 한국CDE학회 논문집 Vol.26 No.4

BIM has been applied in various ways based on success in the United States, Europe and Japan. Based on this, the government mandates BIM for large domestic public orders such as Public Procurement Service and LH. However, the effectiveness of BIM application is being degraded due to the lack of detailed and quantitative BIM application strategies such as BIM Standard, Project Execution Plan, contract system, and evaluation standards for BIM companies and experts. This study conducted expert interviews to derive construction companies' BIM application status, problems, and improvement strategies. Questionnaires were selected to comprehensively understand both company-level strategies and project-level strategies, and based on this, in-depth interviews were conducted with four BIM experts from major domestic companies. Research results and improvement strategies analyzed through interview can be used as basic data for future BIM Standard and application strategies.

췌장암의 증상 경감을 위한 보존요법

조영덕 대한소화기학회 2008 대한소화기학회지 Vol.51 No.2

Unfortunately, only a minority of patients with pancreatic cancers are suitable for resection and potential cure. Despite recent advances in systemic treatment of patients with advanced pancreatic cancer, the prognosis still remains poor. The median survival of patients in whom pancreatic cancers are surgically unresectable is 6 months. Thus, optimal palliation of symptoms to maximize remaining quality of life is of primary importance to most patients. Common problems include pain, unexplained weight loss, nausea, vomiting, streatorrhea, dyspepsia, depression, and jaundice. Management is directed at the palliation of symptoms. Treatment of patients with locally unresectable, recurrent, or metastatic disease is individualized, cosidering the patient age, patient wishes, family influence, and insurance constraints. Success in managing progressive symptoms is needed to palliate patients with advanced pancreatic cancer. (Korean J Gastroenterol 2008;51:119-126)

대청도 자생 순비기나무 토양환경특성과 번식

조영덕 한국토양비료학회 2006 한국토양비료학회 학술발표회 초록집 Vol.2006 No.10