대퇴동맥을 통한 경피적 관동맥 중재시술 환자의 천자부위 지혈을 위한 Angioseal^(�) 사용과 고식적 용수 압박법의 비교 : 전향적 연구

김용훈,권현철,김필호,안석진,유철웅,최진호,이상철,김준수,김덕경,전은석,이상훈,홍경표,박정의,서정돈 대한내과학회 2004 대한내과학회지 Vol.66 No.5

목적 : 경피적 관동맥 중재술은 최근 양적 및 질적으로 급격한 발전을 보였지만 시술 시 천자부위의 혈관 합병증은 아직 해결해야 할 문제점이다. 저자들은 대퇴동맥을 통한 경피적 관동맥 중재술을 환자에게 천자부위 지혈을 위한 혈관폐쇄기구인 안지오실의 안전성과 유용성을 고식적인 용수 압박법과 비교 연구하고자 하였다. 방법 : 2002년 4월부터 2003년 5월 사이에 삼성서울병원 심장혈관센터에서 대퇴동맥을 통한 경피적 관동맥 중재술을 성공적으로 시행한 200명의 환자(안지오실 사용군: A군, 100명, 고식적 용수압박법 사용군 B군, 100명)를 대상으로 시술 후 주요 합병증 및 경한 합병증, 지혈 후 환자가 자리에 앉기까지의 시간, 보행개시 가능시간, 총 재원 기간과 시술 1주 후의 합병증을 전향적으로 조사하여 비교 연구하였다. 결론 : 두 군에서 연령, 성별, 기저질환, 심혈관 질환의 위험요소, 시술의 종류, 시술 중 사용한 헤파린의 양, clopidogrel의 양, ticlopidine의 양, 지혈 시 수축기와 확장기혈압, ACT (activated clotting time)는 차이가 없었다. A군이 B군에 비해 시술 후 자리에 앉기까지의 시간 (A군: 4.3±0.3시간, B군: 13.7±0.8시간, p=0.004) 및 보행개시까지의 시간(A군: 6.8±0.5시간, B군: 18.8±2.1시간, p=0.013)이 유의하게 짧았다. 시술 후 주요 합병증은 두군 모두에서 관찰되지 않았으며, 경한 합병증의 전체발생은 A군에서 유의하게 적었다(A군: 28명, B군: 19명, p=0.003). 반상출혈의 경우는 A군에서 유의하게 낮았지만(A군: 3명, B군: 12명, p=0.01), 혈종, 출혈의 발생은 두군간에 차이가 없었다. 총 재원기간에는 두 군간에 차이가 없었다(p=0.239). 시술 1주 후 경과관찰에서 주요합병증은 역시 두 군 모두에서 관찰되지 않았으며, 경한 합병증의 전체발생은 두 군에서 차이가 없었다(A군: 15명, B군: 13명 p=0.418), 반상출혈의 빈도는 차이가 없었지만 혈종의 발생은 A군에서 더 낮았다(A군: 2명, B군:6명, p=0.004). 두 군 모두에서 출혈은 발생하지 않았다. 결론 : 대퇴동맥을 통한 경피적 관동맥 중재술을 시행한 환자에서 안지오실의 사용은 고식적 용수 압박법에 비해 환자의 침상 안정시간을 줄여 조기 활동개시가 가능하게 하였으며 국소합병증의 위험도를 일부 낮추어, 시술에 따른 환자의 불편을 현저하게 감소시킬 수 있다고 할 수 있을 것으로 기대된다. Background : Although the number and the quality of percutaneous coronary intervention have been recently increased dramatically, the vascular complication at puncture site is still the major cause of patients' morbidity. We evaluated the safety and efficacy of newly of newly-developed collagen-based arterial closure device, Angioseal after transfemoral percuatenous coronary intervention. Methods : This study was designed as a prospective single center non-randomized comparative study. A total 200 patients undergoing transfemoral percutaneous coronary intervention were enrolled between April 2002 and May 2003. They were divided into two groups; Angioseal group (group A, n=100) and manual compression group (group B, n=100). The baseline clinical and angiographic characteristics were reviewed. The time to sit up, the time to ambulation, the duration of hospital stay, major and minor vascular puncture site complications were monitored. The patients were followed-up for 1 week after procedure by telephone. Results : The baseline clinical characteriwtics, clinical diagnosis, cardiocascular risk factors, typesof procedure, doses and numbers of anticoagulants were similar between two groups. The blood pressure and activated clotting time were also similar. The time to sit up (group A: 4.3±0.3 hours, group B: 13.7±0.8 hours, p=0.004) and the time to ambulation (group A: 6.8±0.5 hours, group B: 18.8±2.1 hours, p=0.013) were shorter in group A. No major vascular complications were noted. The incidence of hematoma and bleeding were not significantly different between two groups. The incidence of ecchymosis, however, was significantly lower in group A (group A:12%, group B: 3%, p=0.001) The duration of gospital stay was similar between groups. During 7 days of follow-up period incidence of hematoma was significantly lower in group A (p=0.004). Although the incidence of ecchymosis was not significantly different between two groups. Conclusion : The angioseal may be associated with earlier ambulation and less patients' morbidity with low incidence of local complication rate compared to manual compression after transfemoral percutaneous coronary intervention.

심한 골병변으로 발현된 기능성 낭종성 부갑상선 선종

전숙,김영희,박지영,고관표,박철영,김덕윤,우정택,김성운,김진우,김영설,고석환 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.2

낭종성 부갑상선 선종과 심한 골병변을 동반한 부갑상선 기능항진증은 매우 드문 질환으로서, 저자들은 양측 고관절의 통증을 초기 주소로 내원한 환자에서 고칼슘혈증과 부갑상선 호르몬 증가, 골병변의 방사선적 소견을 통해 부갑상선 기능항진증을 진단하고, 경부 초음파와 컴퓨터 단층 촬영, 부갑상선 스캔검사 및 수술중 부갑상선 낭종액 검사 등을 통해 기능성 부갑상선 낭종의 한 종류인 낭종성 부갑상선 선종을 진단하고 수술적 제거를 통하여 정상화된 1예를 경험하였다. A cystic parathyroid adenoma is rare. A case of primary hyperparathyroidism, with the cystic formation of a parathyroid adenoma and a severe bony lesion, is reported. A 52-year-old male was admitted due to pain in both hips and for evaluation of hypercalcemia. The plasma level of the intact parathyroid hormone (iPTH) was elevated to 1424 pg/mL. Ultrasonography and the computed tomography revealed a parathyroid cyst on the left thyroid lower pole. Parathyroid scintigraphy detected a parathyroid adenoma. A radiograph showed a subperiosteal bone resorption on the phalanges, and a brown tumor (osteitis fibrosa cystica) on the femur shaft was noted. A surgical excision of the parathyroid adenoma was performed. The PTH level in the cystic fluid was increased. A histological examination confirmed a cystic parathyroid adenoma. The PTH level was normalized after the operation (J Kor SOC Endocrinol 18:214-220, 2003).

결장직장암 환자의 임상적 고찰 : 조선대학교 부속병원의 10년 간의 결과

나은종,문성표,장정환,김권천,민영돈,김성환,조현진,김정용,김경종 朝鮮大學校 附設 醫學硏究所 2005 The Medical Journal of Chosun University Vol.30 No.2

Background and Objectives: The colorectal cancer rates 4th in the total cancer prevalence in Korea. The clinical patient demographics were considered with the incidence rate of the colon and rectal cancer. The clinicopathological factors were analyzed for the 5 year survival rate. Materials Methods: Of the 282 patients who were operated from Jan. 1, 1992 to Dec. 31, 2001 and diagnosed by pathological biopsy as colo-rectal cancer, 234 patients were followed up. The age, sex, location of the cancer, TNM stage, operation method, histopathological classification, metastatic region, complications after operation and the survival rate were investigated. Results: Of the 234 patients, male and female consisted of 120 cases (51.3%) and 114 cases (46.7%), with an average age of 61.6 years. The average follow up period was 52.3 months and the peri operative mortality was 5.6%. The site of the cancer was most frequent at the rectum with 127 cases (54.3%). The patients were classified according to the TNM stages with 38 cases of stage 1 (16.2%), 98 cases of II (41.9%), 72 cases of III (30.8%) and 26 cases of IV (11.1%). The 5 year survival rate in the age group older than 50 was 63.3 % and 73.5% in the group younger than 50. In regard to the operation type, the 5 year survival rate was 65.4% for elective operation and 65.8% for emergency operation. The 5 year survival rate for well differentiated, moderately differentiated, poorly differentiated cancer, and mucinous adenocarcinoma was 73.7%, 60.2%, 58.3%, and 92.6%, respectively. The 5 year survival rate of each of the TNM stage is 81.1%, 74.8%, 57.0%, and 11.5% for Classes I, II, III, and IV, respectively. Conclusion: The clinical factors were analyzed for the 5 year survival rate with no statistical significance for the age, sex, and location of the cancer. The TNM stage and histopathological differentiation were statistically significant. The colon cancer showed better prognosis compared to the rectal cancer.

鎔接殘留應力이 應力比에 따라 疲勞龜裂傳播에 미치는 影響

表東根,李龍福,金鍾鉉,吳湞淵 弘益大學校 1989 弘大論叢 Vol.21 No.2

To examine the effects of the welding residual stress on Mode I fatigue crack propagation behavior, 3mm thickness SS41 steel plate was welded by an Auto-matic Submerged Arc Welding. Initial residual stress and relaxation residual stresses according to each stress ratio were measured. The fatigue crack propagation behavior from the region of compressive residual stress to region of tensile residual stress was analyzed. The results predicted by the Forman's equation using the superposition approach of the respective stress intensity factors for the initial residual stress and for the applied stress according to each stress ratio were compared with experimental data. The validity of the superposition approach was investigated. The conclusion are summerized as follows: 1. When the component is subjected to a constant amplitude cyclic tensile loading, the welding residual stress is reduced as stress ratio increase. 2. As the fatigue crack is propagation through the compressive residual stress field, it was found that the effects of welding compressive residual stress on fatigue crack growth in weldments, and the stress ratio decreases, become larger and delay the fatigue crack growth rate. 3. For negative values of the effective stress ratio, R? in the welding compressive residual stress field, the prediction of fatigue crack growth rate by the Forman's equation were found to be corresponded to experimental data for stress ratio R?0.3, as the effective stress ratio R? approached zero, when the stress ratio R>0.3 the prediction of the fatigue crack growth rate by Forman's equation were found to be impossible.

Angiotensin Concerting Enzyme 유전자의 유전적 다형성(Genetic Polymorphism)이 관상동맥 질환 위험인자에 따른 혈중 Plasminogen Activator Inhibitor-1의 농도에 미치는 영향

김덕경,김종원,권현절,류재춘,박승우,김준수,이상훈,홍경표,박정의,이원로 대한고혈압학회 1996 대한고혈압학회지 Vol.2 No.2

고속가공시 다중센서를 이용한 가공상태 감시 기술

김전하,강명창,김정석,나승표,김기태 한국공작기계학회 2000 한국공작기계학회 추계학술대회논문집 Vol.2000 No.-

The high hardened materials that are remarkable in aspects of durability have been used for die and mold industry. As the high hardened materials are hard to machine, the high-speed machining is essential to manufacture these materials. Currently, in the general turning and milling, experiments to the tool wear monitoring have studied, but those have not applied in high-speed machining. In this study, the cutting mechanism was analysed by the cutting force according to cutting conditions, and the parameters to monitor the tool wear were selected from the tendency of the cutting force and acceleration according to cutting length in the high-speed machining of the high hardened materials(STD11).

한국형 우울장애 약물치료 알고리듬 2006 (Ⅲ) : 정신병적 양상을 동반한 주요우울삽화

김원,박원명,서정석,민경준,석정호,전덕인,전현태,이상열,송해철,홍진표,한국형 우울장애 약물치료 알고리듬 2006 연구그룹 大韓神經精神醫學會 2007 신경정신의학 Vol.46 No.6

Objectives : Since the publication of Korean Medication Algorithm Project for Major DepressiveDisorder (KMAP-MD) in 2002, there has been a substantial need for a revision due to rapid progress in the pharmacological management of depressive disorder. We revised KMAP-MD 2002 and developed the Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) 2006. Methods : We developed a questionniare for surveying the opinion of experts on pharmacotherapy of depressive disorder. The questionnaire consisted of 4 parts ; 1) treatment of non-psychotic depressive disorder, 2) treatment of psychotic de-pressive disorder, 3) treatment according to clinical subtypes and drugs choice considering adverse effects, and 4) treatment of depressive disorder in women. The questionnaire was completed by the review committee consisting of 101 experienced Korean psychiatrists. It is composed of 22 questions, and each question includes 54 sub-items. We classified the expert opinionto 3 categories (the first-line, the second-line, or the third-line) by χ²-test. Results : For depressive disorder with psychotic features, most reviewers prefer the combination of antidepressant and atypical antipsychotics. Electroconvulsive therapy and the combination of antidepressant and typical antipsychotics were the second-line treatment. Among antidepressants, venlafaxine was the most preferred, and SSRI and mirtazapine followed. Among atypical antipsychotics, quetiapine, risperidone and olanzapine were the most preferred, in this order. In patients who have no response to the first-line treatment, many reviewers recommended switching to another antidepressant or adding another atypical antipsychotics Conclusion : For severe depressive disorder with psychotic features, the combination of antidepressant and atypical antipsy-chotics was preferred for the first-line treatment. These results suggest that the medication strategies of depressive disorder are rapidly changing and reflects the recent studies and clinical experiences.

의사소통의 활성화가 수학적 추론 능력의 발달에 미치는 영향에 관한 사례연구

김익표,권은영,최정현 大邱大學校 師範大學 附設 敎育硏究所 2010 學校敎育硏究 Vol.5 No.2

NCTM(2000, p.60)은 수학적 추론 능력의 신장을 위한 의사소통의 활성화를 강조하고 있다. 그리고 추론을 포함한 수학적인 활동의 활성화를 위한 학생들 사이의 의사소통을 강조한 사례연구(Elbers, 2003; Goos, 2004)도 소개되었다. 이와 같이 많은 문헌들이 수학적 추론과 의사소통과의 관련성을 언급 하고 있지만 서로 어느 정도의 영향을 미치고 있는지에 대한 연구가 부족한 실정이다. 추론과 의사소통 을 포함한 수학적인 활동들이 별개의 것이 아닌 통합된 전체의 각 부분을 차지하면서 밀접하게 관련되어 있음을 인지하는 것은 학교 수학에서 중요한 부분이다. 따라서 수학교육의 목표를 향하여 가는 학생 들에게 관계망으로 연결된 수학적인 활동들은 효과적으로 목표에 도달할 수 있도록 도와주는 뼈대의 역할을 할 것이다. 본 연구의 목적은 학교 수학에서 의사소통의 활성화가 수학적 추론능력의 신장에 미치는 영향의 분석이다. 이를 위하여 학생들에게 단계적인 과제의 제시를 통하여 의사소통의 활성화를 유도하고 이것이 수학적 추론 능력의 신장에 미치는 영향을 탐색하고자 한다. The importance of mathematical communication and mathematical reasoning is currently standing out in mathematics education. As a matter of fact, lots of theses and documents are dealing with this subject, and are mentioning that these two factors develop together. However, there are few qualitative case studies in this fields. So, this study aimed at qualitative case study about the effects of active communication on mathematical reasoning devolopment throughout the experiments. This study recorded the process of improving mathematical reasoning through mathematical communication. For this, various problems which are from basic to advanced were presented by degrees. We hope this study has a lot of discussions about various methods in order that mathematical communication occurs actively in schools and that students become to recognize the importance of mathematical reasoning.

선형 및 비선형 초음파를 이용한 1Cr-1Mo-0.25V의 열화평가에 관한 연구

김정표,석창성,송성진,김영환 한국비파괴검사학회 2001 한국비파괴검사학회지 Vol.21 No.5

초음파법은 산업설비의 열화 정도나 결함을 평가하기 용이한 비파괴적 방법이다. 본 연구에서는 1Cr-1Mo-0.25V을 630°C에서 등온열화처리하여 4개의 시편을 준비하였다. 이를 사용하여 초음파의 속도, 감쇠계수를 측정하여 재료의 열화를 평가하였으며, 배진동의 발생효률을 나타내는 비선형파라미터를 이용하여 재료의 열화정도를 평가하였다. 감쇠계수와 비선형파라미터는 열화가 진행될수록 증가하였으며, 특히 1,820 시간 열화시편의 배진동 진폭은 원시시편의 배진동 진폭과 비교시 20dB이상 증가하였다. 그러나 열화정도에 따른 속도의 변화는 거의 없는 것으로 나타났다. 본 연구결과에서 감쇠계수와 비손형파라미터는 재질 열화에 민감하게 반응하는 파라미터였으며, 재질 열화도를 평가하기에 적절한 파라미터인 것으로 사료된다. Ultrasonic is a powerful nondestructive technique for getting the information of flaws and material properties of in-services facilities. We prepared 4 different 1Cr-1Mo-0.25V specimens by isothermal aging at 630°C. We evaluated material degradation using ultrasonic parameters, velocity, attenuation and harmonic generation. Attenuation and nonlinear parameter derived from harmonic generation efficiency increased as degradation. Especially the second harmonic of the fundamental wave in the 1,820 h aging material was observed to exceed 20 dB more than that in the un-aged material. But velocity remained virtually the same for all specimens. We concluded that nonlinear parameter and attenuation are sensitive to material degradation, but velocity was not. It'll be a good parameter for evaluating the material degradation.

폐결핵 환자의 우울 상태

홍정표,최선희,조만종,이성주,박종,김기순,김양옥 朝鮮大學校 附設 醫學硏究所 1997 The Medical Journal of Chosun University Vol.22 No.1

The main purpose of this study is to identify and evaluate the depressive states for the patients with chronic pulmonary tuberculosis. A questionnaire(Self-rating Depression Scale, SDS) survey was performed toward 57 pulmonary tuberculosis patients with initial treatment who started chemotherapy and 53 pulmonary tuberculosis patients with retreatment, admitted to one tuberculosis-centered hospital and two general hospital. Fifty three healthy persons as control group were investigated with the same questionnaire for comparison. The survey was performed from July to August 1996. The results are as follws : 1. The patients had significantly high scores in the depression than control and the patient with retreatment showed significantly high scores in the depression than the patient with initia1treatment(P<0.01). 2. The depressive levels of the patients were associated with duration of admission and the expectancy of recovery (P<0.05). 3. The percentage of the subjects with 40 or more scores tentatively classifiable as psychologically depressed was 67.1% of the total subjects, 48.4% of the control groups, 75.0% of the patient with initial treatment and 84.1% of the patient with retreatment. Because patient with pulmonary tuberculosis with initial treatment showed higher depression scores than normal persons, and patients with retreatment due to failure of initial treatment showed higher depression scores than initial treatment, it is necessary to give attention to depression of the patients during treatment of pulmonary tuberculosis.