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나승원 ( Seung Won Ra ),박태선 ( Tai Sun Park ),홍윤기 ( Yoon Ki Hong ),홍상범 ( Sang Bum Hong ),심태선 ( Tae Sun Shim ),임채만 ( Chae Man Lim ),이상도 ( Sang Do Lee ),고윤석 ( Youn Suck Koh ),김우성 ( Woo Sung Kim ),김동순 ( Dong 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.64 No.2
연구배경: 폐확산능을 해석하는 데 필요한 정상예측식으로는 한국인을 대상으로 하여 박 등이 개발한 식(박 식)이 있으나 아직 외국 정상예측식을 많이 사용하고 있다. 이에 국내에서 많이 사용하는 외국 정상예측식인 Burrows 식과 박 식의 임상적 유용성과 정확성을 비교하고자 하였다. 방법: 1. 임상적 유용성 연구; 2006년 7월부터 12월까지 6개월간 폐확산능검사를 시행한 환자 중 두 식을 각각 정상예측식으로 적용하였을 때 폐확산능 해석이 다른 276명(대상군 A)을 대상으로 하였다. 대상군 A에게 두 식을 각각 적용하였을 때 폐확산능 해석과 임상적 판단과의 일치도를 비교하여 임상적 유용성을 평가하였다. 2. 간질성폐질환 진단의 정확성 비교; 2001년부터 2006년까지 폐조직검사를 시행하여 확진된 간질성폐질환군과 서울아산병원에서 모집한 정상군을 대상으로 하여 정상예측식으로 두 식을 각각 적용하였을 때 폐확산능 해석의 정확도를 비교하였고, 두 식이 차이가 나는지 맥니머의 카이스퀘어 검정을 하였다. 결과: 1. 임상적 판단과의 일치도 비교; 276명을 임상정보를 토대로 폐확산능을 예측하여 분류한 결과 정상 54명, 감소 220명, 불분명이 2명이었다. 예측식으로 박 식과 Burrows 식을 적용하였을 때 임상적 판단과 일치하는 환자는 각각 78%와 22%이었다(p<0.001). 2. 간질성폐질환 진단의 정확성 비교; 박 식은 민감도 90.1%, 특이도 100%이었고 Burrows 식은 민감도 64.2%, 특이도 100%로 민감도가 통계학적으로 유의하게 박 식이 높았다(p<0.001). 결론: 우리나라 정상예측식인 박 식이 외국 정상예측식인 Burrows 식을 정상예측식으로 적용하는 것보다 임상적 유용성이나 간질성폐질환 진단의 민감도에서 더 우월하였다. 향후 폐확산능검사의 정상예측식으로 박 식을 사용해야 할 것으로 사료된다. Background: Park et al. developed the Korean reference equation for the measurement of diffusing capacity in 1985. However, the equation has not been widely used in Korea and foreign reference equations have been popularly used. We intended to compare the clinical usefulness and the accuracy of the the Korean reference equation (Park`s equation) with that of the foreign equation (Burrows` equation) that is commonly used in Korea. Methods: 1. Evaluation of clinical usefulness; Among 1,584 patients who underwent diffusing capacity (DLCO) at the Asan Medical Center from July to December 2006, group A subjects included 276 patients who had different interpretations of DLCO in trials employing Burrows` equation and Park`s equation. Clinical assessment was decided by consensus of two respiratory physicians. In order to evaluate the clinical usefulness of Burrows` equation and Park`s equation, agreement of clinical assessment and DLCO interpretation were measured. 2. Evaluation of accuracy; Group B subjects were 81 patients with interstitial lung disease (ILD) and 39 normal subjects. The 81 ILD patients were diagnosed following a surgical lung biopsy. The accuracy of diagnosing ILD as well as sensitivity and specificity were evaluated according to the use of the reference equations (Burrows` equation and Park`s equation) for DLCO. Results: Agreement between clinical assessment and interpretation of DLCO was 22% for the use of Burrows` equation and 78% for the use of Park`s equation. The sensitivity and specificity of the Burrows` equation for diagnosing ILD were 64.2% and 100%. The sensitivity and specificity of the Park`s equation for diagnosing ILD were 90.1% and 100%. The sensitivity of the Park`s equation for diagnosing ILD was significantly higher than that of Burrows` equation (p<0.001). Conclusion: The Korean reference equation (Park`s equation) was more clinically useful and had higher sensitivity for diagnosing ILD than the foreign reference equation (Burrows` equation). (Tuberc Respir Dis 2008;64:80-86)
악성 점막하 종양과의 구별이 어려웠던 Gastritis Cystica Profunda 1예
선제형,박진석,한민석,김수항,김우진,박인형,이숭,유종선,박찬국 朝鮮大學校 附設 醫學硏究所 2006 The Medical Journal of Chosun University Vol.31 No.3
Gastritis cystica profunda (GCP) is a rare disease characterized by gastric foveolae elongation along with hyperplasia and cystic dilatation of the gastric glands extending into the tissue beneath the submucosa. GCP mainly develops at the gastroenterostomy stoma but can arise in a stomach that has not undergone surgery. The proposed pathogenesis is related to chronic inflammation, ischemia and the presence of a foreign body. GCP may present as a submucosal tumor, Polyp or a giant gastric mucosal fold. Endoscopic ultrasonography (EUS) is an effective diagnostic method for differentiating GCP from protruding and elevated gastric lesions. We report a case of GCP along with the endoscopic and EUS findings that were indistinguishable from a malignant submucosal tumor.
사망진단서(사체검안서) 상의 선행사인으로부터 사망통계의 원사인이 선정되는 비율 : 3개 대학병원에서 교부된 사망진단서를 중심으로
박우성,박석건,정철원,김우철,탁우택,김부연,서순원,김광환,서진숙,부유경 한국의료QA학회 2004 한국의료질향상학회지 Vol.11 No.1
Background : To exatnine the problems intolved in writing practice of death certificates, we cotnpated the determination of underlying cause of death for wital statistics using recorded underlying cause of death in issued death statistics. Methods : We collected 688 rnortality certificates issue in year of 2,000 from 3 university hospitals. And we also collected vital statistics from ministry of statistics. The causes of death were coded by experienced medical record wpecialists. And causes of death determined at ministry of statistics for national vita statistics were mapped to causes of death recorded at each death certificates. The rate that underlying causes of death for vital statistics were derived from underlying causes of death recorded at issued death certificaties sere analysed. Results : 64.5% of underlying cause of death for could be derived from underlying cause of death recorded at issued death certificates, 8.6% derived from intermediate cause of death, and 3.9% derived from direct cause of death. In 23% of cases, underlying cause of death could not be derived using issued death certificates. The rate that underlying cause of death for vital statistics could be derived from underlying cause of death recorded at death certificates was different between 3 university hospitals. Ane the rate was also different between death certificates and postmortem certificates. We classified the causes of death using 21 major categories. The rate was different between diseases or conditions tha caused death too. Conclusion : When we examined the correctness of death certificate writing practice using abpve methods, cortectness of writing could not be told as satisfactory. There was difference in correctness of writing between hospotals, between death certificates and postmortem certificates, and between diseases and conditions that caused death. With this results, we suggested some strategy to improve the correctness of death certificate writing practice.
Sun‑Woo Nam,Sang‑Min Park,Do‑Hyang Kim,Taek‑Soo Kim 대한금속·재료학회 2021 METALS AND MATERIALS International Vol.27 No.3
The extraction behavior of dysprosium (Dy) in a rapidly solidified Dy–Fe–B alloy system consisting of Dy2Fe14Band Dy6Fe23phases was investigated using the liquid metal extraction (LME) process. Liquid magnesium (Mg) was selected as the solventmetal in LME because it forms intermetallic compounds with Dy but not with iron (Fe) and boron (B) in this process. Thediffusion behavior of Dy was estimated through thermodynamic calculations and subsequently confirmed by process parameterssuch as temperature and reaction time. As the temperature increases, the extraction rate increases and the maximumextraction efficiency is about 74% Dy for 1 h at 1000 °C. As the reaction time increases, we achieved the maximum extractionefficiency of 95% Dy after 24 h at 900 °C. The factor affecting Dy extraction ratio up to 6 h is Dy6Fe23phase, after which theextraction mainly occurs in Dy2Fe14Bphase. Furthermore, the diffusion behavior is described in detail with analysis basedon microstructural and compositional properties. The effects of process parameters on extraction rate are also discussed.
하절기 단열 성능 향상을 위한 통기성 지붕의 통기 구조에 관한 실험적 연구
박상훈(Park, Sang-Hoon),조구상(Jo, Goo-Sang),이선우(Lee, Sun-Woo),여명석(Yeo, Myoung-Souk),김광우(Kim, Kwang-Woo) 대한건축학회 2014 대한건축학회논문집 Vol.30 No.9
The thermal performance of the building envelope is mainly required for guaranteeing a comfortable and hygienic interior climate. A roof is a part of the building envelope which provides protection from the thermal damage of the sun. To improve this protection ability, we can consider using a ventilated roof, which has a ventilation layer known as a cavity, beneath the roof cover panel. The objective of this study is to evaluate the influence of such factors as the slope of the roof, size or shape of the openings (i.e. inlet or outlet), effective cross section and cavity depth on the improvement of the air flow in the cavity for better thermal performance of the ventilated roof. In this study, the influence on air flow which is caused by the characteristics of these elements is researched. The evaluations are carried out by way of experiments.
Differentiation of Desmoplastic Spitz Nevus from Similar Conditions
( Min-woo Kim ),( Ji Soo Lim ),( Yun Seon Choe ),( Jung Ho Kim ),( Hyun-sun Yoon ),( Soyun Cho ),( Hyun-sun Park ) 대한피부과학회 2016 대한피부과학회지 Vol.54 No.9
The diagnosis of classic Spitz nevus with characteristic histopathologic findings is often straightforward, but unusual variants can cause diagnostic difficulties. Desmoplastic Spitz nevus (DSN) is of particular importance, as its differential diagnosis from other diseases, including desmoplastic malignant melanoma (DMM), is essential but often difficult<sup>1</sup>. A 38-year-old Caucasian woman presented with a 6-mm brownish papule of unknown onset on the dorsum of her left hand (Fig. 1A). She did not report any change in the papule size, trauma history, or related symptoms, but she wanted to have the lesion removed. Punch excision of the specimen revealed proliferation of individual spindle and epithelioid cells with scanty pigmentation within dense colla-genous dermal stroma (Fig. 1B, C). The specimen was focal positive for S-100 and HMB-45, positive for Melan-A, and 1% positive for Ki-67 (Fig. 2A∼C). The lesion did not recur after punch excision at the 1-year follow-up. Since its first report in 1975, there have been only a few case series of DSN owing to the rarity of this disease and its under-recognition, except for intermittent case reports<sup>1-3</sup>. DSN usually presents as a small red-brown papule on the trunk and extremities. It can occur at any age, but is mostly observed in young adults, with a slight female predominance. The distinctive histopathologic features of DSN―an intradermal growth pattern of large spindle or epithelioid nevus cells embedded in a fibrotic stroma, sparse melanin pigment, no junctional activity, no Kamino bodies, no prominent nest formation―can aid its differentiation from clinical simulators. Additionally, immunohistochemistry is essential for a differential diagnosis. DSN tests positive for S-100, Melan-A, and HMB-45, whereas dermatofibroma is negative for all three<sup>3</sup>. Hypomelanotic blue nevus shows uniform positivity for HMB-45, whereas DSN shows differential expression in most spindled cells3. The distinction between DSN and DMM is the most important. DMM is more common in elderly patients and tends to occur on sun-damaged head and neck areas. It also shows cellular atypia, strong mitotic activity and Ki-67 expression, less frequent S-100 and Melan-A positivity, and almost exclusive negativity for HMB-45<sup>2,3</sup>. Some researchers regarded DSN as an end stage of Spitz nevus that had lost continuity with the epidermis and undergone fibrosis. Paniago-Pereira et al.<sup>2</sup> also reported that DSNs occurred in patients older than 30 years. These findings suggest that desmoplasia might be an aging process of Spitz nevus. However, Barr et al.1 found no significant difference in patient age, disease duration, or trauma history between patients with DSN and common variants of Spitz nevus, and suggested that desmoplasia may be a tumor-induced reactive stromal induction rather than a regressive phenomenon. The pathogenesis of desmoplasia has not yet been clearly elucidated. Moreover, it is controversial whether DSN should be regarded as a variant of Spitz nevus or whether it belongs to a spectrum of desmoplastic nevus as a distinctive entity<sup>3,4</sup>. Some researchers5 suggested strict diagnostic criteria for de-smoplastic nevus, including greater cellularity in the super-ficial portion, and a mixture of melanocytic nevus cells, ovoid and dendritic melanocytes, and spitzoid melanocytes. Further, they mentioned that lesions in which one particular type of melanocyte predominates over others are more likely to represent DSN. Dermoscopic findings can also aid the distinction, because DSN shows dotted vessels and reticular depigmentation whereas desmoplastic nevus demonstrates a delicate pigment network over a pinkish background<sup>4</sup>. Although it is regrettable that we did not acquire dermoscopic image to support the diagnosis, our case overall seems more com-patible with DSN. However, the probability of a morphologic spectrum that embraces DSN and desmoplastic nevus cannot be excluded, and requires further studies. Here, we report an unusual desmoplastic variant of Spitz nevus with a literature review, and propose keynotes for differential diagnosis from its simulators, especially DMM.
한의진단명과 진단요건의 표준화 연구 III : 3차년도 연구결과 보고
최선미,양기상,최승훈,박경모,박종현,심범상,김성우,노석선,이인선,정진홍,이진용,김달래,임형호,김윤범,박성식,송태원,김종우,이승기,최윤정,신순식 한국한의학연구원 1997 한국한의학연구원논문집 Vol.3 No.1
The diagnostic requirements were suggested and explained regarding the systems of differentiation of symptoms and signs in the third year study of standardization and unification of the terms and conditions used for diagnosis in oriental medicine. The systems were as follows : - analyzing and differentiating of epidemic febrile disease - analyzing and differentiating in accordance with the Sasang constitution medicine based on four-type recognition - differentiation of disease according to pathological changes of Chong and Ren channels - standards for diagnosis of women's disease - standards for diagnosis of children's disease - standards for diagnosis of motor and sensor disturbance (-muscle. born, joint, etc.) - standards for diagnosis of neuropsychiatric disease - standards for diagnosis of five sense organ disease - standards for diagnosis of external disease The indivisual diagnosis pattern was arranged by the diagnostic requirements in the following order : another name, notion of diagnosis pattern, index of differentiation of symptoms and signs, the main point of diagnosis, analysis of diagnosis pattern, discrimination of diagnosis pattern, prognosis, a way of curing a disease, prescription, herbs in common use, disease appearing the diagnosis pattern, documents. The standards for diagnosis of each disease was arranged by the diagnostic requirements in the following order : another name, notion of disease, the main point of diagnosis, analyzing and differentiating of disease, analysis of disease, discrimination of disease, prognosis, a way of curing and prescription of disease, disease in western medicine appearing the disease in oriental medicine, documents.
각종 소화성질환에서의 Campylobacter Pylori의 검출에 관하여
허정욱,강영우,박준호,박승국,하경임,김재룡,안성훈,박선우 啓明大學校 醫科大學 1988 계명의대학술지 Vol.7 No.2
Peptic disorders are among the most common maladies in korea as the world. In most cases their etiologies not be established and their pathophysioolgy remain obscure. Although the persence of fastric bacteria has been logn established, recently campylobacter pylori seems to be etiologic agent of peptic disorders. Campylobacter pylori is visualized in most cases of peptic disorders and not visualized after treatment of bctericidal agents, bismuth compound or metronidazole. We had a following results for identification of campylocacter pylori in stomach and duodenal mcuosa via endoscipc biopsy. 1. We studied 54 patients who had dyspeptic symptoms, 29 males. 2. Most patients are in 5th decades, next in 3rd and 6th in order. 3. Ptients were composed of 27 peptic ulcer, 22 gastitis and 5 gastric carcinoma. 4. Campylobacter pylori was identified in 69% of total patients, peptic ulcer 63%, gastritis 77%, stomach carcinoma leastly.
한의진단명과 진단요건의 표준화 연구 II (표준화 실례) : 2차년도 연구결과 중간 보고
양기상,최선미,최승훈,안규석,박경모,박종현,김성우,신승호,정우열,전병훈,고현,김정범,신상우,김성훈,김동희,권영규,엄현섭,장혜옥 한국한의학연구원 1996 한국한의학연구원논문집 Vol.2 No.1
The diagnostic requirements were suggested and explained regarding the systems of differentiation of symptoms and signs in the second year study of standardization and unification of the terms and conditions used for diagnosis in oriental medicine. The systems were as follows; - differential diagnosis according to condition of body fluid, differentiation of syndromes according to the state of qi and blood, differential diagnosis according to relative excessiveness or deficiency of yin and yang(氣血陰陽津液辨證) - differentiation of diseases according to pathological changes of the viscera and their interrelation - analyzing and differentiating of febrile diseases in accordance with the theory of the six channels(傷寒辨證) The individual diagnosis pattern was arranged by the diagnostic requirements in the following order : another name(異名), notion of diagnosis pattern, index of differentiation of symptoms and signs(辨證指標), the main point of diagnosis, analysis of diagnosis pattern(證候分析), discrimination of diagnosis pattern(證候鑑別), a way of curing a diseases(治法), prescription(處方), herb in common use(常用藥物), diseases appearing the diagnosis pattern(常見疾病), documents(文獻調査). This study was carried out on the basis of the Chinese documents and references.
2003년 국내 중증급성호흡기증후군 진료 현황 및 문제점 분석
이진수,김은실,정문현,백제중,정선화,안주희,최영화,이선희,고철우,김성범,김민자,박승철,기현균,송재훈,최상호,김양수,이상오,조용균,박영훈,정숙인,김연숙,이흥범,손창희,장성희,정희진,김우주 대한감염학회 2004 감염과 화학요법 Vol.36 No.3
목적 : 2002년 말 중국에서 SARS가 발생한 이후 국내에서도 2003년 10월까지 총 3명의 추정환자, 17명의 의심환자가 보고되었다. 향후 추가적인 SARS의 유행이 우려되는 상황에서, 그간의 SARS 환자 진료에 있어서의 실질적인 준비사항, 진료 현황 등에 대한 조사를 통해 문제점을 파악하여, 향후 더 나은 대비가 될 수 있도록 개선점을 제시하고자 하였다. 재료 및 방법 : SARS로 의심되는 환자를 진료 경험이 있는 병원의료진을 대상으로 2003년 10월에 설문조사를 실시하였다. 설문에는 SARS 환자 진료 시의 실질적인 조치, 진료 현황, 병실, 응급실 및 외래에서의 격리 시설과 준비사항, 보건당국의 관리와 지원에 관한 사항을 포함하였다. 결과 : 대상이 되는 22개 병원 중 17개(17/22, 77.2%) 병원이 설문에 응하였다. SARS 환자를 위한 격리실은 응급실, 외래, 일반병실 및 중환자실에서 각각 9개(9/17, 52.9%), 5개(5/17, 29.4%), 15개(15/16, 93.7%), 4개(4/16, 25%) 병원에서 음압처리가 되어있지 않은 일인실 혹은 다인실이 사용되었고, 1개(1/16, 6.3%) 병원에서만 일반병실에서 음압격리실이 운영되었다. 입원환자의 진찰 시 개인보호구의 착용은 거의 모든 의료기관에서 이루어졌다. 보건당국에서 SARS지정병원의 시설 등을 사전에 확인한 곳은 1곳(1/12, 8.3%)이였고, 14개 병원(14/15, 93.3%)에서는 보건당국에 의뢰한 검사결과를 통하 받지 못하였다. 결론 : 의료기관에서 SARS 환자용 격리실뿐만 아니라 기존의 격리실 설비 등이 미흡하였으며, 특히 중환자실 및 외래의 준비가 더욱 부족하였다. 보건당국의 의료기관에 대한 종합적인 지원이 부족하였고, 병원과의 원활한 연계가 잘 이루어지지 않았다. SARS 만이 아닌 격리를 필요로 하는 질환의 적절한 진료를 위해 향후 병원 시설의 정비와 정부차원에서의 보다 구체적이고 실질적인 대책마련이 필요하다. Background : There was an worldwide outbreak of the Severe Acute Respiratory Syndrome (SARS) originated from China in late 2002. During that period three cases of suspected SARS and 17 cases of probable SARS were reported in Korea. With the concerns about the reemergence of SARS-coV transmission, it is important to be prepared for any possibility. So, this study is aimed to analysis the past measures in managing SARS and propose the amendatory plans to improve the preparedness. Materials & Methods : Questionnaires were collected among clinicians with any experience in managing the probable or suspected SARS cases in Oct. 2003. 17 out of 22 hospitals responded to the questionnaire. The contents in the questionnaire were practical activities, personal equipments, response plans, isolation facilities in emergency centers, outpatient clinics, general wards and intensive care units, and relationship with the public health department. Results : The dedicated isolation rooms in emergency centers, outpatient clinics, general wards, and intensive care units were prepared in 9 (9/17, 52.9%), 5 (5/17, 29.4%), 15 (15/16, 93.7%), and 4 (4/16, 25.0%) hospitals, respectively. Except for one hospital that newly made negative pressure room for SARS, single or multi-bed rooms without airborne infection control were used in all the other hospitals. The personal precaution principles were kept quite well in general wards. Before the designation of SARS hospital by the public health department prior evalution to see if the hospital was suitable for managing SARS was conducted in only 1 (1/12, 8.3%) hospital. The results of laboratory diagnosis were reported back in 1 (1/15, 6.6%) hospital. Conclusions : The isolation facilities which can control airborne infection were almost deficient not only for SARS but also for other respiratory transmissible diseases. For the infection control of transmissible diseases including SARS, more investment is needed on medical facilities and comprehensive support from the public health department required.