계획에 없던 중환자실 재입실 실태 및 원인

송동현,이순교,김철규,최동주,이상일,박수길 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.1

Background : Because unplanned readmissions to intensive care unit(ICU)might be related with undesirable patient outcomes, we investigated the pattern of and reason for unplanned ICU readmission to provide baseline data for reducing unplanned returns to ICU. Methods : The subjects included all patients who readmitted to ICU during the same hospitalization at a tertiary referral hospital between January 1st and June 30th 2002. Quality improvement(QI) nurse collected the data through medical records and a medical director reviewed the data collected. Results : 1)The average unplanned ICU readmission rate was 5.6%(gastroenterology 14.6%, pediatrics 12.7%, pulmonology 11.9%, neurosurgery 6.3%, general surgery 5.3%, chest surgery 3.9%, and cardiology 3.3%). 2)Among the unplanned readmissions, more than 50% of cases were from patients older than 60 years, and the main categories of diagnose at hospital admission were neurologic disease(29.9%) and cardiovascular disease(27.6%). 3)Of unplanned ICU readmissions, 41.8% had recurrence of the initial problems, 44.8% had occurrence of new problems. And 9.7% required post-operative care after unplanned operations. 4)The most common cause responsible for unplanned ICU readmission were respiratory problem(38.3%) and cardiovascular problem(14.3%). 5)About 40% of unplanned ICU readmission occurred within 3 days after ICU discharge. 6)Average length of stay of the readmitted patients to ICUs were much longer than that of non-readmitted patients. 7)Hospital mortality rate was much higher for unplanned ICU readmitted patients(23.6%) than for non-readmitted patients(1.5%)(P<0.001). Conclusions : This study showed that the unplanned ICU readmitted patients had poor outcomes(high morality and increased length of stay). In addition study results suggest that more attention should be paid to patients in ICU with poor respiratory function or elderly patients, and careful clinical decisions are required at discharged from ICU to general ward.

Osteotome Sinus Floor Elevation Procedure를 이용한 임프란트 매식

송종운,조용기,박홍주,김영운,오희균,유선열 대한악안면성형재건외과학회 2002 Maxillofacial Plastic Reconstructive Surgery Vol.24 No.2

Maxillary sinus has an anatomic limitation to bone support available for dental implant. When there is less than 10㎜ of bone remaining between the upper alveolar ridge crest and the maxillary sinus floor, bone augmentation should be considered. In 1994, Summers reported two sinus floor elevation techniques of limmediate implant insertion, using osteotomes, for patients who have at least 5㎜ of bone remaining between the alveolar ridge crest and the maxillary sinus floor. One technique is osteotome sinus floor elevation (OSFE) procedure in which uses osteotomes to elevate the sinus floor. The other is bone-added OSFE (BAOSFE) procedure in which bone graft is added into osteotomy site. Both procedures conserve all of the remaining bone and selectively displace it upward, thereby raising sinus floor. This study was aimed to evaluate the long-term success rate of implants which had been placed by osteotome sinus floor elevation procedure. Between February 1996 and June 1998, 10 implants were placed using OSFE or BAOSFE procedures in 6 patients who had at least 6㎜ of bone remaining between the alveolar ridge crest and the sinus floor. OSFE procedures were performed in patiens, 2∼4㎜ sinus floor elevation was needed, whereas BAOSFE procedures were done in patines, more than 4㎜ sinus floor elevation was needed. During the mean follow-up period of 4 years 4 months (3 years 6 months ∼ 5 years 9 months), no implant was failed and all patients showed good functional results. OSFE and BAOSFE procedures seemed technically easier and less invasive compared to conventional sinus lift procedure. And both procedure have good success rate.

새로운 디지털 워터마킹 알고리듬개발

송상주,김선형 순천향대학교 부설 산업기술연구소 2001 순천향 산업기술연구소논문집 Vol.7 No.1

In this paper, we proposed a new digital watermarking technique. It uses frequency domain of discrete wavelet transform(DWT). Watermarking technique is one of the most important tools for DRM(Digital Right Management). We proposed a new watermarking insertion and detection algorithm. This technique create the watermark sequence using the edge image, spread spectrum technique and DWT. We tested the technique with various attacks, and found that it satisfies the watermarking evaluation criteria. Cox's similarity measurement value is more than 6 on the Lena image and PSNR is more than 40dB on JPEG, Collusion, Clipping and Scaling. By the result, we proved that the new technique satisfies the requirement of digital contents distribution, which are insensibility ,tenacity, statistical undetectablilty.

우리나라의 國防과 財政에 관한 小考

송영식,권선주 昌原大學校 社會科學硏究所 1995 사회과학연구 Vol.2 No.-

감귤류의 Ascorbate 및 Phenolic 획분이 N-nitrosodimethylamine의 생성에 미치는 영향

송미향,이수정,신정혜,최선영,성낙주 한국식품영양학회 2002 韓國食品營養學會誌 Vol.15 No.2

감귤류 (자몽, 레몬, 금귤, 밀감 및 오렌지)를 착즙하여 얻은 쥬스를 sep-pak C_18 cartridge를 사용하여 ascorbate 및 phenolic 획분으로 분리한 다음 pH를 달리한 in vitro 반응계에서 아질산염 소거 및 N-nitrosodimenthylamine(NDMA) 생성억제 효과를 분석하였다. 감귤류 쥬스 ascorbate 획분의 아질산염 소거능은 5ml 첨가시 pH 2.5 에서 79.9 ~ 98.6%, pH 4.2에서 48.5 ~ 86.3%였으나, pH6.0에서는 35.2% 이하였다. Phenolic 획분은 ascorbate 획분에 비해 높은 소거능을 보였으며 특히 pH6.0 에서는 ascorbate 획분에 비해 2배 이상의 높은 소거능을 나타내었다. NDMA 생성억제 효과는 phenolic 획분의 첨가시에 월등히 뛰어나 pH 2.5의 반응용액에 금귤, 밀감 및 오렌지쥬스의 phenolic 획분을 첨가했을 때 92.8% 이상이었으나, ascorbate 획분이 첨가된 경우에는 NDMA 생성 억제 효과를 거의 나타내지 못하였다. 따라서 감귤류 쥬스의 NDMA 생성억제와 관련된 주된 인자는 phenol 화합물인 것으로 사료된다. Five citrus juices were separated into a ascorbate and phenolic portion using sep-pak C_18 catridge, respectively, in order to elucidate the nitrite scavenging effect and N-nitrosodimethylamine (NDMA) formation in model system. the nitrite scavenging effect of ascorbate portion from citrus juices, in the different pH, when added with 5ml were 79.9 ~ 98.6% under the condition of pH 2.5, 48.5 ~ 86.3% at pH 4.2 and lower than 35.2% at pH 6.0. The nitrite scavenging effect was excellent phenolic portion rather than ascorbate portion. Particularly, the effect was more 2 times than ascorbate portion under the reaction condition of pH 6.0. When added the phenolic portion in the reaction mixture, NDMA formation was inhibited 92.8% or more in kum quat, mandarin orange and sweet orange juices. But the ascorbate portion was a negative response of the inhibition of NDMA formation. The inhibition on NDMA formation in citrus juice may be due to phenolic compounds were reacted.

구개부에 발생한 다형선종의 처치

하주원,백승,송종운,박충열,이용욱,박홍주,오희균,유선열,김옥준 大韓顎顔面成形再建外科學會 2001 Maxillofacial Plastic Reconstructive Surgery Vol.23 No.6

Pleomorphic adenoma of the palate is the most common of all intraoral salivary tumors. It can occur at any age but it presents most commonly in the 40∼60 age group, and there is no significant sex preponderance. It grows slowly and is usually painless, firm, well-circumscribed nodule. Because of high rate of recurrence, extra-capsular excision including the overlying mucosa and margin of normal tissue is recommended. We report 10 cases of palatal pelomorphic adenoma which have been successfully treated by extra-capsular excision. The surgical defects smaller than 3㎝ in diameter were covered with palatal acrylic splint for the secondary healing. The larger defects were repaired using palatal island flap in 3 cases, rotation flap and buccal fat graft in each 1 case. No patient showed any recurrence or malignant change during the mean follow-up period of 4 years and 9 months. These repair methods seem to be simple, reliable and uncomplicated procedures in the palatal surgical defects.

담즙정체성 간염의 임상적 양상

최선택,은종렬,임상우,김봉준,이헌주,구미진,최준혁 영남대학교 기초/임상의학연구소 2001 Yeungnam University Journal of Medicine Vol.18 No.1

Background: Cholestatic hepatitis is failure of bile to reach the duodenum with hepatocellular damage and no demonstrable obstruction of the major bile ducts. The prognosis is usually good with recovery in less than 4 weeks after withdrawal of the offending drug. However, a prolonged course lasting over 3 months is possible and, in rare cases, progression to ductopenia with development of a vanishing bile duct syndrome occurs. A differential diagnosis with other causes of Chronic liver disease is needed. Materials and Methods: From January 1991 through Jaunary 2000, 14 patients diagnosed as cholestatic hepatitis by liver biopsy were inclouded. The possible causative drug, clinical features, laboatory findings, and progression of cholestatic hepatitis were evaluated. The semiquantitative study of liver lesions was performed by two independent observers. Results: Causes of cholestatic hepatitis are 5 cases of oriental medicine, 3 cases of anti-tuberculosis medication, 1 case of ticlopidine and antibiotics and 4 cases of unknown causes. The clinical features of cholestatic hepatitis were jaundice, itching, urine color change, and general weakness. During 6 to 30 months, LFT of 5 patients showed prolonged elevation. Elevated total cholesterol ≥250 mg/dL in 6 patients, pheripheral blood eosinophilia in 5 patients, auto-antibody positive in 6 patients were observed respectively. The biopsies showed intralobular bilirubinostasis with a mixed portal inflammatory infiltration. Conclusion: In cholestatic hepatitis. durations of abnormal LFT are variable regardless of causative drugs. If cholestatic hepatitis progresses toward chronic course, viral hepatitis, primary biliary cirrhosis, and autoimmune hepatitis should be differentially diagnosed and sequential liver biopsies are needed.

L-형 장골이식을 이용한 구순열 비변형의 수정

유선열,박홍주,손영휘,윤천주,박충열,송종운,이용욱 대한악안면성형재건외과학회 2000 Maxillofacial Plastic Reconstructive Surgery Vol.22 No.6

Patients with a cleft lip nasal deformities hope for a pleasing nasal profile, a well-defined angular nasal tip, and symmetry of the nose. The main objective of the correction of cleft lip nasal deformity is to achieve nasal symmetry and an improved nasolabial relationship. The present study was carried out to assess the effect and prognosis of correction of cleft lip nasal deformity with L-shaped iliac bone graft. We performed correction surgery of the severe cleft lip nasal deformity with the autogenous L-shaped iliac bone graft in five patients and described the technique of correction. The columella portion of the L-shaped graft provided stabilization, eliminating the see-saw effect of the bridge on the bony fulcrum of the bony bridge, The disadvantage of this technique was stiffening of the nasal tip, which included the distal end of the grafted bone. However, the nasal tip gradually becomes softer, probably due to resorption of the bony edge several months after the operation. We obtained stable and symmetric reconstruction of the supporting elements of the nose. These results suggest that L-shaped iliac bone graft is stable and esthetic reconstruction method for correction of the severe cleft lip nasal deformity

항갑상선제로 치료한 그레이브스병 환자의 관해예측인자

남일송,윤여일,김선규,김용현,이주영,목지오,윤석기,김철희,김영선,변동원,서교일,유명희 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.2

Background: Most cases of Graves' disease have been treated by antithyroid drugs in Korea. The major drawbacks of antithyroid drugs are the relative high rate of relapse and the inconvinience of long term therapy. Measurement of TBII and TRH stimulation test have been considered as the most reliable tests predicting relapse, but the predictive power is not high enough to use in clinical situation. This study was performed to find good prognostic indicators in Graves' disease patients after the discontinuation of antithyroid drug therapy. Subjects and methods : We restrospectively evaluated 96 patients with Graves' disease who showed normal TRH test at the end of antithyroid drug therapy and were followed for more than one year. Serum T3, T4, T3/T4 ratio, TBII, Anti-TPO Ab and TGAb levels were measured at the time of diagnosis and at the end of therapy. Two to three months after withdrawal of antithyroid medication, serum TSH and free T3 responses to TRH were examined. These parameters were compared between the relapse group and the remission group. Results : Among the 96 patients, 22 patients(22.9%) relapsed(Group Ⅱ) and 74 patients(77.1%) remained in remmision(Group Ⅰ). No significant difference was observed between the relapse and the remission group in clinical parameters, serum T3, T4, TSH, T3/T4 ratio, TBⅡ and Anti-TPO Ab determined before and after treatment. Serum TSH and free T3 levels measured after TRH stimulation were also similar in both groups. Serum TGAb levels determined at the end of treatment were significantly higher in the remission group(p<0.05). Relapse following the discontinuation of therapy occured within 24 months in 72.7% of the relapsed cases. After 24 months, relapse rate was reduced significantly. Conclusion : These results suggest that high serum TGAb levels could be a favorable prognostic indicator for the long term remission of Graves' disease treated with antithyroid drugs, and may suggest that Hashimoto's thyroiditis is combined with Graves' disease in those patients.

國際化와 企業稅制에 관한 考察

권선주,송영식 昌原大學校 産業經濟硏究所 1996 産經硏究 Vol.13 No.-