순환기 내과로 자문의뢰된 환자의 임상상

황진용,최지용,손상균,조용근,채성철,전재은,박의현 慶北大學校 醫科大學 1996 慶北醫大誌 Vol.37 No.4

목적 : 순환기내과 영역은 많은 과로부터 자문의뢰를 받는 영역으로 알려져 있다. 특히 최근 우리나라의 순환기질환의 유형이 변화되고 입원환자가 고령화되면서 동반된 심질환의 유병율도 증가하고있다. 이에 저자들은 타과로 입원하여 순환기내과로 자문의뢰되는 환자의 임상상과 3차병원인 경북대학교병원에서의 순환기내과자문의 유용성 등을 평가하여 향후 순환기질병에 대한 협의진료에 도움을 주고자 본 연구를 시행하였다. 방법 : 1995년 3월부터 순환기내과로 공식자문의뢰된 첫 100명을 대상으로 전향적으로 연령, 의뢰이유, 최종진단명, 수술과의 관련성 여부, 순환기내과의 최종조치, 타과의 순응도 등을 조사하였다. 결과 : 1) 자문을 의뢰한 환자는 평균 58±16(15-89, 중앙치 61)세였고 60세이상의 환자가 57%로 고령의 환자가 많았다. 2) 내과계열 25%, 외과계열 75%로 외과계열의 자문이 많았고 일반외과가 26%로 가장 많았고 내과의 다른 분과가 12%, 신경외과 12%, 정형외과 11%, 흉부외과 11%, 신경과 11% 등의 순이었다. 외과계열중 수술을 시행한 경우는 58례로 이중 응급수술이 13례였다. 술전 위험도 평가를 위한 자문이 38례에서 있었는데 순환기적인 문제로 수술을 받지 못한 경우는 2례(1례는 허혈성 심질환, 1례는 심낭질환)이었다. 이때 응급수술을 제외한 입원일과 술전 자문일파의 간격은 평균 3±7일(입원일-42일)이고 술전 자문일과 수술일과의 간격은 평균 6±4일(1-16일)이었다. 3) 타과의 의뢰이유는 심전도 이상이 36례, 높게 측정된 혈압이 20례, 순환기질환의 과거력 17례, 환자의 증상 때문인 경우가 10례였고 심전도의 이상중에는 부정맥이 18례, 이상 Q파 6례, ST절 이상이 5례, 각차단이 3례의 순이었다. 순환기과거력 중에는 허혈성 심질환이 6례, 현재 혈압은 정상이나 고혈압의 과거력이 있는 경우가 4례 순이었고 환자의 증상은 흉통 6례, 호흡곤란이 3례, 기절이 1례였다. 4) 자문후 최종진단이 가능했던 91례를 진단별(총 97 진단명)로 나누어 보면 고혈압이 28례, 부정맥이 16례, 허혈성 심질환이 14례, 판막질환이 11례, 순환기질환이 아닌경우가 19래였다. 이들중 추적진료가 필요하다고 응답한 경우가 57례였으나 순환기내과 외래에 1번이상 추적진료한 경우는 32례(56%)로 환자의 순응도는 낮았다. 결론 : 순환기내과의 자문의뢰는 고령자에게 많았고 수술과 관련된 경우가 많았으며 심전도의 이상이 의뢰이유로 가장 많았으며 진단별로는 고혈압과 부정맥이 가장 많았다. 그리고 순환기적인문제로 수술을 받지 못한 경우는 드물었고 자문후 지속적인 추적진료를 위해 환자의 교육이 필요하겠다. Objective : Clinical characteristics of the patients with cardiovascular diseases in the general hospital have been changed and prevalance of co-existing cardiovascular disease in the patients who were admitted for non-cardiac diseases has been increased remarkably as the proportion of elderly patients increased rapidly in Korea. We evaluated clinical features of the patients consulted for cardiological evaluation and effectiveness of the consultation in the setting of tertiary general hospital, Kyungpook University Hospital. Method : One hundred patients were studied between January 1995 and January 1996. They were evaluated for the reason of consultation, final diagnosis, final recommendation from cardiologists and its impact on the management of the patients, and compliance of the consulting departments. Results : 1) The ages ranged between 15 and 89 (mean 58±16, median 61) years, 57 patients were male and 43 female. Fifty seven patients were older than 60 years. 2) Consultations from surgical parts were 75 patients. Consultation from general surgery was most frequent (26%), followed by other divisions of internal medicine (12%), neurosurgery (12%) and orthopedic surgery (11%), chest surgery (11%), neurology (11%), obstetrics and gynecology (8%), urology (4%), ophthalmology (2%), dermatology (2%), ENT (1%). Among 75 patients from surgical parts, operation was done on 58 patients, including 13 emergency cases. Preoperative cardiac risk evaluation was the reason of consultation in thirty eight patients, of which operation could not be done in only 2 patients (one had severe ischemic heart disease, the other large pericardial disease). Interval between consultation day and operation day was 6±4 days (1-6 days). 3) Reasons for cardiac consultation were electrocardiographic (ECG) abnormalities in 36 patients, high blood pressure in 20 patients, previous cardiovascular diseases in 17 patients, symptoms of the patients in 10 patients. Among EGG abnormalities, arrhythmias was the reason in 18 patients, abnormal Q waves in 6 patients, ST-T segment abnormalities in 5 patients, bundle branch block in 3 patients. Among previous cardiovascular disease, presence of ischemic heart disease was the reason in 6 patients, previous hypertension in 4 patients. Chest pain was the reason of the consultation in 6 patients, dyspnea in 3 patients, syncope in 1 patient. 4) Definite diagnoses could be made in 91 patients with 96 diagnoses which were hypertension and its complications in 28, arrhythmia with underlying disease in 16, ischemic heart disease in 14. valvular heart disease in 11, non-cardiovascular disease in 19. Cardiological follow up was recommended in 57 patients. However, 25 patients (44%) were lost to follow-up. Conclusion : Cardiological consultation was frequent in the elderly patients. Most frequent reason for consultation was EGG abnormalities. Hypertension or arrhythmia was most common final diagnosis. Inoperability due to cardiovascular problems were rare.

여행업문화가 조직유효성에 미치는 영향에 관한 연구

이선희,이용근 문화관광연구학회 1999 문화관광연구 Vol.1 No.1

ABSTRACTAn Influence of Travel Agency's Culture on Organizational Effectiveness Sun-Hee Lee·Yong-Keun Lee The Effects of corporate culture on the organizational effectiveness and/or corporate competitiveness have been widely recognized and discussed among both the incumbent managerial and the academicians of economics and sociology in recent years. The purpose of this study is to review the functions of the corporate culture and to examine the factors of the corporate culture among the travel agencies.The present study starts with a conceptual review of the corporate culture. The characteristics of corporate culture is shaped usually with the two major elements; the styles of management and decision-making of the top managerial and the subculture of the employees. Each of the four components of Corporate culture is operationalized as follows; ① tough-guy, macho culture, ② work hard, play hard culture, ③ bet-your-company culture, ④ process culture. These four components of corporate culture become the independent variables while the recognition of environment becomes the dependent variables in the analytical model proposed in this paper. The recognition of environment such as danger and feed-back speed is divided into pre-IMF and post-IMF.Some results of the findings are as follows: First, before IMF, as the danger is recognized low and feed-back speed fast, the corporate culture is shown as work hard, play hard culture. Second, after IMF, as the danger is recognized high and feed-back speed fast, the corporate culture is shown as tough-guy, macho culture.

급성하벽심근경색에서 전흉부유도 ST절 하강의 의의

정병천,배호상,곽동훈,김영태,배용학,황종현,임현주,류재근,조용근,채성철,전재은,박의현 慶北大學校 醫科大學 1997 慶北醫大誌 Vol.38 No.2

목적 : 급성하벽심근경색증 환자에서 심전도상 흔히 동반되는 전흉부유도 ST절 하강의 의의를 알아보았다. 방법 : 심근경색후 24시간에서 48시간에 얻은 심전도를 기준으로 52명의 급성하벽심근경색증 환자를 전흉부유도에서 ST절의 하강이 있는 군과 없는 군으로 나누었으며 심도자, 관상동맥조영술, 심초음파도 및 방사성 핵종을 이용한 좌심구혈율 측정 등을 시행하였다. 결과 : 1) 좌심실확장기말압은 전흉부유도에서 ST절의 하강이 있는 경우에서 16.9±5.33mmHg로 없는 경우의 11.0±4.02mmHg보다 유의하게 높았다(p<0.05). 그러나 운동량 및 좌심구혈을은 흥부 유도상 ST절의 하강이 있는 경우 7.6±3.0 METs 및 53.9±9.1%로 없는 경우의 9.1±2.7 METs 및 54.6±9.5%보다 낮았으나 통계적 유의성은 없었다(p=0.180, p=0.823). 2) 관상동맥조영술상 전흉부 ST절의 하강이 동반된 군에서는 유의한 좌전하행지나 좌회선지의 협착이 있는 경우가 60.9% 및 57.9%로 ST절의 하강이 없는 군에서의 34.5% 및 7.7%와 비교해 좌관상동맥에 협착이 동반된 경우가 많았다(p=0.050, p=0.001). 3) 관상동맥조영술상 세 혈관질환의 빈도는 흉부유도상 ST절의 하강을 보인 23예에서 10예로 ST절 하강이 없었던 29예중 2예에 비하여 유의하게 많았고(P=0.007), 단 혈관질환의 빈도는 ST절의 하강을 보인 군에서 23예중 5예로 ST절 하강이 없었던 29예중 17예에 비하여 유의하게 적었다(P=0.002). 두 혈관질환의 경우에는 각각 8예와 10예로 양군간에 유의한 차이가 없었다. 4) 흉부유도상 ST절 하강의 빈도는 단 혈관질환 22예 중 5예에서, 두 혈관질환 18예중 8예, 세 혈관질환 12예 중 10예에서 관찰되어 협착이 있는 관상동맥의 수가 많을수록 ST절의 하강이 나타나는 빈도가 많음을 보였다(p=0.00308). 그러나 흉부유도상 나타난 ST절의 하강을 모두 합하여 구한 ST절 하강의 합은 협착이 있는 관상동맥의 수와 통계적인 유의성이 없었다. 5) 심초음파도상 좌심실 하벽의 벽운동은 ST절 하강을 보인 군에서는 akinesia가 83.3%, hypokinesia가 11.1%, 정상 벽운동이 5.6%로, ST절 하강이 없었던 군에서의 dyskinesia가 3.6%, akinesia가 39.3%, hypokinesia가 25.0%, 정상 벽운동이 32.1%와 비교하여 ST절의 하강이 있는 군에서 유의하게 벽운동의 장애가 빈번함을 보였다(p=0.03891). 그러나 좌심실전벽, 측벽 및 중격부위에서는 유의한 벽운동의 차이가 없었다. 결론 : 급성하벽심근경색증 환자의 전흉부유도에서 ST절의 하강이 동반되는 경우 다혈관 질환의 가능성이 높으며 좌심실확장기말압이 상승되었고 운동능력은 감소되어 있었다. 또한 심초음파도상 좌심실하벽의 벽운동장애도 심하였다. 따라서 전흉부 ST절의 하강을 동반한 급성하벽심근경색증 환자는 전흉부유도에 ST절 하강이 없는 경우보다 예후가 불량할 것으로 생각되며, 보다 적극적인 치료가 필요할 것으로 생각된다. The purpose of this study was to determine the significance of precordial ST segment depression appearing during acute inferior myocardial infarction and to assess the correlation of that with angiographic finding. 52 patients were allocated into two groups based on the existence of precordial ST segment depression : 23 patients with ST segment depression and 29 patients without ST segment depression. The extent of coronary artery disease as well as the prevalence of significant stenosis (≥70%) in left anterior descending artery were more frequent in patients showing precordial ST segment depression than in patients not showing them (p=0.050) and the result were similar in cases of left circumplex artery (p=0.001). On echocrdiographic examination of left ventricular (LV) wall motion, it showed more severely decreased inferior LV wall motion in patients showing precordial ST segment depression than in patients not showing them (p=0.03891) even though the other segment of LV wall motion didn't show the statistical difference between both groups. The other cardiac parameters such as LVEDP, exercise amount (METs) and ejection fraction were tend to showing bad profile in patients with precordial ST segment depression. From the above results, we could deduce that patients with precordial ST segment depression have relatively large infarction or concomitant left coronary artery disease, so they need more caution and intensive theraphy.

위암환자의 복강내에 투여한 Mitomycin C-Carbon Particle의 Mitomycin 용출에 관한 연구

노승무,조영훈,정경수,오정연,김진향,양준묵,강대영,송규상,조준식,최선웅,이진호,민병무,김용백,김창식,박근성,인현빈,정현용,김학용 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

Locoregional recurrence is the most common type of recurrence in surgical operation of gastric adenocarcinoma, and peritoneal dissemination is one of the most difficult problems in advanced gastric adenocarcinoma treatment. Because the peritoneal cavity is the most common site of the first recurrence after gastric cancer resection, intraperitoneal chemotherpy seems a logical choice for cancer chemotherapy. The Mitomycin C(MMC) adsorbed by the activated charcoal particles(CH) is relatively released when the drug concentration surrounding the carbon particles becomes low in the peritoneum of the peritoneal cavity. For the intraperitoneal chemotherapy on the advanced gastric adenocarcnoma, mitomycin C adsorbed on activated carbon particles was administered in the peritoneal cavity just before abdominal wall closure. The closed drainage tubes were inserted in the peritoneal cavity and clamped for tuo hours after completion of operation. MMC concentrations were serially measured in peritoneal fluid, plasma and urine at 2hour, 48 hour, 72 hour and 168 hour following its administration in order to study the efficacy of the MMC-CH as a drug delivery system. There were minimal toxicities in born marrow, liver, and gastrointestinal system after intraperitoneal MMC-CH administration. The data of this study suggested that MMC-CH may have a somewhat more beneficial effect than surgery alone when administered in optimal dose and schedules, but the MMC concentration of the peritoneal fluid was not sufficient to eradicate remnant cancer cells, and effective duration of maintenance was only below 24 hours in the peritoneal fluid and plasma.

경막내 척수 섬유지방성 과오종 치험 1례 - 증 례 보 고 -

이용근,조준,문창택,장상근 대한신경외과학회 1998 Journal of Korean neurosurgical society Vol.27 No.10

부비동 환기의 연구를 위한 인체 비부비동 모형

정용수,김상렬,김동환,정동근,최순섭,정인호,서세훈 대한이비인후과학회 1999 대한이비인후과학회지 두경부외과학 Vol.42 No.9

방사선 불투과성 치과용 아크릴릭 레진의 개발

이용근,이건일,이성재 대한치과기재학회 1997 대한치과재료학회지 Vol.24 No.2

Aspiration or ingestions of fragments of dental appliances are common occurrences. If they have proper radiopacity, their localization in and progress through the gastrointestinal tract or trachea can be more effective. To make radiopaque dental acrylic resin, many radiopaque materials, such as iodide compound, magnesium oxide, silver alloy, bismuth compound or barium compound were added into dental carylic resins. However the results were not so satisfactory as to be used clinically. The purpose of this study was to develop a radiopaque dental acrylic resin, which has clinically detectible radiopacity with minimal changes of mechanical and esthetic properties. The radiopacity, color change(CIE ΔE), transverse strength, modulus of rupture and Vickers hardness of acrylic resins were determined after mixing radiopaque glass(SiO₂ 50%, BaO 30%, B₂O₃ 10% and Al₂O₃ 10%) of 10∼50wt%, silane coated radiopaque glass of 10∼50 wt%, triphenyl bismuth of 5∼20% or titanium oxide of 10%. The specimens were thermocycled in 5 and 55℃ distilled water for 1,000 times, after then the radiopacity, color change and Vickers hardness were re-measured. The radiopacity of specimens on the X-ray films was measured with Photoshop program with a film scanner. The color change was determined with differential colorimeter(Model TC-6FX, Tokyo Denshoku, Japan). and the Vickers hardness was measure with microhardness tester(Mitsuzawa, Japan). The flexural strength and modulus of rupture were deterined using the Universal Testing Machine(Zwick 1456, Z020, Germany) with the cross head speed of 5mm/min. The following results were obtained : 1. After mixing silane coated radiopaque glass about 30 wt%, the radiopacity and modulus of rupture increased significant(p<0.05), however the flexural strength and Vickers hardness did not changed significantly(p>0.05) compared to unmodified dental acrylic resins. So, this compost to unmodified dental acrylic resins. So, this composition can be used as a successful radiopaque dental acrylic resin. 2. After mixing radiopaque glass, the flexural strength decreased significantly as the mixing ratio of glass increased(p<0.05). Also the Vickers hardness decreased after mixing in the case of heat cured duntal acrylic resins. 3. After mixing triphenyl bismuth, the flexural strength and Vickers hardness decreased significantly in the case of heat cured duntal acrylic resins(p<0.05). 4. After mixing titanium dioxide, the radiopacity increased significantly(p<0.05), and mechanical properties did not change significantly(p>0.05). However, translucency decreased definitely.

고선량 방사선 조사후 치아수복재의 특성변화

이용근,이건일,이성재,박수아,허정무 원광대학교 생체재료·매식연구소 1996 원광생체재료·매식 Vol.5 No.2

To investigate the effect of high dose irradiation on the Vickers hardness number(VHN), color change and wear rate of dental filling materials, esthetic filling material specimens were studied. Six kinds of composite resins and two kinds of glass ionomers(GI) were used. One(CLF) was chemically cured composite resin, and five(HCX, HPL, PHB, POF, PRT and RZI) were light cured composite resins. One(FJT) of GI was chemically cured GI and one(FLC) was light cured GI. The filling material specimens were made according to the manufacture's instructions and were finally polished with Microcloth(Buehler). Half of the specimens were irradiated with 100 Gy radiation using a linear accelerator(Mitsubishi, 6 MV). VHN and CIELAB color were measured before and after irradiation, and wear test were performed for nonirradiated specimens by brushing with toothpaste, From the experiment , the following results were obtained. 1. The CIELAB color difference was significantly different depending on the material(p<0.01), and FLC showed the highest color difference (CIELAB ΔE) of 9.452 and CLF showed the lowest value of 3.642. 2. The VHNs of nonirradiated specimens were 12.22∼73.58 and those of irradiated specimens were 25.53∼84.53. The VHNs of irradiated specimens were significantly higher than those of nonirradiated specimens(p<0.05) except RZI, FJT and FLC. 3. The wear rate of irradiated specimens of RZI, FLC were significantly lower than those of nonirradiated specimens(p<0.05). 4. The color difference after brushing of irradiated specimens were higher than those of nonirradiated specimens except CLF.

정량적관상동맥조영술의 정확도 및 재현도

조용근,황진용,박헌식,채성철,전재은,박의현 慶北大學校 醫科大學 1996 慶北醫大誌 Vol.37 No.4

목적 : 정량적관상동맥조영술이 최근 널리 보급되고 있지만 국내외를 막론하고 이의 정확도 및 재현도에 관한 연구가 불충분하여 본 연구를 하였다. 대상 및 방법 : 110명의 환자에서 미국 General Electric사의 Advantx L/C/LP 디지탈혈관찰영기와 미국 USCI사의 좌관상동맥용 Judkins형의 Pro-Flo XT^(TM) 6F 도자를 이용하여 좌관상동맥조영술을 같은 각도에서 3회 실시하고 도자의 외경을 일본 Mitutoyo사의 정밀도 0.01㎜의 micrometer로 측정한 후 측정된 도자의 실제 직경과 정량적관상동맥조영술로 측정된 관상동맥의 직경을 비교하였다. 결 과 : USCI® Pro-Flo XT^(TM) 6F 좌관상동맥용 도자의 실제 외경은 1.91±0.03㎜이었고 정량적관상동맥조영술로 측정 한 도자의 외경은 1.94±0.11㎜이었다. 도자를 5.7F로 calibration했을 매 도자의 외경은 1.87±0.12㎜이었다. 세번 다 다른 화상에서 측정한 경우 근위부관상동맥 직경의 차이는 0.02±0.12㎜이었고 같은 화상에서 3회 측정하였던 경우에는 0.11±0.01㎜이었다. 결론 : 정량적관상동맥조영술의 정확도 및 재현도는 사용에 적합한 정도이나 적지 않은 문제점에 대한 보완이 필요하다고 생각된다. During quantitaive coronary angiography(QCA), contrast filled catheter is usually used as a scaling device. However the real diamerer of catheter is almost always smaller than the listed diameter. We measured the real diameter of catheters with precision micrometer(Mitutoyo® Japan). After caliberating the catheter as listed French size and diameter, we did QCA at the same tube position of the diameters of catheter and proximal left coronary artery. All measurements were done 3 times consecutively. The mean real diameter of USCI® Pro-Flo XT^(TM) 6 F left Judkin catheter was 1.91±0.03 ㎜. The mean QCA diamter of the same catheter was 1.94±0.11 ㎜. When we calibrated catheter as 1.91 ㎜. the mean QCA diameter was 1.87±0.12 ㎜. The mean differences of the diameters of the proximal left coronary artery were 0.20±0.12 ㎜ when the measurements were done in three different frames. When the measurements were done in the same frmae, the mean difference decreased to 0.11±0.01 ㎜. We conclude that the precision and reproducibility of QCA are within reasonable range, but more refimement is needed.

열중합과 열순환에 따른 치과용 콤포짓트레진의 상아질 결합강도와 표면특성

이용근 대한치과기재학회 1998 대한치과재료학회지 Vol.25 No.1

The mechanical properties of composite restorations are improved when the composite is free of voids, and the resin matrix is fully polymerized. Making dense, well-cured composite resin restoration is best accomplished by additional heat curing. The purpose of this study was to measure the effect of heat curing or thermocycling of composite resins on the Vickers hardness, color and bond strength to dentin surface. In bond strength study, the effects of other variables such as type of cement and silane treatment were also determined. Two kinds of composite resin(VFP-direct filling composite resin. CRI-composite resin for inlay) were studied. Half of the specimens for hardness and color tests were only light cured and the others were light and heat cured. Vickers hardness and color(CIE L*, A*, B* values) were measured using Microhardness testers(Mitsuzawa Seiki Co., Japan) and Differential Colorimeter(Model TC-6FX, Tokyo Denshoku Co., Japan) before thermocycling, and after thermocycling between 5~55℃ for 500, 1,000 and 2,000 cycles. The composite resin specimen for bond strength test was 5mm in diameter and 6 mm in height. Half of the specimens were only light cured and the others were light and heat cured. These specimens of not-thermocycled and 1,000 thermocycled were bonded to the extracted dentin surface with or without silane application. Two kinds of cement(PAN-adhesive resin cement, FDT-resin modified glass ionomer cement) were used in bond strength to dentin surface test. After 24 hours, the shear bond strength was measured using Universal Testing Machine(Zwick 1456, Z020, Germany) with the cross-head speed of 0.5 mm/min. From this study, the following results were obtained: 1. The Vickers hardness of VFP was significantly higher after additional heat curing than that of only light cured specimen(p<0.05), however that of CRI showed a little change after additional heat curing. The Vickers hardness of VFP decreased significantly after thermocycling(p<0.05), however that of CRI did not changed significantly. 2. The color difference(CIEΔE) value of VFP between not-thermocycled specimen and thermocycled specimen was 3.105∼8.070, and that of CRI was 3.157∼8.752. These color changes were visually perceivable. 3. The color difference (CIEΔE) value of VFP between only light cured specimen and light and heat cured specimen was 2.725∼3.934, and that of CRI was 2.879∼6.143. These results indicated that additional heat curing changed the color of composite resins clinically perceivable. 4. The shear bond strength of VFP to the extracted human dentin surface was 6.353∼14.168 MPa. Additional heat curing did not influenced the bond strength(p>0.05), however the bond strength of thermocycled composite resin specimen was generally lower than that of not-thermocycled. 5. The shear bond strength of CRI to the extracted human dentin surface was 6. 789∼14.790 MPa. In some cases using PAN as the cement, additional heat curing influenced the bond strength(p<0.05). 6. The shear bond strength was influenced significantly by the variables of composite resin, cement and thermocycling (p<0.05).