• Journal of Chest Surgery
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• 제30권2호
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• pp.195-199
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• 1997

복부대동맥과 그 이하 주요분지들의 동맥폐쇄에 의한 하지 만성허혈은 동맥경화증이 주원인이며 이 질환의 임상적 중요성은 혈관이 진행적으로 폐쇄됨에 따라 혈류장애가 발생하여 간헐적 파행, 휴식시 동통이 일어나며 더 진행되면 조직의 괴사가 발생,결국괴사된 조직의 절단을 초래하게된다. 본한국보 훈병원 흉부외과에서는 1992년 12월부터 1995년 12월까지 폐쇄성 하지동맥 경화증으로 입원한 20명의 환자를 대상으로 동맥간 우회술을 시 행하였다. 임상증상은 괴사및 괴저 9례(45B4), 파행 7례(35%), 안정 시 동통 4례(20%)순이었다. 사용한 혈관은 복부대동맥및 총대퇴동맥의 경우 Y-형및 I-형 인조혈관을 사 용하였고 대퇴동맥이하의 혈관에서는 주로 자가 대복재정 맥을 사용하였다. 술후 합병증은 4례로 20% 를 보였고 이식된 혈관내 혈전증 2례, 창상감염 2례 였다. 술후 혈관개존율은 복부대동맥과 양측 대퇴동 맥간 우회술의 경우 100%였고 대퇴동맥 이하에서는 6개월이 92.6%, 1년 84.2%, 2년 75.4%, 3년 69.4% 였다.

• Journal of Preventive Medicine and Public Health
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• 제29권3호
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• pp.639-655
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• 1996

Cerebrovascular disease and coronary heart disease are the first and the fourth common causes of death among adults in Korea. Reported risk factors of these diseases are mostly alike. But some risk factors of one of these diseases may prevent other diseases. Therefore, we tried to compare and discriminate the risk factors of these diseases. We recruited four case groups and four control groups among the inpatients who were admitted to Wonju Christian Hospital from March, 1994 to November, 1995. Four control groups were matched with each of four case groups by age and sex. The number of patients in each of four case and control groups were 106 and 168 for acute myocardial infarction(AMI), 84 and 133 for subarachnoid hemorrhage(SAH), 102 and 148 for intracerebral hemorrhage(ICH), and 91 and 182 for ischemic stroke(IS) respectively. Factors whose levels were significantly higher in AMI and IS than in responding control group (RCG) were education, economic status, and triglyceride. Factors whose levels were significantly lower in hemorrhagic stroke than in RCG were age of monarch, and prothrombin time. The factor whose level was higher in AMI than ill RCG was uric acid. The factor whose level was higher in AMI, ICH, and SAM than in RCG was blood sugar. Factors whose levels were significantly higher in all the case groups than in RCG were earlobe crease, Quetelet index, white blood cell count, hemoglobin, hematocrit, and total cholesterol. The list of risk factors were somewhat different among the four diseases, though none of the risk factors to the one disease except prothrombin time acted as a preventive factor to the other diseases. The percent of grouped cases correctly classified was higher in the discrimination of ischemic diseases(AMI and IS) from hemorrhagic diseases(SAM and ICH) than in the discrimination of cerebrovascular disease from AMI. The factors concerned in the discrimination of ischemic diseases from hemorrhagic diseases were prothrombin time, earlobe crease, gender, age, uric acid, education, albumin, hemoglobin, the history of taking steroid, total cholesterol, and hematocrit according to the selection order through forward selection.

• 한국방사선학회논문지
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• 제12권3호
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• pp.313-319
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• 2018

방사선 치료시 산란성 등의 피부영향을 피할 수 없으며 내부의 정상장기의 피폭은 피할 수 없다. 방사선 치료의 역사는 정상조직의 흡수선량 감소를 위한 역사라고 해도 과언이 아니다. 특히, 왼쪽 유방암의 방사선 치료시 내부 인접 장기로는 정상유방조직, 심장과 폐를 대표로 들 수 있는데 심장에 발생할 수 있는 부작용은 심정지, 심근경색 등이 있다. 본 논문에서는 왼쪽 유방암 환자의 방사선 치료시 호흡조절기법을 사용한 것과 일반 방사선치료계획을 시행하는 것 사이에 심장의 체적과 선량의 변화를 관찰하여 호흡으로 인해 발생하는 심장의 체적과 선량을 알아보았다. 연구결과 4차원 컴퓨터 단층촬영영상을 기준으로 심장의 체적은 평균 $12.8{\pm}8.7cc$의 차이가 나타났으며 이에 대해 선량은 평균 $17.3{\pm}12.1cGy$의 차이를 보였다. 이러한 체적과 선량의 차이는 향후 방사선 치료시 부작용을 발생시킬 수 있는 우려가 있으므로 호흡조절기법을 활용하여 심장의 정확한 위치를 기반으로 방사선 치료계획을 수립하여야 할 것이다.

• Journal of Trauma and Injury
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• 제24권1호
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• pp.12-17
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• 2011

Purpose: A rib fracture secondary to blunt thoracic trauma continues to be an important injury with significant complications. Unfortunately, there are no definite treatment guidelines for severe multiple rib fractures. The purpose of this study was to evaluate the result of early operative stabilization and to find the risk factors of surgical fixation in patients with bilateral multiple rib fractures or flail segments. Methods: From December 2005 to December 2008, the medical records of all patients who underwent operative stabilization of ribs for severe multiple rib fractures were reviewed. We investigated patients' demographics, preoperative comorbidities, underlying lung disease, chest trauma, other associated injuries, number of surgical rib fixation, combined operations, perioperative ventilator support, and postoperative complications to find the factors affecting the mortality after surgical treatment. Results: The mean age of the 96 patients who underwent surgical stabilization for bilateral multiple rib fractures or flail segments was 56.7 years (range: 22 to 82 years), and the male-to-female ratio was 3.6:1. Among the 96 patients, 16 patients (16.7%) underwent reoperation under general or epidural anesthesia due to remaining fracture with severe displacement. The surgical mortality of severe multiple rib fractures was 8.3% (8/96), 7 of those 8 patients (87.5%) dying from acute respiratory distress syndrome or sepsis. And the other one patient expired from acute myocardial infarction. The risk factors affecting mortality were liver cirrhosis, chronic obstructive pulmonary disease, concomitant severe head or abdominal injuries, perioperative ventilator care, postoperative bleeding or pneumonia, and tracheostomy. However, age, number of fractured ribs, lung parenchymal injury, pulmonary contusion and combined operations were not significantly related to mortality. Conclusion: In the present study, surgical fixation of ribs could be carried out as a first-line therapeutic option for bilateral rib fractures or flail segments without significant complications if the risk factors associated with mortality were carefully considered. Furthermore, with a view of restoring pulmonary function, as well as chest wall configuration, early operative stabilization of the ribs is more helpful than conventional treatment for patients with severe multiple rib fractures.

• 정신신체의학
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• 제12권1호
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• pp.23-29
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• 2004

본 연구의 목적은 관상동맥질환 환자들과 정상인 간의 분노수준을 비교하고자 하는 것이었다. 233명의 관상동맥질환 환자들과 215명의 정상대조군을 대상으로 조사하였다. 분노수준을 평가하기 위해서 분노표현척도, 스트레스반응척도의 분노 및 공격성 하위척도, SCL-90-R의 적대감 하위척도를 사용하였다. 관상동맥질환 환자군은 정상대조군보다 분노표현 하위척도점수 및 분노전체 하위척도 점수, 스트레스반응척도의 분노 및 공격성 하위척도 점수가 각각 유의하게 더 높았다. 협심증 환자들은 심근경색증 환자들보다 분노표현 하위척도점수 및 분노전체 하위척도 점수가 유의하게 더 높았다. 환자군에서 남자는 여자보다 분노억제 하위척도 점수가 유의하게 더 높은 반면, 여자는 남자보다 분노표현 하위척도 점수가 유의하게 더 높았다. 이상의 결과는 관상동맥 질환 환자들이 정상인들보다 분노수준, 특히 분노표현의 정도가 더 높다는 것과 성별에 따라 분노표현에 차이가 있음을 시사해 준다. 또한 환자들의 높은 분노 수준은 병의 경과에 나쁜 영향을 미칠 수 있다는 점에서 관상동맥질환 환자들에 대한 분노관리의 필요성이 강조된다.

• 보건행정학회지
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• 제23권1호
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• pp.3-18
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• 2013

This paper investigates the possibility of expanding pay-for-performance (P4P) program as a provider payment system, in terms of financial, economical, and political sustainability. In order to expand the sustainable P4P, P4P should have usefulness in terms of economic value as well as efficiency in the financial aspects of health care. More importantly, the P4P would be politically sustainable only when both providers and consumers can accept. Korea's healthcare system seems to have logical ground for the P4P program financially and economically. However, how well the P4P can work remains to be proven in its implementation. After 43 tertiary hospitals applied the P4P program for acute myocardial infarction (AMI) and C-section in 2007, the number of hospitals adopting the P4P program for AMI and C-section has increased to 316 in 2011, and an incentive for hospitals applying the P4P has risen to 2% from 1% of health insurance benefits. This shows that the P4P program introduced by Health Insurance Review and Assessment Service is quite successful. In addition, people are aware of the need for improved P4P program and policy alternatives have been already made. Therefore, it is very important to come up with politically supportable strategies that can make providers and consumers accept the P4P program while maintaining the governance of the existing health insurance policy. To this end, there are some tasks to be considered. First, the expansion of the P4P program should be placed on the agenda of the Health Insurance Policy Review Committee, the highest decision-making body, and a separate agency for P4P planning should be established. Second, for more efficient P4P program, the processes of review and assessment, currently carried out separately, should be integrated into a single process. Third, infrastructure to measure the quality of medical services should be sharply expanded. Fourth, the current paradigm for the assessment should be changed. Lastly, a P4P program for consumers should be considered. Given that the consumers in Korea can use medical services freely, the National Health Insurance Corporation could initiate the P4P program for consumers as a means of controlling excessive use of medical services and adjusting consumer's moral hazard.

• 한국산학기술학회논문지
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• 제19권2호
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• pp.202-209
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• 2018

본 연구는 연령층별 구강건강과 저작불편이 영양소 섭취에 미치는 영향을 분석하기 위해 수행되었다. 대상은 국민건강영양조사 제6기(2015), 질병관리본부 자료를 이용하였으며, 그 중 20세 이상 성인 5,855명을 선정하였다. 자료는 SPSS 21.0을 이용하여 분석하였다. 연구결과 저작불편군은 60세 이상이 39.5%로 나타났으며, 20-39세 8.1%에 비해 5배 가까이 높게 조사되었다. 저작불편군은 치주질환 33.4%, 치아우식 30.1%, 당뇨 41.8%, 심근경색 57.3%, 관절염 44.0%, 천식 48.0%, 우울증 41.9%를 현재 경험하고 있었고. 저작불편군의 86%가 발음 불편을 경험하고 있었다. 저작불편군의 식품섭취량은 1446.59g으로 저작용이군 1666.62g보다 낮았고 단백질, 탄수화물, 식이섬유 등 다양한 식품 섭취량이 유의하게 낮은 것으로 조사되었다. 결론적으로 저작불편은 식품섭취, 전신 및 정신건강과 관련이 있었고, 연령증가에 따른 저작불편은 발음 불편의 문제와도 연관성이 있었다. 그러므로 연령증가에 따른 구강건강 문제를 해결하기 위해 예방처치에 관심을 갖고 구강건강을 유지할 필요가 있으며, 저작불편 문제의 초기치료가 요구되었다. 그리고 구강질환 예방을 위한 치과적 치료뿐만 아니라 구강근훈련을 통한 구강기능 개선으로 저작, 발음 기능을 유지하여 건강한 삶을 유지할 수 있도록 지속적인 구강건강관리가 요구되었다.

• 한국패류학회지
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• 제27권4호
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• pp.323-330
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• 2011

동해안 일대의 양식자원 증식과 어업인의 소득증대를 위해 남해안 일대에서 주를 이루고 있는 전복양식을 동해안 일대로 넓히기 위해서 수심이 깊고 파고가 높은 동해안 지역에 맞는 전복과 해삼 복합사육기를 개발하고 복합사육기의 효과를 알아보고자 양식 생산력을 조사하였다. 전복해삼복합사육기에 각장 5 cm 전복 500마리와 7-9 cm 해삼을 50, 75, 100마리로 각각 넣어 실험한 결과 해삼 적정수용능력은 13-18마리/$m^2$로서 사육기당 52-72마리가 적절하였다. 수용량에 따른 생화학적 건강도를 조사하기 위해서 복합사육기에 각장 5 cm 전복 300마리와 500마리를 각기 달리 수용하고, Reflotron kit를 이용하여 GOT (glutamate oxaloacetate transaminase) 와 GPT (glutamate pyruvate transaminase) 를 조사하였으며, 전복과 해삼을 함께 사육하여 RNA/DHA ratio와 DNA 및 RNA contents (ug/mg) 를 조사한 결과, 전복 단독구와 복합사육구간에 유의적인 차이가 없어 (P > 0.05) 전복과 해삼을 함께 양성하더라도 해삼이 전복 성장에 영향을 미치지 않는 것으로 나타났다. 또한, 자체 개발한 전복해삼 복합사육기와 남해안에서 주로 사용되고 있는 전복 사육기의 생산능력을 비교하기 위해서 수하식으로 8개월 동안 실험한 결과, 자체 개발한 복합사육기에서 양식한 전복과 해삼이 성장이 빨라 전복해삼복합사육기가 동해안 일대의 양식사업에 적합한 것으로 나타났다.

• 한국의료질향상학회지
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• 제20권1호
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• pp.12-24
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• 2014

Objectives: The aim of this study was to explore whether emergency bell could shorten door to electrocardiograms (ECG) time in chest pain patients presenting to emergency department (ED) by self-transport. Methods: This was a planned 6-month before-and-after interventional study design. We set up the emergency bell in walk-in patients' waiting room. Prior to the change, patients were triaged before an ECG was obtained. In new process, as soon as patient with chest pain push the emergency bell, emergency physicians examined patient and prioritized performing ECG. We analyzed door to electrocardiograms (DTE) times for patients with chest pain and ST segment elevation myocardial infarction (STEMI) patients between two periods. Results: During the enrollment period, a total of 63 patients called emergency bell. The median DTE time was 6 min (interquartile range: 3.0 - 9.0) and 82.5% received an ECG within 10 minutes, and only three patients were STEMI. DTE time in patient with chest pain was not different between two periods (p=0.980). Before intervention period, 15 walk-in patients admitted in ED for STEMI and 53.8% of STEMI patients received an ECG within 10 minutes. After intervention period, total 19 walk-in patients admitted in ED for STEMI. Of these, 89.5% met the time requirement. Conclusion: Because a small portion of patients with chest pain activated the emergency bell, new strategy for promotion of emergency bell must be needed.

• Radiation Oncology Journal
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• 제33권1호
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• pp.12-20
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• 2015

Purpose: To evaluate treatment outcomes and determine prognostic factors in patients with esophageal cancer treated with esophagectomy after neoadjuvant chemoradiotherapy (NCRT) Materials and Methods: We retrospectively evaluated 39 patients with esophageal cancer who underwent concurrent chemoradiotherapy followed by esophagectomy between 2002 and 2012. Initial clinical stages of patients were stage IB in 1 patient (2.6%), stage II in 5 patients (12.9%), and stage III in 33 patients (84.6%). Results: The median age of all the patients was 62 years, and the median follow-up period was 17 months. The 3-year overall survival (OS) rate was 33.6% in all the patients. The 3-year locoregional recurrence-free survival (LRFS) rate was 33.7%. In multivariate analysis with covariates of age, the Eastern Cooperative Oncology Group performance status, hypertension, diabetes mellitus, tumor length, clinical response, clinical stage, pathological response, pathological stage, lymphovascular invasion, surgical type, and radiotherapy to surgery interval, only pathological stage was an independent significant prognostic factor affecting both OS and LRFS. The complications in postoperative day 90 were pneumonia in 9 patients, anastomotic site leakage in 3 patients, and anastomotic site stricture in 2 patients. Postoperative 30-day mortality rate was 10.3% (4/39); the cause of death among these 4 patients was respiratory failure in 3 patients and myocardial infarction in one patient. Conclusion: Only pathological stage was an independent prognostic factor for both OS and LRFS in patients with esophageal cancer treated with esophagectomy after NCRT. We could confirm the significant role of NCRT in downstaging the initial tumor bulk and thus resulting in better survival of patients who gained earlier pathological stage after NCRT.