수술 후 성인 Fallot 4징 환자의 임상적 고찰

장기영,김선영,문주령,허준,강이석,박승우,전태국,박표원,이흥재,Jang, Gi Young,Kim, Sun Young,Moon, Joo Ryung,Huh, Joon,Kang, I-Seok,Park, Seung Woo,Jun, Tae Gook,Park, Pyo Won,Lee, Heung Jae 대한소아청소년과학회 2003 Clinical and Experimental Pediatrics (CEP) Vol.46 No.7

목 적 : Fallot 4징 환자에 대한 수술 및 수술 후 집중 치료의 발달로 생존율이 향상되면서 교정 수술을 받은 Fallot 4징 환자의 연령이 점차 증가하였고, 이에 따라 장기 생존에 따른 여러가지 문제점들이 알려지게 되었다. 저자들은 완전 교정 수술을 받은 성인 Fallot 4징 환자에서 나타나는 주요 임상적인 문제점들을 알아보고자 하였다. 방 법 : 1994년 5월부터 2000년 7월까지 삼성서울병원 성인선천성심장병클리닉(GUCH Clinic)에 등록된 Fallot 4징 환자는 30명으로, 내원 당시 자연 생존자는 6명, 수술 후 생존자는 24명이었다, 이들중 본 조사 당시까지 완전 교정 수술을 받은 환자 28명을 대상으로 임상 기록, 심전도, 심장 초음파, 심도자 검사, 수술 기록 등을 후향적으로 조사하여 주요 임상 문제점을 알아보았다. 결 과 : 1) 본 조사 당시 평균 연령은 30.8세(16-53세)였고, 교정 수술시 나이는 15.8세(2-49세)였다. 남녀 비는 1.3 : 1이었다. 2) 완전 교정 수술 후 임상적으로 유의한 문제점들은 부정맥(11례), 폐동맥 역류(8례), 좌폐동맥 협착(6례), 잔존 심실 중격 결손(6례), 승모판막 역류(5례), 삼첨판막 역류(4례), 우심실 유출로 협착(3례), 우심실 유출로 낭성 확장(3례), 대동맥판막 역류(3례), 심내막염(1례) 및 단백 소실 장증(1례) 등이었다. 3) 부정맥이 있었던 환자군(Group I, 11명)과 부정맥이 없었던 군(group II, 17명)으로 나누어 비교하여 보았을 때, 수술 시 연령이 낮을수록 수술 후 부정맥이 적게 관찰되었고(P<0.05), 부정맥 군이 부정맥이 없었던 군에 비해 흉부 방사선 소견상 심.흉 비 0.55 이상의 심비대가 유의하게 많았다(P<0.05). 심전도에서 QRS폭이 넓을수록 심비대가 많았으며(P<0.05), 수술 후 심비대가 있는 군(심/흉 비>0.55)과 심비대가 없는 군으로 나누어 비교해 보았을 때는 심비대가 있는 군에서 QRS폭이 넓었고 (P<0.05), 의미 있는 폐동맥 역류와 삼첨판막 역류가 많이 관찰되었다(P<0.05). 4) 재수술은 총 28례 중 8례에서 시행되었다. 재수술의 원인으로, 잔존 심실 중격 결손만 있었던 경우가 3례, 우심실 유출로 협착이 동반된 잔존 심실 중격 결손이 1례, 우심실 유출로 협착과 폐동맥 역류가 동반된 잔존 심실 중격 결손이 1례, 우심실 유출로 협착, 감염성 심내막염으로 인한 삼첨판막 우종 및 잔존 심실 중격 결손이 1례, 좌폐동맥 협착이 1례, 우폐동맥 협착(추정)이 1례 있었다. 결 론 : Fallot 4징은 교정 수술 후 대부분의 환자가 별 문제없이 정상적인 생활이 가능하지만 본 조사에서처럼 여러 가지 문제점들-부정맥, 폐동맥 역류, 잔존 심실 중격 결손, 우심실 유출로 협착, 폐동맥분지 협착, 감염성 심내막염 등-이 발생할 수 있으므로 장기적인 예후를 좋게 하기 위해서는 정기적이고도 지속적인 관찰과 조기 교정이 필요하다고 생각된다. Purpose : This study was performed to find the chief clinical problems associated with the ages of adult patients of tetralogy of Fallot(TOF) who had undergone total correction. Methods : Of the 30 patients who were registered at the Grown-Up Congenital Heart Disease (GUCH) Clinic of Samsung Medical Center for TOF, a retrospective investigation was carried out on 28 patients who underwent total correction. Results : Mean age at retrospective study was 30.8(range : 16-53) years old. Age at total correction was 15.8(range : 2-49) years old. Problems after corrective surgery were assessed. They were arrhythmia, pulmonary valve regurgitation, left pulmonary artery stenosis, residual ventricular septal defect, mitral valve regurgitation, tricuspid valve regurgitation, right ventricle outflow tract obstruction, aortic valve regurgitation, infective endocarditis and protein losing enteropathy. After repair of TOF, such arrhythmias as atrial arrhythmia and AV conduction disturbances were observed in some patients. Cardiomegaly was found significantly in the subjects with arrhythmia(P<0.05), and arrhythmia was less observed in patients who underwent surgery at a young age. Eight patients required a reoperation; the main indications were residual ventricular septal defect, right ventricle outflow tract obstruction and peripheral pulmonary artery stenosis. Conclusion : The majority of the patients seemed to live normal lives after Tetralogy of Fallot repair. However, as residual anatomic and functional abnormalities exist postoperatively, continued careful follow-up is needed to detect and correct structural and functional abnormalities.

鵝掌風에 關한 文獻的 考察

장기영,노석선,Jang, Gi-young,Roh, Sek-seon 대한한방안이비인후피부과학회 1998 한방안이비인후피부과학회지 Vol.11 No.1

In the literatual studies on the ajangpung(鵝掌風), the results were as follows. Ajangpung(鵝掌風) is called 'Jangsimpung(掌心風)', is concerned with 'Tinea Manus(手癬)' in western medicine. The pathogenic factors of Ajangpung were stomach-heat & blood dryness, wind-cold-wetness evil, or contact infection etc. The treatments of Ajangpung were used external treatments for dispelling wind-evil & cooling blood, dispelling wetness-evil & parasiticidal therapy. In the frequency of prescription, the most numerous prescription was Yibansan(二礬散) and the next were Yungigo(潤肌膏), Gupungjihwanghwan(祛風地黃丸) etc.

동북아시아 경제협력과 TSR 활성화 방안

장기영(Gi-young Jang) 한국국제상학회 2009 國際商學 Vol.24 No.2

These days, in the Northeast Asia, each transportation system depends on national harbors except part of transportation between countries. It is because the inland transportation system of that area has not been developed and been managed independently without cooperation with neighboring countries. The freight in the Northeast including freight that used Korea, Japan and the central Asia as starting and end points have had to rely on sea transportation. However, it is expected that it will change existing starting and end points into railway networks of the Northeast Asia. Russia, China, the Korean Peninsular and Japan are closely related and in particular, Korea is located in the middle of them, which as a bridge of the Northeast Asia. If connection of TSR, TCR, and TKR proceeds, most of the freight that has used Bostonich Port, Russia or Chinese regional port and inland trains passing through existing transportational network such as Busan Port Gwangyang Port will be moved to overland routes, which will have a great economic ripple effect. Therefore, this study speculates the connection project of TSR and TKR and activation plans of TSR for economic cooperation between countries in the Northeast Asia.

인터넷 쇼핑몰의 서비스 품질이 고객만족 및 e-충성도에 미치는 영향

장기영(Gi-young Jang),정분도(Boon-do Jeong),윤봉주(Bong-ju Yun) 한국인터넷전자상거래학회 2009 인터넷전자상거래연구 Vol.9 No.4

This study analysed the effects of the quality of services provided for customers of Internet shopping malls on customer satisfaction and e-loyalty based on SERVQUAL. Considering five variables of service quality revealed through a factor analysis as sub-variables, we analysed the effect of service quality on satisfaction and e-loyalty using a regression analysis and the results are presented as follows: As there is a limit of online business in Internet shopping malls in spite of its convenience, customers' credibility is poor in quality, sanitation, payment and stable delivery. Therefore, the government should develop effective directions on professional and composite quality assesment for reliability between customers and companies, payment and safe delivery.

한-콜롬비아 FTA의 추진현황 및 대응방향

장기영(Gi-young Jang) 韓國貿易硏究所 2010 무역연구 Vol.6 No.3

This study aims to analyse the current status of FTA between Korea and Colombia and present some issues and countermeasures against relevant problems. For the purpose, it identified the progress of FTA, trade and investment between two countries. This study carried bibliographical investigations, using results reported by Korea Institute of International Economic Policy, SAMSUNG Economy Research Institute, and Ministry of Foreign Affairs and Trade. For trade indexes, the data from Korea International Trade Association (KITA), Korea Exim Bank and Statistical Office of Colombia, various Internet sites, statistical data and newspapers were used. The result of the study has a significant meaning in that it seeks for cooperation in resources for FTA, development of stable markets, and expansion of export of automobiles and spare parts. In the progress of agreement on FTA, countermeasures against issues on automobiles and spare parts, farming products, and protection of investors should be developed.

온라인 쇼핑몰 구매자의 제품별 구매 유형에 관한 조사연구

서갑성(Gab-Sung Seo),장기영(Gi-Young Jang) 한국통상정보학회 2007 통상정보연구 Vol.9 No.4

The recent stabilization of the Internet is now driving every aspect of life into an Internet presence. In the coming years, the Internet will see growth in numbers unlike the world has ever seen. The subject of this study is the Research Study on the Products Purchase Type of On-line Shopping Mall Buyer. Also, this paper is to examine the relations between customer satisfaction and intensity of repurchase intention and complaining behavior in on-line context. On-line shopping customer depths interview it led and the online afternotes trust evaluation dimension was discovered the of useful characteristic, intention characteristic, exaggerating characteristic and on-line afternotes with or without. From these results, this paper suggests effective marketing strategy to the marketer who plans to run on-line shopping mall in the near future and also to the marketer who plans to sell products through the on-line shopping mall.

현장타설 끼움벽체로 보강된 철근콘크리트 골조의 비선형 이력거동에 관한 해석적 연구

이지훈 ( Lee Jee-hoon ),장기영 ( Jang Gi-young ),박우철 ( Park Woo-cheol ),윤현도 ( Yun Hyun-do ),정수영 ( Chung Soo-young ) 한국구조물진단유지관리공학회 2002 한국구조물진단유지관리공학회 학술발표대회 논문집 Vol.6 No.2

To develope an analytical tool for assessing seismic performance of lightly reinforced concrete frame strengthened with CIP infill wall, hysteresis failure models were developed and incorporated into computer program IDARC for dynamic analysis of LRC frame. These models are empirical expressions relating three hysteresis parameters which are the simulating deterioration behavior of stiffness(α), strength(β), pinching( γ ) to materials and geometric properties of reinforced concrete frame. The empirical expressions resulting from these regression analysis are the hysteresis failure models. Empirical expressions were developed for estimations of ultimate lateral shear strength, story drift ratio, ductility factor of existing reinforced concrete frame. The expression provide "benchmark" values for quick estimations of seismic capacity of reinforce concrete framstrengthened with CIP infill wall.

Aldosterone Blockade Induces Hypoxia in the Neonatal Rat Kidney

임형은 ( Hyung Eun Yim ),장기영 ( Gi Young Jang ),배인순 ( In Sun Bae ),유기환 ( Kee Hwan Yoo ),홍영숙 ( Young Sook Hong ),이주원 ( Joo Won Lee ) 대한신장학회 2008 춘계학술대회 초록집 Vol.28 No.1

전자무역의 물류/유통 개선에 대한 RFID/USN의 진보적인 활용방안 연구

정분도 ( Boon Do Jeong ),장기영 ( Gi Young Jang ) 한국통상정보학회 2008 통상정보연구 Vol.10 No.3

소아에서 뇌수막염에 동반된 대뇌 염류 소모증후군 1례

김세훈(Se Hun Kim),장현오(Hyun Oh Jang),김동욱(Dong Wook Kim),조희승(Heui Seung Jo),문진수(Jin Soo Moon),장기영(Gi Young Jang),남승연(Seung Yeon Nam),이종국(Chong Guk Lee) 대한소아신경학회 2002 대한소아신경학회지 Vol.10 No.2

급성 뇌병증이 있을 때 저나트륨혈증은 흔하게 보이는 소견이며 감별해야하는 질환으로는 항이뇨호르몬 분비과다증후군과 대뇌 염류 소모증후군, 요붕증 등이 있으며 각각은 발생기전과 치료방법이 다르다. 저자들은 급성 뇌수막염에 이환된 환아에서 수분과 염류를 충분히 보충해 줌으로써 치료할 수 있었던 대뇌 염류 소모증후군 1례를 경험하였기에 보고하는 바이다. Hyponatremia is commonly seen in those patients with central nervous system injury associated with infection or trauma. And decreasing intracranial pressure through restriction of maintenance fluid and salt is practiced as a routine therapeutic measure in the early stages of meningitis to prevent or ameliorate the syndrome of inappropriate secretion of antidiuretic hormone(SIADH). However, lots of patient do not show the typical symptoms of SIADH, instead they are dehydrated, have low plasma volume, increased urine sodium concentration and increased net sodium loss, which are the symptoms of cerebral salt wasting syndrome(CSW). Recent reports have prompted a reconsideration of CSW distinct from SIADH and moreover CSW has more proportion of hyponatremia associated with acute brain insult. CSW involves renal salt loss leading to hyponatremia and volume loss, whereas SIADH is a euvolemic or hypervolemic condition. While fluid restriction is the treatment of choice in SIADH, the treatment of CSW consists of vigorous sodium and volume replacement. And by correcting hyponatremic state as soon as possible, we can reduce mortality rate and improve neurologic sequelae. We report a case of CSW which was treated by replacement of vigorous sodium and volume replacement.