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        위절제술 환자의 표준진료지침 개발 및 적용 효과

        김은희,김철규,이순교,김순덕,이혜옥,권정순,이경미,이민미,심순미,유용만,신종식,강은희,이상일,김병식,오성태,육정환,박수길 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.2

        Background : Gastric cancer is the most common malignant tumor in Korea. surgical operation is one of the major treatment modalities for gastric cancer patients. Therefore, gastrectomy is one of the most common procedures in General Surgery. There were variation in length of hospital stay and medical treatment for gastrectomy between three surgeons at Asan Medical Center. Clinical pathways have received considerable attention as a tool for recucing the medical practice variation, increasing the efficiency of care process, and improving the quality of care. The aim of this study was to evaluate the effect of a clinical pathway for gastrectomy in gastric cancer patients. Methods : The clinical pathway for gastrectomy was developed and implemented by a multidisciplinary group in Asan Medical Center. A computerized clinical pathway program was developed and revised after a pilot test. A total of 145 patients underwent gastrectomy by three surgeons at Asan Medical Center. We compared the length of hospital stay, patient satisfaction, and unplanned readmission rate between the pre-pathway group(n=67) and the post-pathway group(n=78). We also investigated the degree of satisfaction among the physicians and nurses who were main end-users of the clinical pathway. Results : The clinical pathway was applied to all target patients. The average length of hospital stay was shortened from 12.7days to 10.6days(p<0.01). The degree of patient satisfaction with the care process changed from 90.3% to 89.2% after the implementation of the clinical pathway, but the difference was of satistically significant(p=0.761). Unplanned readmission rate was 2.9% in the pre-pathway group. More than 90% of physicians and nurses answered that the clinical pathway had been a useful tool in their medical practice. Conclusions : The findings of the study demonstrated that implementation of the clinical pathway for gastrectomy produced substantial reduction in the length of hospital stay while improving the quality of patient outcomes. The computerized clinical pathway program can be used as one of the powerful patient management tools for reducing the practice variations and increasing the efficiency of care process in Korea hospital settings.

      • 전하 제어법을 이용한 압전 액추에이터의 이력저감

        정순종,이대수,송재성,홍원표,강은구,최원종 한국공작기계학회 2005 한국공작기계학회 춘계학술대회논문집 Vol.2005 No.-

        This paper presents a method to reduce hysteresis in multilayer ceramic actuator by connecting the actuator with a capacitor in a series circuit. The change in hysteresis with respect to the capacitor was examined. 0.2Pb(Mg_(1/3)Nb_(2/3))O₃-0.8Pb(Zr_(0.475)Ti_(0.525)) O₃ ceramic material was used as a piezoelectric material for the actuator. Displacement of the actuator was measured in a capacitive gap sensor measuring system. In case of inserting a capacitor in a total circuit, hysteresis became dramatically decreased, and then finally the hysteresis value can be reduced below 0.2%. It was found in this present study that reducing the hysteresis in the actuator is dependent upon the characteristics of the capacitor in total circuit and also operating frequency

      • Silver Nitrate溶液의 精巢內 注射에 衣한 家兎의 去勢效果에 關한 硏究

        金鐘洙,趙聖均,李殷奉 順天大學校 1984 論文集 Vol.3 No.1

        This experiment was carried out to develop a Chemical castration with a single intratesticular injection of silver nitrate solution in domestic rabbits. A total of 44 bucks of 4 to 5 months old were alloted at random into the following 4 groups; 9 bucks for controls; 6 bucks for 0.3㎖ injection of 1% AgNO₃to each testis; 14 bucks for 0.5㎖ injection of 1% AgNO₃: and 15 bucks for 0.5㎖ injection of 5% AgNO₃. Changes in body weight, testicuar width in scrotum sac, weight and histology of testis at slaughter, blood cell counts and serum levels of testosterone of the buck were measured for 4 weeks after treatment. The results obtained were summarized as follows: 1. Compared with the controls the body weght gain of bucks treated with AgNO₃was not significantly (P<0.05) different during the experimental period for 4 weeks. 2. The white blood cell counts were increased slightly but insignificantly 1 day after injection of AgNO₃and then decreased to normal level soon. There was no significant change in red blood cell counts in the bucks treated with AgNO₃. 3. Most of the testis of bucks were swollen significantly (P<0.05) by 6 to 12㎜ in the width of testis in scrotum sac 1 day after injection of AgNO₃, but decreased in size 3 days after treatment and regained their normal size in a week. 4. The AgNO₃injection was not sufficient for same bucks to be successfully castrated. Only 60.0 to 66.7% of the bucks treated with 0.5㎖ dose of 1 to 5% AgNO₃showed the serum level of testosterone of lower than 0.1ng/㎖ by 28 days after treatment. This was considered to be resulted from the fact that not a whole but a limited part of testis injured by this scheme of injection. 5. The weight of testis of the bucks showing less than 0.1ng/㎖ of serum testosterone by 7 to 28 days after treatment was not significantly (p<0.05) different between the treatments of periods after treatment. This result indicates that the period of 4 weeks might be not sufficient for the injured testicular tissue to be necrotized and absorbed. 6. The extent of damage of testis by injection of AgNO₃was much different by the local effect in the parts of distance from injection. A proximal portion of testis injected with AgNO₃was fully damaged and necrotized, but a distal part of testis was not severely damaged.

      • 고속액체크로마토그래피에 의한 나프록센 광학이성질체의 분리 및 품질관리

        정수진,진전성,이은주,이은실,강종성 忠南大學校 生命科學硏究院 醫藥品開發硏究所 2006 藥學論文集 Vol.21 No.-

        Enantiomeric separation of naproxen is necessary in drug evaluation processes as the pharmacological activity of naproxen resides mainly in the (S)-enantiomer, The enantioseparation of naproxen was carried out with three different stationary phases. The methods were validated with the terms of linearity, intraday and interday precision, accuracy, selectivity and recovery. Among the selected stationary phases, ChiroSil DMB column with hexane : t-butylmethylether : acetic acid (60:40:0.1, v/v/v) as mobile phase showed the best enantioseparation of the naproxen in the commercial preparations. The wavelength for detection was 270 nm and flow rate was 2.0 mL/min. The contents of (S)-naproxen in the commercial preparations were 92.7 - 98.3%, indicating that all tested preparations were satisfactory to current regulation. However, the contents of (R)-naproxen as impurity in the commercial preparations were varied from 0.08% to 1.08%.

      • Cefteram의 Group A streptococcus, Haemophilus influenzae 및 Streptococcus pneumoniae에 대한 시험관내 항균력

        박수은,정혜선,곽영호,이환종 대한화학요법학회 1998 대한화학요법학회지 Vol.16 No.3

        목적 : cefteram은 새로이 개발된 경구용 세펨계 항균제로서 종래의 세펨계 항균제와 비교하여 β-lactamase에 안정적이다. 저자들은 소아의 호흡기 감염의 주요 원인균인 group A streptococcus, Haemophilus influenzae, Streptococcus pneumoniae의 국내 분리 균주를 대상으로 하며 cefteram의 항균력을 다른 페니실린계 및 세펨계 항균제와 비교하였다. 방법 : 서울대학교 소아병원에서 각종 감체로부터 분리된 group A streptococcus 29주, H. influenzae 53주 (β-lactamase 음성 23주, 양성 30주) 및 S. pneumoniae 93주를 (페니실린 감수성 및 중등도 각각 21주, 내성 51주) 대상으로 하여, cefteram, penicillin 또는 ampicillin, ampicillin/sulbactam, cefaclor, cefuroxime, cefixime, cefpodoxime 및 ceftriaxone 등의 항균제의 최소 억제 농도(MIC)를 한천희석법의로 측정하였다. 항균제 감수성 검사 결과는 MIC 범위, MUC_(50) 및 MUC_(30)으로 나타내었다. 결과 1. Group A streptococcus에 대한 cefteram의 MIC 범위는 <0.015-0.015 ㎍/mL이었고, MIC_(50) 및 MIC_(90)은 모두 0.008 ㎍/mL으로서 검사한 항균제 중 가장 낮았다. 2. β-lactamase 음성인 H. inflenzae에 대한 cefteram의 MIC 범위는 <0.015-0.06 ㎍/mL 였으며, MIC_(50) 및 MIC_(90)은 각각 0.015 ㎍/mL , 0.03㎍/mL 로 ampicillin, cefaclor, cefuroxime보다 낮았으며, cefixime과는 비슷하였다. β-lactamase 양성인 균주에 대한 MIC 범위는 <0.015-0.125㎍/mL , MIC_(50) 및 MIC_(90)은 각각 0.015 ㎍/mL , 0.06㎍/mL 로 amplicillin/sulbactam, cefaclor, cefuroxime보다 우수한 항균력을 보였고, cefixime과는 비슷한 항균력을 나타내었다. 3. 페니실린 감수성 S. pneumoniae에 대한 cefteram의 MIC 범위는 ≤0.015-0.03 ㎍/mL 으로 매우 낮았다. 페니실린 중등도 내성주에 대해서, MIC_(50)이 cefteram 외의 각 항균제들은 0.125㎍/mL 이상이었으나 cefteram은 0.06㎍/mL 으로서 매우 낮았으며, MIC_(50)는 모두 0.25㎍/mL 이상이었으며 cefteram은 0.25㎍/mL 로서 비교적 낮은 값을 보였다. 페니실린 고도 내성균주에 대해서는 검사한 항균제의 MIC가 모두 0.5㎍/mL 이상이었으며, cefteram의 MIC 범위, MIC_(50) 및 MIC_(90)는 각각 0.5- >64㎍/mL , 1㎍/mL 및 4㎍/mL 이었다. Background : Cefteram is an orally administered aminothiazolyl iminomethoxy cephalosporin. I t has been reported to be highly active against group A streptococcus, Haemophilus influenzae and Streptococcus pneumoniae. However, there is a wide geographic variation in the prevalence of antimicrobial resistance, and antimicrobials should be evaluated against isolates from each of particular community where they are going to be used. Methods : Minimum inhibitory concentrations (MIC) of cefteram, penicillin or ampicillin, ampicillin/sulbactam, cefaclor, cefuroxime, cefixime, cefpodoxime, and ceftriaxone were determined by agar dilution method against 29 strains of group A streptococcus, 53 of H. influenzae and 93 of S. pneumoniae, isolated at the Seoul National Umversity Children's Hospital. The results of susceptibility test were presented by MIC range, MIC?? and MIC??. Results : 1. MIC range of cefteram against group A streptococcus was <0.015-0.015 ㎍/mL. MIC?? and MIC?? of cefteram were the lowest among the antimicrobials tested. 2. MIC ranges of cefteram against β-lactamase negative and plactamase positive H. influenzae were <0.015-0.06 ㎍/mL, and <0.015-0.125 ㎍/mL., respectnely. Cefteram was more active against β-lactamase positive H, infuenzae than amplilin/sulbactam, cefaclor, cefuroxime, and comparable with ceftriaxone, cefixime or cepfodoxime. 3. Cefteram had the lowest MIC?? and MIC?? against penicillin susceptible (0.008 ,㎍/mL and 0.015 ㎍/mL ) and intermediate S. pneumoniae (0.06 ㎍/mL and 0.25 ug/ml), but had rather high MIC?? and MIC?? (1 ,ug/mL and 4 ,㎍/mL) against penicillin resistank strains as other oral cephalosporins. Conclusion : The results indicate that cefteram has in vitro activity against group A streptococcus, H. influenzae and S. pneumoniae equal to or higher than other oral antimicrobials tested.

      • KCI등재후보

        감염근관에서 Black-Pigmented Bacteria의 동정에 대한 연구

        권은경,김은숙,곽주석,이황,이수종,임미경 大韓齒科保存學會 2002 Restorative Dentistry & Endodontics Vol.27 No.1

        Black-pigmented bacteria have been implicated in the endodontic infections. This group of microorganisms includes Porphyromonass endodontalis, Porphyromonas gingicalis, Prevotella intermedia, and Prevotella nigresceus. The organisms display a wide variety of virulence factors that may be pertinent to acute endodontic infections. The aim of this study was to identify P.endodontalis, P.gingivalis, P.intermedia, and P.nigrescens by using special potency disk test, filter paper spot test, 16S rRNA gene-directed PCR, and API 32A. Microbial samples were collected from root canals of 33 intact teeth with necrotic pulp and/or apical periodontitis. Conventional laboratory methods were used for identification of the strains of black pigmented bacteria. Eighteen of 33 samples were positive for the growth of black-pigmented bacteria. Five colonies were cultured from each pure cultured colonies from Brucella agar plate. Seventy seven colonies were positive for the growth of black-pigmented bacteria. Thirty three of 77(42.6%) were identifed as P.nigrescens, 10 of 77(12.9%) were P.gingivalis, 6 of 77(7.8%) were P.endodontalis, 10 of 77(12.9%) were P.intermedia. On the contraty the reference strains of P.nigrescens, experimental strains of P.nigrescens was sensitive to kanamycin in special potency disk test. 16S rRNA gene PCR and API test after rapid presumptative identification methods. such as special potency disk test and filter paper spot test, would be accurate detection methods for black-pigmented bacteria.

      • 야생효모, Wickerhamomyces anomalus HO9-2로부터 급성 폐손상 억제물질인 호중구 elastase 저해물질 생산 및 생산균주의 균학적 특성

        장지은, 문정수, 김하근, 이종수 배재대학교 자연과학연구소 2023 自然科學論文集 Vol.34 No.1

        This study was performed to produce acute lung injury-preventing neutrophil elastase inhibitor from non-pathogenic wild yeast and further determine enzyme activity and physiological functionality of the potent wild yeast. Culture supernatants and cell-free extracts of one hundred twenty five non-pathogenic wild yeast strains were prepared and their neutrophil elastase inhibitory activities were measured. The neutrophil elastase inhibitory activity of the cell-free extract from Wickerhamomyces anomalus HO9-2 showed the highest inhibitory activity of 38.4% and its elastase inhibitor was maximally produced(IC50,3.2㎎) when Wickerhamomyces anomalus HO 9-2 was cultured in pH 7.0 of malt extract medium at 20℃ for 24h. Wickerhamomyces anomalus HO9-2 was oval shape and did not form ascospore and pseudomycelium. The HO9-2 strain grew well in YPD and YM media and was halophilic yeast which grew well in YPD medium containing 15% NaCl. Cell-free extract of the HO9-2 strain were showed high 17.2U of glucoamylase activity and anti-diabetic α-glucosidase inhibitory activity of 87.5%. 본 연구는 급성 폐손상 예방(또는 치료)의약 소재를 개발하기 위하여 비병원성 야생효모들의 elastase 저해활성을 측정하여 우수 균주를 선발하였다. 또한 선발균주의 elastase 저해제 생산 조건을 최적화 하였으며 선발균주의 미생물학적 특성 등을 조사하였다. 비병원성 야생효모인 Wickerhamomyces anomalus HO9-2의 무세포추출물이 38.4%의 호중구 elastase 저해활성을 보여 우수균주로 선발하였고 이 균을 pH 7.0 의 malt extract 배지에서 20℃로 24시간 배양하였을 때 최고의 elastase 저해활성(IC50, 3.2mg)을 보였다. 또한 이 균은 난형으로 포자와 의균사를 형성하지 않았고 YPD와 YM배지에서 생육이 양호하였고 NaCl을 15% 함유한 배지에서도 생육하는 호염성 효모이었다.

      • 임신과 동반된 난소섬유난포막종 1례

        류은석,김윤숙,전섭,김종수,최승도,선우재근,배동한,양승화 순천향의학연구소 2005 Journal of Soonchunhyang Medical Science Vol.11 No.1

        Fibrothecoma are mesenchymal tumors deriving from the ovarian stroma and consisting of theca-like elements and fibrous tissues. The reported incidence is between 0.4 and 8.0% of all ovarian tumors and this side variability can be attributed to the difficulty in differentiation fibrothecoma from ovarian fibroma or hyperplastic stroma nodules. We experienced a rare case of ovarian fibrothecoma in woman at 38 weeks gestation with previous repeat cesarean section diagnosed after tertiary cesarean delivery and bilateral tubal ligation with a brief review of literature.

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