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( Tae Hwan Ha ),( Tae Hoon Oh ),( Sung In Yu ),( Min Kim ),( Jong Wook Kim ),( Won Ki Bae ),( Jae Hyung Kim ),( Seung Suk Baek ),( Mi Jin Ryu ),( Ye Na Choi ),( Ji Young Park ),( Eileen L Yoon ),( Tae 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Non-variceal upper GI bleeding (NVUGIB) is a common medical problem that has signifi cant association with morbidity and mortality. Angiographic detection and subsequent transarterial embolization (TAE) is a primary treatment option when medical and endoscopic treatments fail. We investigated clinical factors that could affect the success of the angiographic detection and prognosis after TAE in patients with NVUGIB refractory to endoscopic therapy. Methods: A retrospective analysis of the clinical data was done in patients with failed endoscopic treatment who underwent angiography for the treatment of acute NVUGIB between May 2002 and May 2013. Patients were divided into detection or non-detection groups according to the presence of bleeding stigmata in angiographic fi nding. Rebleeding defi ned as subsequent bleeding event within 7 days and mortality within 30days were analyzed as outcome parameters after TAE following detection in angiography. Results: A total 45 patients 37 (male, mean age, 65.9±14.9 years) were analyzed and classifi ed as a detection group (n=25, 55.5%) and non-detection group (n=20, 44.6%). Peptic ulcers were the most common cause of refractory NVUGIB. Larger transfusion amount (5.7±3.9 unit vs. 3.5±2.8 unit; P=0.03), prolonged aPTT level (34.2±17.3 sec vs. 21.8±13.8 sec; P=0.01) and short time interval between last endoscopy and angiography (17.5±25.9 hours vs. 34.3±59.5 hours; P=0.04) were found to be signifi cant factors for predicting angiographic detection. TAE was performed in all patients detected in angiography. Rebleeding (44%) was significantly associated with higher Rockall score (8.3±1.5 vs. 6.6±2.4; P=0.046) and mortality (12%) was signifi cantly associated with higher Rockall score (9.3±0.6 vs. 7.1±2.2; P=0.002) and higher level of BUN (55.3±47.4 vs. 27.6±17.4; P=0.01). Conclusions: Clinical characteristics associated with angiographic detection in patients with NVUGIB refractory to endoscopic therapy were severe bleeding, bleeding tendency and early angiographic intervention. The Rockall score is useful parameter for predicting rebleeding and mortality after TAE.
임신 종결 후 발생한 자궁 동정맥 누공에서 자궁동맥색전술로 치료한 1예
김종민,이해혁,김태희,남계현,심일구,이권해,김형문,이임순,장종호 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2
Arteriovenous fistula of uterus is rarely reported disease. This vascular malformation is very dangerous condition because Dilatation & curettage can cause massive uterine bleeding without accurate diagnosis. The diagnosis is made by angiography, gray scale ultrasonography, color and duplex doppler ultrasonography, computed tomography, and magnetic resonance imaging is helpful. Especially color and duplex doppler ultrasonography is allows convincing detection and diagnosis of arteriovenous fistula. Recently transcatheter uterine artery embolization is treatment of choice. We have experienced a case of arteriovenous fistula of uterus. Which is presented with a brief review of literature.
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.
목형의 엔드 밀링시 절삭조건에 따른 가공 특성에 관한 연구
김성일,김종택,김민호,신형곤,김태영 한국공작기계학회 2006 한국공작기계학회 추계학술대회논문집 Vol.2006 No.-
The cutting tests of wood patterns are carried out using CNC milling machine. The cutting forces and surface characteristics of machined surface are investigated at various cutting conditions such as spindle speed, feed speed, cutting direction of wood pattern and wood material. In the CNC end-milling, the surface roughness increases as feed speed increases and decreases as spindle speed increases. However, the cutting force and surface roughness are different along the cutting direction and material of wood pattern.
김명철,김덕환,신상태,임준호,김남중,김종만 충남대학교 수의과대학 동물의과학연구소 1998 動物醫科學硏究誌 Vol.6 No.-
Abomasal impaction with cecal dilatation was diagnosed in a 3 years old holstein cow. The clinical signs were loss of appetite, scant feces and moderate distension of the abdomen. Ping sound was revealed in the right 11th intercostal space by auscultation. Cecal dilatation and abomasal impaction were ascertained by right flank laparotomy and abdominal exploration, and intestinal content and gas were removed from the cecal apex incised. One day later, 2.5㎏ of sand was removed by ventral paramedian abomasotomy.
자동차 조립작업자의 사회ㆍ심리적 스트레스와 근골격계 증상과의 연관성
김일룡,김재영,박종태,최재욱,김해준,염용태 대한산업의학회 2001 대한직업환경의학회지 Vol.13 No.3
목적 : 이 연구는 자동차 조립라인 근로자들의 사회·심리적 스트레스와 작업관련 근골격계 자각증상간의 연관성을 확인하는 데에 있다. 방법 : 경인지역 소재 자동차 회사 두곳의 조립라인에 근무하는 근로자 636명을 대상으로 하여, 근골격계 자각증상에 대해서는 목과 어깨, 팔과 팔꿈치,. 손목과 손, 허리부위에서의 통증, 쑤심, 뻣뻣함, 화끈거림, 무감각 또는 저림 등을 묻는 표준화된 설문지로 질문하였고, 스트레스 정도는 4개 분야, 45개 항목으로 이루어진 Psychosocial Well-being Index 설문지를 배포후 3점 척도를 적용하였다. 이들간에는 카이자승법, ANOVA rm리고 로짓회귀분석을 사용하여 통계적으로 유의한 연관성을 알고자 하였다. 결과 : 1. 수면시간을 제외하고 연령, 근속기간, 결혼여부, 학력수준, 흡연력, 음주력에 따른 상지근골격계 증상의 빈도 차이는 없었다. 2. 30세 미만의 작업자군에서 사회 심리적 스트레스 점수(p-value: 0.0461)와 스트레스 Factor 3 (p-value: 0.0368), Factor 4 (p-value: 0.0053)의 점수가 높았다. 3. 11∼15년의 근속기간을 가진 작업자의 경우 Factor 1을 제외한 PWI(p-value: 0.0001), Factor 2(p-value:0.0001), Factor 3(p-value: 0.0004), Factor 4(p-value: 0.0001)에서 기타의 근속기간을 갖는 동료에 비해 높은 스트레스 점수를 보였다. 4. 미혼자는 Factor 4에서 기혼자보다 높은 스트레스 점수를 보였다(p-value: 0.0068). 5. 수면시간이 6시간 이하인 작업자군은 6시간을 초과하는 작업자보다 PWI(p-value: 0.0087), Factor 2(p-value: 0.0194), Factor 3(p-value: 0.0048), Factor 4(p-value: 0.0314) 등에서 높은 스트레스 점수를 보였다. 6. 스트레스 점수는 정규분포를 이루었으며 정상군과 스트레스위험군간에 증상의 빈도 차이는 없었다. 7. 근골격계 증상이 있는 작업자군은 무증상군과 비교하여 기타 스트레스 점수는 두 군간에 유의한 차이가 없었으나, Factor 2에서 통계적으로 유의하게 높은 스트레스 점수를 보였고(p-value: 0.028), 단변량(OR: 1.02) 및 다변량(OR: 1.04) 로짓 회귀분석에서도 Factor 2가 양의 회귀계수(0.0226; 0.0352)를 보여 증상에 영향을 주는 것으로 나타났다. 결론 : 근골격계 자각 증상이 있는 조립작업자군은 증상이 없는 군에 비해 우울증 항목에서 높은 스트레스 점수를 보였으나 기타 사회적 역할 수행 및 자기신뢰도, 수면장애 및 불안, 일반건강 및 생명력등의 사회심리적 스트레스 항목에서는 두 군간에 유의한 차이를 보이지 않았다. 로짓회귀분석예서도 우울증이 근골격계 증상에 영향을 주는 것으로 나타나서 비록 제한적이지만 우울증에 해당하는 항목인 Factor 2와 증상간의 연관성을 일부 확인할 수 있었다. 그러나 근골격계 증상발현에는 스트레스 이외에도 인간공학적 혹은 알려지지 않은 요인들 중요하게 작용하므로 이들을 통제한 후의 추가적인 조사를 해야 할 것으로 생각된다. Objectives : To determine the relationship between stress Factors and work-related muscul-loskeletal symptoms of assembly line workers in the automobile industry. Methods : A cross-sectional study was conducted in two Factories of automobile manufacturing companies where inappropriate posture and repetitive motions were required. The total number of subjects was 636, and consisted entirely of men. The Age, length of work duration, marital status, education level, smoking status, drinking status, sleeping time and stress scores were investigated according to subgroups of general characteristics. We divided the subjects into a Reference group and a Stress risk group to compare the frequency of the variables between them. The stress scores of the Positive symptom group were compared with the Symptom free group by the t-test. To measure the stress level, the PWI(Psychosocial Well being Index) which consists of 4 Factors, totaling 45 items, was used. A standardized self-reported questionnaire was used to assess the symptoms in workers. The criteria for positive symptoms were based on Operational Definition of Work-related Musculoskeletal Disorders of the NIOSH. Results : 1) The subgroups of Age, Work duration, Marital status, Education level, Smoking status, Drinking status and Sleeping time revealed no differences in frequencies in musculoskeletal symptoms. 2) Higher PWI(p<0.05), Factor 3(p>0.05) and Factor 4(p<0.01) scores were observed in younger workers compared with older workers. 3) The workers who had work durations betwen 11-15 years showed higher PWI(p<0.01), Factor 2(p<0.01), Factor 3(p<0.01), and Factor 4(p<0.01), compared with other work duration subgroups. 4) Singles had higher Factor 4 scores(p<0.01). 5) The sleeping time of less than 6 hours a day expressed a higher PWI(p<0.01), Factor 2(p<0.05), and Factor 3(p<0.01), Factor 4(p<0.05). 6) There was no difference in the prevalence of musculoskeletal symptoms between the Reference group and Stress risk group. 7) The subjects who had Positive musculoskeletal symptoms showed a significant difference in Factor 2 scores compared with the Symptom free groups. 8) According to a univariate logistic regression analysis, Factor 2(OR: 1.02, 95% CI:1.00-1.04, p-value: 0.0291) expressed significant but mild effects on the musculoskeletal symptoms and a multivariate logistic regression showed a statistically significant effect on musculoskeletal symptoms(OR:1.04, 95% CI: 1.01-1.07, p-value: 0.0170). Conclusion : Psychosocial stress scores were not higher in symptomatic subjects compared with those who had no symptoms. Sleeping longer showed a protective effect on symptoms but this was not statistically significant. There was no relationship between the stress scores and musculoskeletal symptoms in social performance and self-confidence, general well-being and vitality. Factor 2(Depression) was statistically significant though its effect was mild. Limited to this study, We could find partial relationship between psychosocial stress(Depression) and musculoskeletal symptoms. So it could therefore be suspected that ergonomic or other unknown factors may be more significant causes of musculoskeletal symptoms but we did not investigate these.