20세기 한국 임상의학의 발자취

宣熙湜 대한의사협회 1999 대한의사협회지 Vol.42 No.12

빌트인 모터를 이용한 2축 제어 미세 가공기 개발

김건희,김효식,양순철,이상용,국명호,이선규,김윤중,홍권희 한국공작기계학회 2007 한국공작기계학회 추계학술대회논문집 Vol.2007 No.-

This paper describes development of low cost precision machine that has combined the Build-in Motor with a vacuum chuck. This study mainly aims to find out a cutting condition for maintaining optimum surface condition and to examine cutting characteristics of the precision machine that is equipped by diamond bites. The cutting materials is Al alloy. Several experiments were carried out to find out the main factors that affect the surface roughness such as principal axis RPM(rotation per minute), feeding speed, and cutting depth. As a result, we obtain The optimum cutting condition of the developed precision machine.

구속된 비행 청소년들의 특성 및 석방 후 6개월간 재범여부와 관련된 변인

정선주,김원식,고승희,구영진,김홍창,서동혁 대한소아ㆍ청소년정신의학회 1999 소아청소년정신의학 Vol.10 No.2

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.

임신여성을 제외한 성인에서의 B군 연쇄구균 감염에 관한 임상적 고찰

고경식,권선희,안우석,이원욱,김구엽,서환조 대한감염학회 1995 감염 Vol.27 No.4

목적:B군 연쇄구균은 최근 보고에 의하면 만성 기저질환(당뇨병, 악성종양등)이 있는 성인에서 감염빈도 및 사망률, 이환율이 증가하고 있는 추세이며 그 중요성이 대두되고 있다. 이에 저자들은 B군 연쇄구균 감염의 임상양상, 기저질환(위험인자)을 알아보고, B군 연쇄구균 항균제 감수성등을 규명하고자 하였다. 방법:1986년 1월부터 1993년 12월까지 경희대학교 부속병원에서 B군 연쇄구균이 배양된 274예를 대상으로 의무기록지를 검토하였다. 결과: 1) 전체 연구대상은 274예로 98예(35.8%)가 남자였고, 176예(64.2%)가 여자였다. 이들의 연령분포를 보면 신생아군에서 감염이 많이 발생하였다 이후 감소추세를 보이다가 20대 이상에서 다시 증가 하는 추세를 보였다. 2) 감염 양상은 274명중 명확한 감염이 156명(56.9%), 추정감염이 55명(20.1%), 비감염이 63명(23.0%)이었다. 임신을 제외한 18세 이상의 성인은 231명으로 남자가 83명, 여자가 148명이었고 남여 비율은 1:1.78이었다. 이중 133예(57.6%)에서 명확한 감염이었고, 46명(19.9%)에서 추정 감염, 52명(22.5%)에서 비감염이었다. 명확한 감염환자 133명중 31명(23.3%)이 병원내 감염이였다. 3) 18세 이상의 성인 231명에서 Group B Streptococcus가 분리 동정된 감염 부위는 자궁 경부 77예(33.3%), 요 73예(31.6%), 객담및 상기도 39예(16.9%), 농 24예(10.4%)등이었다. 4) 명확한 감염을 가지고 있었던 성인 133명의 임상양상은 요로 감염 37명(28%), 자궁 경부염 37명(28%), 피부, 연조직 감염 23명(17%), 폐렴 10명(8%), 패혈증 8명(6%)등이었다. 5) 명확한 감염을 가지고 있었던 성인 133명중 92명(69%)에서 한가지 이상의 만성 기저질환이 있었으며, 이중 당뇨병 32%, 뇌 혈관 질환 21%, 고혈압 19%, 신부전 12%, 악성종양 5%등을 차지하였다. 6) 항균제 감수성 검사(251예)에서 penicillin 98.4%, cephalothin 99.6%, cefamandol 98.8%, erythromycin 96.0%, clindamycin 89.4%, oxacillin 88.8%, lincomycin 87.8%, methicillin 86.8%, minocycline 49.4%, trimethoprim-sulfamethoxazole 15.5%의 감수성을 보였다. 7) 명확한 성인 감염 133명중 6명(4.5%)이 사망하였다. 결론:B군 연쇄구균은 만성 기저질환이 있는 성인에서 감염 빈도가 높고, 치명적인 결과를 초래할수 있으므로 감염 예방 및 조기 발견, 적절한 항균제 감수성 검사에 따라 조기 치료로 사망률을 줄여야 할것으로 생각된다. Background: Several reports have suggested that the incidence of diseases caused by Group B streptococcus is increasing in nonpregnant adults, particularly those with serious underlying diseases. The objectives of this study were to define the clinical manifestations, underlying conditions(risk factors) of definite group B streptococcal diseases in nonpregnant adults and to obtain antimicrobial sensitivity of these infections. Methods: We analyzed the records of 274 cases of the Group B streptococcus isolated in Kyung-Hee University hospital between 1986 and 1993. Results: 1) Total Group B streptococcal isolates were 274 cases : Of these cases, 7 percent were 1 month of age or younger, 3 percent were older than 1 month but younger than 18 years of age, and 91 percent were 18 or older. 2) Men and nonpregnant women accounted for 87 percent (n=231) : 133 cases (57.6%) with definite infection, 46 cases(19.9%) with possible infection, and 52 cases(22.5%) with no infection. 31 cases of 133 (23.3%) nonpregnant adult with definite infection apeared to have acquired the disease nosocomially. 3) In the 133 nonpregnant adult patients, the most common clinical diagnosis were urinary tract infection(28%), and cervicitis(28%). 4) In the 133 nonpregnant adult patients, the underlying diseases or conditions were diabetes mellitus(32%), cerebrovascular accident(21%), hypertension(19%), renal failure(12%), and malignant neoplasm(5%), Sixty-nine percent of the cases had one or more underlying diseases. 5) In the antimicrobial sensitivity tests, 98.4% of isolates were sensitive to penicillin, 99.6% to cephalothin, 98,8% to cefamandol, 96.0% to erythromycin, 89.4% to clindamycin, and 49.4% to minocycline. 6) The case mortality rate was 4.5%(6 of 133). Conclusion:We found group B streptococcal infection to be a significant and apparently increasing cause of definite diseases in nonprognant adults, particularly in those with serious underlying diseases. Recognizing these infections early in the groups with serious underlying diseases will be helpful in lowering mortality.

병원성 칸디다 혈증에 관한 임상적 고찰

고경식,권선희,김병준,김구엽,서환조 대한감염학회 1995 감염 Vol.27 No.5

목 적 : 최근 칸디다혈증의 발생율이 매우 증가하여 병원 감염의 중요한 원인으로 대두되고 있다. 이에 저자등은 칸디다혈증에 대한 임상적 특성을 알아보기위하여 다음과 같이 연구하였다. 방 법 : 1988년 1월부터 1993년 12월까지 경희대학부속병원에서 발생하였던 병원성 칸디다혈증 61예를 대상으로 의무기록지를 검토하였다. 결 과 : 1) 연도별 발생 빈도는 1988년 부터 1933년까지 각각 2예, 7예, 9예, 11예, 15예, 17예로 증가하였으며, 최근에는 non-albicans 균주에 의한 감염이 증가하고 있었다. 2) 연령분포는 4-83세였으며 평균연령은 51.0±17.4세였고, 남자 32예, 여자 29예였다. 50대와 60대가 57.3%로 가장 많았다. 3) 균주별 발생빈도는 C. albicans 30예, C. tropicalis 13예, C. parapsilosis 10예, C. glabrata 6예, C. guilliermondii 1예, C. krusei 1예로서 C. albicans가 가장 많았다. 4) 기저질환으로 뇌혈관계질환이 25예(41%)로 가장 많았으며, 외과적질환 11예(18%), 고형악성종양 10예(16.4%), 혈액종양질환 9예(14.8%), 기타 내과적질환 6예(9.8%)였다. 5) 균주간 선행인자는 비슷하였으나, C. albicans와 C. tropicalis에서는 수술을 시행받은 예가 많았고, C. parapsilosis는 정주 영양 공급을 받은 경우가 많았다. 6) Amphotericin B 치료군(20예)과 fluconazole 치료군(11예) 사이에 예후에서 유의한 차이는 없었다. 7) 총 61예중 28예에서 사망하여 사망율은 45.9%였으며 정형외과적 수술을 시행받은 경우(83.3%)와 C. glabrata인 경우 사망율이 가장 높았다(83.3%). 결 론 : 칸디다 혈증은 중요한 병원 감염으로 대두되고 있으며 최근에는 non-albicans 진균주에 의한 병원성 칸디다 혈증의 발생율이 증가하는 추세이다. Background : The aim of this study is to determine the annual occurrence of nosocomial candidemia, the relation between Candida species and underlying illness, the relation bewteen Candida species and predisposing factors, and also to compare between the outcome of candidemia of the amphotericin B treatment group and that of the fluconazole treatment group. Methods : We reviewed medical records of 61 cases with nosocomial candidemia between 1988 and 1993 in Kyung Hee University Hospital retrospectively. Results : Two cases occurred in 1988, 7 in 1989, 9 in 1990, 11 in 1991, 15 in 1992, and 17 in 1993. The incidence of candidemia by non-albicans species has increased during this period and accounted for 64.7% in 1993. The infecting candida species were C. albicans(30 cases, 49.2%), C. tropicalis(13 cases, 21.3%), C. parapsilosis(10 cases, 16.4%), C. glabrata(6 cases, 9.8%), C. guilliermondii(1 case, 1.8%), and C. krusei(1 case, 1.8%). The most common underlying disease was cerebrovascular disease(41%) followed by surgical disease(18%), solid cancer(16.4%), hematological malignancies(14.8%), and other medical illness. There were no significant differences between the amphotericin B treatment group(n=20) and the fluconazole treatment group(n=11) in mortality. Overall mortality was 45.9%. The highest mortality was in patients with previous orthopaedic surgery(83.3%) and with C. glabrata candidemia(83.3%). Conclusion : Candidemia emerged as an important hospital infection and candidemia caused by non-albicans species has significantly increased in recent years.

간세포암과 감별이 어려웠던 악성중피종 치험 1예

김선문,허원석,채경훈,강윤세,정재훈,김연수,박기오,문희석,이엄석,김석현,성재규,이병석,이헌영,신경숙,조준식,송인상,강대영 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

Malignant peritoneal mesothelioma is a rare neoplasm that arises from the mesothelium of a serosal cavity and is a rapidly fatal disease with a median survival of 4 to 12 months for untreated cases. Recently, we experienced a case with malignant peritoneal mesothelioma who was suspected hepatocelluar carcioma by abdominal CT scan and was confirmed by biopsy including immunohistochemical stain(calretinin) after surgery. We performed tumor excisions and wedge resection of the liver(segment Ⅷ)and inserted Tencoff catheter in abdominal cavity at 25th day of post-operation. We treated with intraperitoneal paclitaxel(25mg/m^(2)/day for 5 days) six courses monthly. She was well tolerable and is still living without any evidence of recurrence for 14th month of post-operation.

놀이학습프로그램이 초등학생의 사회성 발달에 미치는 영향

박성식,임선희 금오공과대학교 2007 論文集 Vol.28 No.-

백서 해마에서 카이닌산에 의한 조기유전자의 발현과 p42, p44 MAPK 및 EIK-1 인산화의 발달 단계에 따른 변화

정희연,김수진,김종흔,정선주,박주배,김용식,조수철 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.4

연구목적 : 어린 백서에게 카이닌산(kainic acid, KA)을 주사하여 발작을 일으킨 후, 해마에서 조기유전자 -c-fos, junB, 및 TIS1의 발현 유도 양상을 발달 단계별로 조사하여 전기경련충격(electroconvulsive shock, ECS)에서의 결과와 비교함으로써 백서 뇌 신호전달계의 성숙과정을 파악하고자 하였다. 그리고 KA 주사후 p42, p44 mitogen activated protein kinase(MAPK)의 인산화 및 그에 의해 활성화되는 것으로 알려진 전사인자 Elk-1의 인산화를 관찰하여, KA 주사후 MAPK 신호절달계를 통한 c-fos의 발현로 알려진 전사인자 Elk-1의 인산화를 관찰하여, KA 주사후 MAPK 신호전달계를 통한 c-fos의 발현 경로를 발달 단계별로 밝히고자 하였다. 방 법 : 생후 7, 14 21일 된 수컷 백서에서 KA를 복강내 주사한 후, 백서 해마에서 조기유전자의 발현 양상은 northern blot analysis로, p42, p44 MAPK와 Elk-1의 인산화는 immunoblotting으로 관찰하였다. 결 론 : 생후 7일된 백서의 해마에서는 ECS와는 달리, KA에 의한 세 가지 조기유전자의 발현이 관찰되지 않았다. 그러나 생후 14일부터 이들 조기유전자의 뚜렷한 발현을 관찰할 수 있었고 생후 21일에는 성숙한 백서와 같은 수준의 발현 양상을 볼 수 있었다. 세 가지 유전자 모두 백서의 연령과 KA 주사 후 시간에 따른 발현 유도 양상은 비슷하였다. p42, p44 MAPK는 생후 7일부터 상당한 수준의 기저치 인산화가 관찰되었으나, KA에 의한 인산화 증가는 생후 14일부터 관찰되었다. Elk-1의 인상화 역시 생후 7일부터 높은 수준으로 관찰되었으나 KA 주사 후 시간에 따른 Elk-1 인산화의 변화는 관찰할 수 없었다. 결 론 : ECS와 KA가 조기유전자 발현 양상에 차이를 보이는 것은 이들 유전자의 발현과 관련되어 활성화되는 신호전달경로의 차이 때문으로 생각된다. 백서 해마에서 KA에 의한 MAPK 활성화에 관여하는 신호 전달 기구는 연령이 높아짐에 따라 점차 성숙하고, MAPK의 활성화로 전달된 신호는 Elk-1 이외의 다른 경로를 통해 c-fos 발현을 조절하는 것으로 추측된다. Objectives : In order to investigate the maturational process of intracellular signal transduction system in rat brain, we studied the induction of the immediate early genes(IEGs)-c-fos, iunB, and TIS1 in each developmental stage after kainic acid(KA)-induced seizure in young rat hippocampus and then compared these with the results after electroconvulsive shock(ECS) And to elucidate the induction mechanism of c-fos via mitogen-activated protein kinase(MAPK) by KA in each developmental stage, we investigated the phosphorylation of p42, p44 MAPK and Elk-1 after KA treatment in young rat hippocampus. Methods : We examined the induction patterns of IEGs by northern blot analysis, and the phosphorylation of p42, p44 MAPK and Elk-1 by immunoblotting in rat hippocampus at post-natal day 7, 14, and 21(P7, P14 & P21), respectively after intraperitoneal injection of KA. Results : Unlike ECS, KA did not induce c-fos, junB, and TIS1 in P7 hippocampus. But these genes were apparently induced at P14 and to an adult level at P21. These three IEGs showed similar temporal patterns of induction in each developmental stage. Although the basal level of phosphorylated 42p, 44p MAPK was considerable in P7 rat hippocampus, the increase or phosphorylation after KA treatment was observed at P14. While the phosphorylation of Elk-1 was detected with high basal level in P7 rat, the amount of phosphorylated Elk-1 was not changed after KA treatment. Conclusion : Our results suggest that the differences in IEGs induction patterns between KA and ECS may be due to the differences in the activated signal transduction pathways. And our results also implicate that the signal transduction system involved in MAPK phosphorylation after KA treatment mature with aging and c-fos induction via MAPK activation may be regulated through some pathways other than Elk-1 in rat hippocampus.

태권도 수련 프로그램 적용에 따른 정신력 효과

김응식,윤오남,선석령,구희성 朝鮮大學校 스포츠科學硏究所 2003 스포츠科學硏究 Vol.14 No.-

This study had a purpose to define an effect of mental strength according to the application of Taekwondo Training Programs. In order to achieve this study objective, the Delphi Technique Analysis and the Quantitative Research were carried out. For this purpose, firstly, experts' opinions about the programs which were practiced in the Taekwondo gym was analyzed. Secondly, the background variable and training level, the training programs, and the difference of Taekwondo mental strength were analyzed. And thirdly, the relations between the Taekwondo training level, the training program, and the Taekwondo mental strength, etc. were analyzed. The analysis of Taekwondo training programs by the DeIphi Technique was performed by means of the 3rd analysis with 30 experts. And as for the Quantitative Research, the study subjects were targeted for the total 265 pupils composed of 224 boys and 41 girls who were selected by the Group Random Sampling. This study took the primary school students in 4-6 years as the population who were training Taekwondo in the gym which was located in Gwangju. The measurement instrument for research survey consisted of five (5) question items for background variables, three (3) question items for training level, three (3) question items for training programs, and twenty-five (25) question items for Taekwondo mental strength, that is, which totaled thirty-six (36) question items in all. As for the relationship model settings between the related variables, gender, school year, income level, academic records, training motive variables were established. As for the independent variables, the medium variables for Taekwondo training level were set up by the training programs. And, the Taekwondo mental strength variables were established for the dependent variables. The data which were collected by using questionnaires were dealt with according to the research objectives. As for the statistical techniques for analysing the treated data, skill statistics, unitary variance analysis, multiple regression analysis were employed. As for the relation of mental strength according to the application of Taekwondo training programs based on the method and procedure of this study, the following results were obtained in accordance with the basis of the Delphi Technique Analysis and result of the Quantitative Research. First, in the program analysis through the Delphi Technique, it was investigated that the following factors were achieved. In the body-centered programs, factors such as curiosity, creative power, interest, etc. were achieved. In the mind-centered programs, factors such as social nature, character, etiquette. sense of cooperation, creative power, and interest etc. were achieved. In the play-centered programs, factors such as meditation, personal relations, creative power, self-esteem, and reliance etc. were achieved. Second, in the differences of Taekwondo programs on the basis of the background variables, school year and income level showed the statistically significant differences in the body-centered and the mind-centered programs among the types of Taekwondo training programs. And the statistically significant difference was shown about the income level in the play-centered programs. This result showed the fact that, in training Taekwondo, pupils showed differences for adapting themselves to the contents of body-, mind-, and play-centered programs according to the contents of programs based on school year and income level which were parts of the background variables. Third, in the relations between the Taekwondo training level and the programs, for the great influence which they had on the body-centered programs about the period, frequency, and the intensity. pupils could adapt themselves well to the training as the period became longer in the body-centered programs. They could also adapt themselves well to the high-intensity training when they were not absent and trained more frequently. As for the period, about the thing which it influenced the mind-centered programs, as they were trained longer in the mind-centered programs, the training period became longer. Also, as for the period and frequency. it was considered that what influenced the play-centered programs was the fact that, as pupils were trained longer, the training period became longer in the play-centered programs. And they seemed to feel more pleasure and interest as the training period became longer and when they were not absent, and when they were trained more frequently. Fourth in the relation between the Taekwondo training level and the mental strength, for the period and the frequency which belongs to the training level, the thing which had significant impact on the sub-factors of the mental strength such as patience, courage, and etiquette was the fact that patience, courage and etiquette which were the sub-factors of mental strength were improved as the Taekwondo training period was longer, and they were trained more frequently. Fifth, in the relation between the type of Taekwondo program and the mental strength, patience, courage, and etiquette was highly improved in the body-centered programs. And courage was highly improved in the mind-centered programs. Also, what had significant impact on patience, courage and etiquette was the body of the Taekwondo program type in the play-centered programs. Likewise, for the mind- and play-centered programs, the mental strength such as patience, courage and etiquette was highly improved as they were trained more frequently.