베체트씨병에 의한 대동맥판 폐쇄부전의 수술적 치료

김경환,김기봉,김원곤,김주현,안혁,Kim, Kyung-Hwan,Kim, Ki-Bong,Kim, Won-Gon,Kim, Joo-Hyun,Ahn, Hyuk 대한흉부심장혈관외과학회 2000 Journal of Chest Surgery (J Chest Surg) Vol.33 No.5

Background: Cardiac involvement of Behcets disease is very rate, however, the prognosis of Behcet disease depends on cardiovascular complications. In this article, we described surgical treatment of aortic insufficiency with Behcets disease. Material and Method: From March 1986 to February 1998, we operated on 10 patients of aortic insufficiency with Behcets disease. Male to female ratio was 8 to 2, and age ranged from 21 to 40 years(mean 32.8 years). There were 8 patients with evidence of Behcets disease and another 2 patients had some suspicious findings of Behcets disease(i.e., prosthetic value dehiscence, hypertrophied aortic wall). Adequate preoperative medical treatment for Behcets disease was done in 3 patients. Result: We performed 24 open heart surgeries in 10 patients. Redo value replacements using prosthetic valves were done in 4 patients. Among them, 2 patients were operated on for a second redo valve replacement and one of them operated on for a 4th and 5th operation because of recurrent paravalvular leakage. These 4 patients expired. 1 patient who had undergons tissue value replacement is alive. 1 patient who underwent Cabrol operation expired dut to rupture of graft anastomosis site. We used homografts in 3 patients. In 2 of them, we performed aortic root replacement and subcoronary valve replacement in another patient. The patient who underwent subcoronary valve insertion had remnant aortic insufficiency, so we are closely observing him. We also performed Ross operation in a 24 year old female who suffered severs aortic insufficiency and endocarditis after aortic valvuloplasty. 5 patients are alive and mean follow up duration is 49.0 months. Among them, we used homografts or sutografts in 4 patients. We could observe excellent clinical results in the patients who underwent aortic root replacement using homograft and they were treated medically for Behcets disease. Conclusion: We concluded that adequate preporative diagnosis, clinical suspicion, and periopertive medical treatment for Behcets disease are very important for the result of surgical management of aortic insufficiency with Behcets disease. The use of homograft or autograft was helpful for the healing of anastomosis site and we should carefully observe the long term follow up results.

앉고 일어서기 동작에서 점진적 체중 이동을 이용한 시각적 되먹임 훈련이 만성 편마비 환자의 균형 및 보행능력에 미치는 영향

김경환,박성훈,김형민,박노욱,김다연,Kim, Kyung-hwan,Park, Sung-hoon,Kim, Hyung-min,Pak, Noh-wook,Kim, Da-yeon 대한고유수용성신경근촉진법학회 2017 PNF and Movement Vol.15 No.1

Purpose: This study aimed to investigate the effect of visual feedback training-for gradual weight shift in sit-to-stand training-on the balance and walking abilities of chronic hemiplegia patients. Methods: Twenty patients with chronic hemiplegia volunteered to participate in this study. The experimental group received visual feedback for gradual weight shift in the sit-to-stand training, while the contrast group followed the standard process for the sit-to-stand training. The evaluation of the balance and walking ability was conducted with the functional reach test (FRT), Berg balance scale (BBS), five time sit-to-stand (FTSTS) test, timed up and go (TUG) test, 10 m walk test (10MWT), balancia, activities-specific balance confidence (ABC) scale, and falls efficacy scale (FES). Results: In the results before and after intervention, there was a significant difference in TUG, 10MWT, ABC, and FES in the visual feedback training group (p < 0.05). In the control group, there was a significant difference in the 10MWT and ABC (p < 0.05). Also, in the evaluation of the postural fluctuations, the control group data showed a significant increase in Covar. The visual feedback group showed a significant difference in the W average. Conclusion: The visual feedback training group showed some improvement in terms balance and walking ability and on the ABC scale and FES. Therefore, if the diagonal progressive weight bearing exercise is combined with the various patterns and basic principles of PNF, it may be a more efficient intervention method.

CPM Bar Chart 기법을 활용한 일정계획

김경환,김수유,김재준,Kim Kyung-Hwan,Kim Soo-Yoo,Kim Jae-Jun 한국건설관리학회 2004 건설관리 : 한국건설관리학회 학회지 Vol.5 No.5

본 연구에서는 바차트(bar chart) 기법과 CPM 기법의 장점을 결합한 CPM bar chart(CBC) 기법을 제시한다. CBC는 기존의 fenced bar chart(FBC)의 장점을 유지하면서 단점을 보완한 것으로, 작업 관계를 나타내는 fence에 방향성을 부여함으로써, 기존 FBC에서 상당한 혼란을 유발하는 fence의 분리과정 없이 작업들의 관계를 표현할 수 있다. 또한, fence의 분리를 파악하기 위해 더미작업(dummy activity)을 확인하는 과정이 생략되어 보다 손쉽게 작성할 수 있는 장점도 있다. 바차트의 간결성을 유지하면서 CPM의 네트워크 논리 표현이 가능해짐에 따라, CBC는 다양한 프로젝트 참여자들 간의 원활한 의사소통에 기여하리라 예상된다. 또한, resource constrained scheduling, resource leveling, 작업 분리가 고려된 일정 조정, 공기 지연 분석 등의 CPM 기법에 기초한 다양한 일정 계획 및 관리에도 적용이 용이하여, 실무뿐만이 아니라 공정관리 교육과정에서도 활용성이 높으리라 기대된다. This paper proposes the CPM bar chart (CBC), a hybrid of the bar chart and the critical pad method (CPM). The CBC overcomes shortages of the fenced bar chart, while still keeping advantages. The fence with direction is applied instead of the broken fence, which triggers considerable problems to identify and apply in the fenced bar chart. In addition, the notorious task to find dummy activities is no longer required. Upon the benefits of simplicity in the bar chart and logical work sequence in the CPM network. the CBC provides a relatively easy way to create and understand a schedule, thus improving communication quality between project participants. With the advantages, the CBC can also be effectively applied to various scheduling techniques such as resource constrained scheduling, resource leveling, scheduling with activity split, delay impact analysis, etc.

고양지역 두 병원에서의 약물 중독 양상

김경환,박준석,신동운,노준영,김혜진,구홍두,조진경,김아진,Kim Kyung-Hwan,Park Jun-Soek,Shin Dong-Wun,Rho Jun-Young,Kim Hey-Jin,Gu Hong-Du,Cho Jin-Kyung,Kim Ah-Jin 대한임상독성학회 2006 대한임상독성학회지 Vol.4 No.1

Purpose: In the year of 2005, it enforced the basic study for establishing program of Poison Control Center by National Institute of Toxicologic Research. The object of our survey is to analyze the characteristics of intoxication from the City of Goyang by same protocol. Methods: We retrospectively reviewed the data of medical records of the intoxication patient in the two hospitals of the Goyang from 2004 June 1st to 2005 May 31th. The investigation protocol applied the TESS report form which was used from the Basic study for establishing program of Poison Control Center. Results: The intoxication patients were total 269 persons, the patients of A hospital were 184 persons, B hospital were 185 persons. The most common intoxication materials were medicines, in afterwords it was an agricultural chemical. The most common place of intoxication was the home. The intentional suicidal attempts in the reason of intoxication were 51.2%. The rate of the patients who discharges from the emergency department was 50.4% and death rate was 4.3%. Conclusion: We concluded that the continuous and systemic report and analysis should be accomplished from the Goyang area.

수직자기기록용 박막의 제작

김경환,김명호,손인환,김재환 ( Kyung Hwan Kim,Myung Ho Kim,In Hwan Son,Jae Hwan Kim ) 한국전기전자재료학회 1997 한국전기전자재료학회 추계학술대회논문집 Vol.1997 No.1

대한민국 흉부외과 수술자료수집을 위한 코드

김경환,김광택,노환규,박승일,박영환,선경,성숙환,송현,심영목,원태희,임청,이정렬,정경영,전태국,박수정,Kim, Kyung-Hwan,Kim, Kwang-Taek,Rho, Hwan-Kyu,Park, Seung-Il,Park, Young-Hwan,Sun, Kyung,Sung, Sook-Hwan,Song, Hyun,Shim, Young-Mok,Won, Tae-He 대한흉부심장혈관외과학회 2001 Journal of Chest Surgery (J Chest Surg) Vol.34 No.1

흉복부 대동맥류의 외과적 치료

김경환,안혁,Kim, Kyung-Hwan,Ahn, Hyuk 대한흉부심장혈관외과학회 2000 Journal of Chest Surgery (J Chest Surg) Vol.33 No.11

배경: 흉복부 대동맥류는 질환 자체가 광범위하고 수술 중 척수를 포함한 각종 장기의 보호 및 허혈 방지라는 면에서 아직도 수술 합병증이 높은 질환이다. 본 연구에서는 그 동안의 임상경험을 바탕으로 치료성적, 합병증 발생, 사망률 등을 검토하였다. 대상 및 방법: 1990년 1월부터 1999년 12월까지 흉복부동맥류로 수술을 시행한 38명의 환자를 대상으로 의무 기록 검토을 통한 후향적 분석을 시행하였다. 결과: 남자가 22명, 여자가 16명, 평륜 연령은 46.2$\pm$12.3세였고, 크로포드 진단분류 상 1형 이 13례(34.2%), 2형이 19례(50%), 3형이 4례(11%), 4형이 2례(4.8%)였다. 만성 대동맥박리증에 관련된 경우가 29례(76.3%)로 가장 많았고, Marfan 증후군이 동반된 경우가 9례(23.7%)에서 있었다. 원위부 대동맥 관류를 35례에서 시행하였으며, 고동맥-고정맥 심폐바이패스를 31례에서, 좌심방-고동맥 바이패스를 4례에서 시행하였다. 심폐바이패스를 이용한 31례중 4례에서 초저체온하 완전순환정지를 이용하였다. 대동맥 차단 중 복강내 주요 대동맥 분지로의 선택적 관류를 시행하였다. 대동맥류의 최대직경은 평균 8.2$\pm$2.4cm이었고, 동맥류가 파열된 경우는 11례(28.9%)에서 있었다. 전례에서 인조혈관을 이용한 대동맥의 치환술을 시행하였다. 단계적으로 흉복부 대동맥을 겸자하면서 인공혈관을 문합하였고, Adamkiewicz 동맥으로 생각되는 부위의 늑간 동맥을 문합해주었는데, 8번째부터 12번째 흉추 사이의 늑간 동맥 중 역류혈류가 나타나고 상대적으로 내경이 큰 것들을 문합해 주었다. 술 후 조기사망은 3례에서 있었으며, 사인은 심폐기 이탈 실패 (2례), 저혈압 및 산증(1례) 등이었다. 조기 합병증으로는 애성 5례, 출혈 5례, 창상간염 3례, 장기간의 인공호흡기보조가 3례 등이 있었다. 치명적인 조기 합병증인 하지마비는 2례(5.3%)에서 발생하였고, 이 중 1례는 대동맥의 심한 석회화로 늑간동맥을 문합해 주지 못했던 경우였다. 35명의 환자에서 평균 추적기간은 103.1$\pm$6.1 개월, 2년 생존율은 93.8%, 5년 생존율은 86.1%, 8년 생존율은 80.7%였다. 추척기간 동안 4례의 만기사망이 관찰되었고, 사인은 2례에서는 갑작스런 의식소실이 발생하여 규명하기 어려웠으며, 대동맥-식도루 발생에 의한 경우가 1례, 경동맥류 파열에 의한 경우가 1례 등이었다. 만기 합병증으로는 복부 대동맥류(2례), 상행 대동맥 및 대동맥 근부 확장(1례), 대동맥-늑막루(1례), 창상 부위 탈장(1례), 역행성 사정(1례) 등이 있었다. 결론: 저자들은 흉복부대동맥류의 수술에 있어 심폐우 회술 혹은 좌심방-고동맥 바이패스를 통한 원위부 관류 및 저체온법, 수술 시 척수의 혈류공급과 관련된 늑간동맥의 연결 등으로 주요 신경합병증의 발생을 줄이고 좋은 성적을 거두고 있다고 판단하였으며 향후 임상 경험 축적과 함께 보다 정련된 위험인자의 분석이 필요하다고 본다.

태양전지용CuInSe₂와 CuGaSe₂ 흡수층의 전자구조해석을 위한 표면 청정기술 개발

김경환,최형욱,공석현,Kim, Kyung-Hwan,Choi, Hyung-Wook,Kong, Sok-Hyun 한국전기전자재료학회 2005 전기전자재료학회논문지 Vol.18 No.2

Two kinds of physical treatments were examined for the analysis both of intrinsic surface and interior nature of CuInS $e_2$[CIS] and CuGaS $e_2$[CGS] films grown in separated systems. For the first method, a selenium protection layer which was immediately deposited after the growth of the CIS was investigated. The Se cap layer protects CISe surface from oxidation and contamination during the transport under ambient atmosphere. The Se cap was removed by thermal annealing at temperature above 15$0^{\circ}C$. After the decapping treatment at 2$25^{\circ}C$ for 60 min, ultraviolet photoemission and inverse photoemission measurements of the CIS film showed that its valence band maximum(VBM) and conduction band minimum (CBM) are located at 0.58 eV below and 0.52 eV above the Fermi level $E_{F}$, respectively. For the second treatment, an Ar ion beam etching was exploited. The etching with ion kinetic energy $E_{k}$ above 500 eV resulted in broadening of photoemission spectra of core signals and occasional development of metallic feature around $E_{F}$. These degradations were successfully suppressed by decreasing $E_{k}$ below 400 eV. CGS films etched with the beam of $E_{k}$ = 400 eV showed a band gap of 1.7 eV where $E_{F}$ was almost centered.st centered.

자세변화에 따른 PNF 패턴이 체간 근육활성에 미치는 영향

김경환,윤혜진,박성훈,임진우,Kim, Kyung-Hwan,Youn, Hye-Jin,Park, Sung-Hun,Lim, Jin-Woo 대한고유수용성신경근촉진법학회 2016 PNF and Movement Vol.14 No.1

Purpose: The purpose of this study was to analyze the effects of proprioceptive neuromuscular facilitation (PNF) patterns on electromyography (EMG) activity in the rectus abdominis, internal abdominal oblique, external abdominal oblique, and erector spinae according to position changes. Methods: Ten healthy adults volunteered to participate in the study. The subjects were required to complete exercises that followed two PNF extremity patterns, namely, an upper extremity extension-adduction-internal rotation pattern and a lower extremity flexion-adduction-external rotation pattern. The exercises were applied in the supine, side-lying, and sitting positions. Repeated measure one-way ANOVA and post-hoc Bonferroni correction were used to determine the influence of the patterns on muscle activity for each muscle, and descriptive statistics were then used to determine the local/global muscle ratios. Results: The upper extremity pattern had a significant effect on the rectus abdominis and erector spinae in the supine position, and on the internal oblique and external oblique in the sitting position (p<0.05). The median value for the internal oblique/rectus abdominis showed a high ratio of 2.05, and a high ratio of 1.01 was shown for the internal oblique/external oblique in the sitting position. The lower extremity pattern had a significant effect on the rectus abdominis in the side-lying position and on the internal oblique, external oblique, and erector spinae in the sitting position (p<0.05). The median value for the internal oblique/rectus abdominis showed a high ratio of 2.83 in the sitting position and a high ratio of 1.30 for the internal oblique/external oblique in the side-lying position. Conclusion: The PNF pattern increases local muscle activation in an unstable position. Therefore, when the pattern is used for intervention purposes, trunk stability and varied position changes should be taken into account.

PNF 패턴에서 각도에 따른 Normal Timing의 적용이 체간 근육활성에 미치는 영향

김경환,윤혜진,박성훈,임진우,Kim, Kyung-Hwan,Youn, Hye-Jin,Park, Sung-Hun,Lim, Jin-Woo 대한고유수용성신경근촉진법학회 2015 PNF and Movement Vol.13 No.2

Purpose: The purpose of this study was to analyze the effect of normal timing according to angular motion in PNF patterns on electromyography (EMG) activity in rectus abdominis, internal oblique abdominal muscle, external oblique abdominal muscle, and erector spinae. Methods: Ten healthy adults volunteered to participate in this study. The participants were required to complete following two PNF extremity patterns; upper extremity extension- adduction-internal rotation pattern with $180^{\circ}$, $90^{\circ}$, $30^{\circ}$ and lower extremity flexion- adduction-external rotation pattern with $0^{\circ}$, $60^{\circ}$, $90^{\circ}$. A paired t-test was used to determine the influence of the two PNF patterns on muscle activity in each muscle. Descriptive statistics were used to determine the ratio of local muscle activity to global muscle activity. Results: In terms of their effect on applied normal timing, the upper and lower extremity pattern significantly affected the rectus abdominis, internal oblique, external oblique, and erector spinae (p < .05). The upper extremity pattern (at an extension angle of $30^{\circ}$) and the lower extremity pattern ((at a flexion angle of $90^{\circ}$) influenced the rectus abdominis, internal oblique, external oblique, and erector spinae (p < .05). Conclusion: The effect of the upper and lower extremity patterns on applied normal timing was significant in that these patterns increased trunk muscle activation. The upper extremity pattern (at an extension angle of $30^{\circ}$) and the lower extremity pattern (at a flexion angle of $90^{\circ}$) increased trunk muscle activation. Normal timing is required to increase trunk muscle strength and extremity movement.