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점막 병변 없이 점막하 종양의 형태를 보인 저등급 MALT 위림프종 1예
김두랑,정원석,권용대,조남영,김효정,박종재,김재선,목영재,채양석,김인선,박영태,이창홍 대한소화기내시경학회 2002 Clinical Endoscopy Vol.25 No.2
Low grade mucosa-associated lymphoid tissue (MALT) lymphoma is a very indolent disease and can achieve complete remission with only localized treatment unlike the low grade B-cell lymphoma originating from peripheral lymph nodes. The endoscopic finding of the low grade gastric MALT lymphoma is usually presented as multiple and superficial erosions or ulceration. We recently experienced one case of low grade gastric MALT lymphoma without any mucosal lesion. The patient was initially considered as a submucosal tumor originating from the proper muscle layer of stomach and underwent the subtotal gastrectomy. But the submucosal tumor was confirmed to the low grade gastric MALT lymphoma without H. pylori infection. (Korean J Gastrointest Endosc 2002;25:103-106) 점막 연관 림프조직(mucosa-associated lymphoid tissue: MALT)에서 유래된 림프종은 림프절에서 발생하는 림프종과는 달리 병기보다는 조직학적 소견이 예후에 많은 영향을 미치며, 특히 저등급 MALT 림프종은 장기간 국소 병변으로 존재하여 완치가 가능한 질환이다. MALT 위림프종의 상부위장관 내시경 소견은 다양한 크기의 궤양성 혹은 미란성 병변, 화산양 궤양, 거대추벽, 융기성 병변과 궤양성 병변의 동반 등 매우 다양한 소견을 보인다. 그러나 궤양 등의 점막 병변 없이 점막하 종양 형태를 보인 MALT 위림프종은 현재까지 보고된 바가 없다. 이에 저자들은 최근 상부위장관 내시경 및 초음파내시경검사에서 점막하 평활근 종양으로 의심되어, 정확한 진단과 치료를 위하여 위아전절제술을 시행한 결과, 저등급 MALT 위림프종으로 판명되었던 1예를 경험하였기에 문헌 고찰과 함께 보고하고자 한다.
Effect of Having a Usual Source of Care on Medical Expenses – Using the Korea Health Panel Data
김두리,김솔잎,박혜경,하인혁,정보영,류원형,이상일,성낙진 대한의학회 2019 Journal of Korean medical science Vol.34 No.35
Background: There is a controversy about the effect of having a usual source of care on medical expenses. Although many studies have shown lower medical expenses in a group with a usual source of care, some have shown higher medical expenses in such a group. This study aimed to empirically demonstrate the effect of having a usual source of care on medical expenses. Methods: The participants included those aged 20 years and older who responded to the questionnaire about “having a usual source of care” from the Korean Health Panel Data of 2012, 2013, and 2016 (6,120; 6,593; and 7,598 respectively). Those who responded with “I do not get sick easily” or “I rarely visit medical institutions” as the reasons for not having a usual source of care were excluded. The panel regression with random effects model was performed to analyze the effect of having a usual source of care on medical expenses. Results: The group having a usual source of care spent 20% less on inpatient expenses and 25% less on clinic expenses than the group without a usual source of care. Particularly, the group having a clinic-level usual source of care spent 12% less on total medical expenses, 9% less on outpatient expenses, 35% less on inpatient expenses, and 74% less on hospital expenses, but 29% more on clinic expenses than the group without a usual source of care. Conclusion: This study confirmed that medical expenses decreased in the group with a usual source of care, especially a clinic-level usual source of care (USC), than in the group without a usual source of care. Encouraging people to have a clinic-level USC can control excessive medical expenses and induce desirable medical care utilization.
김두리,이정섭,최국명,김승형,고명주,송병철,이무숙,이경렬,고수연,김봉수 대한자기공명의과학회 2017 Investigative Magnetic Resonance Imaging Vol.21 No.2
Purpose: To compare three, motion-resistant, T1-weighted MR sequences on the hepatobiliary phase for gadoxetic acid-enhanced MR imaging of the liver. Materials and Methods: In this retrospective study, 79 patients underwent gadoxetic acid-enhanced, 3T liver MR imaging. Fifty-nine were examined using a standard protocol, and 20 were examined using a motion-resistant protocol. During the hepatocyte-specific phase, three MR sequences were acquired: 1) gradient recalled echo (GRE) with controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA); 2) radial GRE with the interleaved angle-bisection scheme (ILAB); and 3) radial GRE with golden-angle scheme (GA). Two readers independently assessed images with motion artifacts, streaking artifacts, liver-edge sharpness, hepatic vessel clarity, lesion conspicuity, and overall image quality, using a 5-point scale. The images were assessed by measurement of liver signal-to-noise ratio (SNR), and tumor-toliver contrast-to-noise ratio (CNR). The results were compared, using repeated posthoc, paired t-tests with Bonferroni correction and the Wilcoxon signed rank test with Bonferroni correction. Results: In the qualitative analysis of cooperative patients, the results for CAIPIRINHA had significantly higher ratings for streak artifacts, liver-edge sharpness, hepatic vessel clarity, and overall image quality as compared to, radial GRE, (P < 0.016). In the imaging of uncooperative patients, higher scores were recorded for ILAB and GA with respect to all of the qualitative assessments, except for streak artifact, compared with CAIPIRINHA (P < 0.016). However, no significant differences were found between ILAB and GA. For quantitative analysis in uncooperative patients, the mean liver SNR and lesion-to-liver CNR with radial GRE were significantly higher than those of CAIPIRINHA (P < 0.016). Conclusion: In uncooperative patients, the use of the radial GRE sequence can improve the image quality compared to GRE imaging with CAIPIRINHA, despite the data acquisition methods used. The GRE imaging with CAIPIRINHA is applicable for patients without breath-holding difficulties.
구조적 불연속에 기인하는 원통구조물의 응력집중현상에 관한 유한요소법에 의한 연구
김두만,정세헌 한국산업안전학회 1988 한국안전학회지 Vol.3 No.2
The stress concentration phenomena due to the structural incontinuty are studied by finite element method. In this study, a circular cylinder is treated. Under the axial load, the membrance action is dominate and the 24 D.O.F. cylindrical membrane finite element is used. The assembly of this element can successfully represent the original structure geometrically. The internal displacement function is such organized that the inter element compatibility condition is fully satisfied. In this study, the stress concentration factors due to the presence of a hole on the cylinder wall are obtained, and the factors versus the location of the hole is computed and plotted. It is found that the hole effect on the stress concentration disappears beyond the neighboring region of the hole size from the edge of the hole. Those results are useful for practical design in determining the region where the re-inforcing is necessary.