대장수술 후에 발생한 급성신부전의 위험인자

이혜미,황창재,김재황,김흥대,박대팔,서일숙,송선옥,김세연,이덕희,지대림 영남대학교 의과대학 2007 Yeungnam University Journal of Medicine Vol.24 No.2

연구 배경 : 급성 신부전은 술 후 발생할 수 있는 합병증 중에서 사망률은 큰 영향을 줄 수 있으므로 이 연구를 통해 위험인자를 알아보려고 한다. 재료 및 방법 : 2004년 1월부터 2006년 12월까지 3년간 영남대학교 의과대학 부속병원에서 대장 수술을 받은 570명의 환자들을 대상으로 하였다. 환자들의 성별과 연령, 미국 마취과학회 신체등급, 동반질환, 수술의 종류, 응급수술의 여부, 수술 시간, 재수술의 여부, 술 중의 투약 상황, 술 후에 자가 통증 조절기에 사용한 약제, 술 중에 저혈압의 유무, 수혈 여부, 술 후 기계적 환기를 시행한 경우를 비교하였다. 결과 : 비교 결과에서 성별과 수술의 종류, 응급 수술의 여부, 개복여부 등에는 유의한 차이를 보이지 않았다. 반면 환자의 나이와 수술 시간, 재수술의 여부, 술중에 이뇨제 등을 사용한 경우, 술 중에 저혈압의 유무, 술 후에 기계적 환기를 시행한 경우 등에는 유의한 차이를 보였다. 결론 : 이상의 결과로 급성신부전의 원인은 어느 한 가지라고 하기 보다는 위험인자에 얼마나 노출되어 있는가가 결정하는 것 같고, 그 원인들이 모여서 상승효과를 내는 것 같다. 그러므로 수술 전부터 많은 위험에 노출된 환자는 술 중 더 적극적인 감시를 시행하여 수술 후의 합병증 발생을 줄이는 노력을 기울여야 하겠다. Background : Acute renal failure is one of the leading causes of postoperative morbidity and mortality. The purpose of this study was to determine the risk factors that are associated with acute renal failure after colorectal surgery. Materials and Methods : Five hundred seventy patients who operated colorectal surgery at the Yeungnam University Medical Center over three years from 2004 to 2006 were enrolled in this study. The effects of gender, age, ASA classification, concomitant disease, surgery type and duration, reoperation, urogenital manipulation, medication, hypotension, hypovolemia, transfusion, and postoperative ventilatory care on the occurrence of acute renal failure after colorectal surgery were studied. Results : The major risk factors of acute renal failure after colorectal surgery were age of patients (P=0.003), ASA classification (P<0.001), concomitant disease (P<0.001), duration of the time surgery (P=0.034), reoperation (P=0.001), use of intraoperative diuretics (P=0.005), use of postoperative diuretics (P<0.001), intraoperative hypotension (P=0.018), intraoperative transfusion (P<0.001), postoperative transfusion (P<0.001), and postoperative ventilatory care (P=0.001). Conclusion : Multiple factors cause synergistic effects on the development of acute renal failure after colorectal surgery. Therefore, efforts to reduce the risk factors associated with acute renal failure are needed. In addition, intensive postoperative care should be provided to all patients.

Complication of Intraoperative Radiation Therapy (IORT) in Gastric Cancer

김명세(Myung Se Kim),김성규(Sung Kyu Kim),송선교(Sung Kyo Song),김홍진(Hong Jin Kim),권굉보(Koing Bo Kwan),김흥대(Heung Dae Kim) 대한방사선종양학회 1992 Radiation Oncology Journal Vol.10 No.2

영남대학교 의료원 치료방사선과에서 1988년 6월 15일에 위함 환자의 수술중 방사선치료를 시작한 이래 1992년 8월 30일까지 총 58예에서 시도하여 그중 53예에서 IORT를 실시하였으며, 정기적인 추적검사에서 한명의 국소개발 환자도 보고되지 않고 있다. 출혈(3예), 장관폐쇄(3예), 폐혈증(2예), 골수기능저차(1예)를 포함한 총 9예(17%)의 합병증이 보고되었고, 이중 6예(13%)가 사망하였다. IORT(1500cGy), 외부 방사선치료 (-4500cGy)와 강한 항암제를 병합치료 하였음에도 불구하고 주등(수술과 항암제 치료)의 25.2%, 김등(수술 불가능한 환자에서 항암제 투여)의 18%, 리등(수술)의 18.5%, Kraming등(IORT 2800-3500cGy)의 35.3%에 비해 낮은 합병증을 보여 IORT가 위암의 치료에 공헌할 수 있음을 시사하였다. 그러나 비교적 높은 치사율(11.3%)은 더욱 세심한 수술수기 및 수술 후 환자의 치료가 필요하며 외부 방사선치료와 항암제치료의 적절한 시기 조절 및 치료선량의 가감이 필요할 것으로 생각된다. Local control is the important prognostic factor in cancer treatment because local control decrease the relative risk of metastatic spread and increase distant metastasis free survival. IORT is the modality which could increase local control without increasing complication, combined with curative operation. Eventhough we could achieve significant deacreased local failure by IORT and curative resection, it should not be committed as a main treatment modality without proving acceptable complications. Therapeutic Radiology Department of Yeungnam University Medical Center have tried 58 IORT from June 15, 1988 and performed 53 IORT in patients with gastric cancer. No local failure had been reported including interstinal obstrution, hemorrhage, sepsis, and bone marrow depression. These complications could be comparable to Jo's 25.2% (chemotherapy + operation), Kim's 18% (chemotherapy only in inoperable patients), because our treatment regimen is consisted of IORT (1500cGy), external irradiation (--4500cGy) and extensive chemotherapy (FAM, 5FU + MMC, BACOP). Our data encouraged us to re-inforce further IORT in stomach cancer treatment.

雜犬에서 Enflurane 마취시 Sodium Nitroprusside에 의한 유도저혈압이 血力學에 미치는 影響

김흥대,최세진 충남대학교 의과대학 지역사회의학연구소 1987 충남의대잡지 Vol.14 No.1

To maintain the adequate cerebral blood flow and tissue perfusion to the vital organs is crucial during hypotensive anesthesia. Enflurane maintains the myocardial contractility better than halothane because of increased beta-sympathetic activity and inhibition of aortic baroreceptor activity, and sodium nitroprusside(SNP) that commonly used as a vasodilator during hypotensive anesthesia also has the tendency to increase the heart rate and to maintain the cardiac output. Therefore, induced hypotensive anesthesia using enflurane with SNP seems to be different from the halothane with SNP anesthesia in terms hemodynamic changes. The purpose of this study was to investigate whether enflurane anesthesia with SNP used in induced hypotension has the similar effects as has been described in halothane anesthesia with SNP. In fifteen mongrel dogs with supine position, anesthesia. was induced using 15mg/kg of thiopental sodium, and then endotracheal intubation was performed without succinylcholine. Heart rate, cardiac output, central venous pressure, pulmonary capillary wedge pressure and pulmonary artery mean pressure were measured and stroke volume, systemic vascular resistance and pulmonary vascular resistance were calculated during IPPV with 100% oxygen(l), 30 minutes after anesthesia with 2.0% enflurane-100%0₂( II ), one minute after enflurane-0₂anesthesia with 2. Oug/kg/min SNP(II), three minutes after(IV), and five minutes after enflurane-O2-SNP anesthesia(V). The results were as follows: 1. Heart rate was decreased significantly from 162±7.0/min in I to 146±5.7/min in V, which was reduced by 9.9%(P<0.05). 2. Mean arterial pressure was decreased progressively from 105.7±5.70mmHg in I to 56.1±6.90 mmHg in V, which was reduced very significantly by 46.9%(P<0.005). 3. Cardiac output was decreased significantly from 2.05±0.41ℓ/min in I to 1.65±0.12 ℓ/min in V, which was reduced by 19.5%(p<0.05). 4. Pulmonary capillary wedge pressure was 3.7±0.42mmHg in I, but it was increased to 4.5±0.56mmHg in II and to 4.0±0.73mmHg in III. Level of III was maintained in iV and V. 5. Systemic vascular resistance was decreased significantly from 62.7±14.36mmHg/ℓ/rain in I to 32.7±2.38mmHg/8/min in V, which was reduced by 47.8%(p<0.01). It is concluded that enflurane anesthesia. has the tendency to maintain cardiac output and SNP also has the same effect on cardiac output although it decrease MAP, but enflurane a .esthesia with SNP infusion brings about marked decrease in arterial pressure and moderate decrease in cardiac output.

2001 세계도자기 엑스포 개최의 경제적 파급효과분석

김대우,김흥식 문화관광연구학회 2002 문화관광연구 Vol.4 No.2

This study explores and demonstrates the economic impact of the 2001 World Ceramic Exposition which will be held in Kyonggi-Do. The study uses the regional Leontief-Keynes inverse matrix model which extends a static standard model. The results found that the macroeconomic effects of the EXPO are enormous at the regional level as well as the national level. By sector, economic impact of the tourism-related sectors, especially shopping-related and service-related tourism sectors, is great. Further applications of the I/O analysis in the context of economic impact are needed to establish and confirm the results. The implications of these findings for host regions are discussed. Finally, the strategies for a successful millennium event are also presented.

심혈관계를 침범한 Wilms종양 1례

김흥식,강진무,차홍대 啓明大學校 醫科大學 1986 계명의대학술지 Vol.5 No.2

This report is a presentation of a rare case of wilms tumor involved rigth kidney, right renal vein, ingerior vena cava and right atrium seen in a girl of 4 years of age, who presented abdominal distention and hematuria for last 1 month. Ultrasonography of the abdomen revealed dilatation of right renal vein and inferior vena cava and mass iesion in the right atrium was seen on Echocardiogram. A mass of the right upper quadrant which invaded inferior vena cava and right atrium through the right renal vein was found on CT scan of the chest and abdomen, which suggested the wilms tumor of right kidney propagated into the right renal vein, inferior vean cava and right atrium as a tumor thrombosis. A brief review of literature was made.

회계이익과 경제적 부가가치의 정보내용 비교

김흥식,민대홍 충남대학교 경영경제연구소 2000 경영경제연구 Vol.23 No.2

1960년대 이후 경영환경의 변화에 따라 가치위주 경영이 새롭게 강조되고 있는데 이를 위한 관리기법으로 경제적 부가가치(EVA)에 의한 성과평가 및 투자결정이 재무 및 회계분야에서 논의되고 있다. 본 연구는 EVA 측정치외 전통적인 회계이익 측정치의 정보내용을 자본시장에 기초하여 실증적으로 비교 분석하였다. 누적초과수익률을 종속변수로 회계이익과 EVA를 독립변수로 하여 다중회귀분석을 통한 EVA의 추가적인 정보내용을 검증하였다. 또한 사건연구를 하였는데 사건일은 개별기업의 감사보고서일로 하였으며, 기업규모에 따라 정보내용에 차이가 있는지도 비교분석하였다. 실증분석결과 EVA의 추가적인 정보효과는 누적기간에 걸쳐 부분적으로 확인되었으며, EPS 등과 같이 EVA도 개별기업이 측정하여 공시할 필요성을 제기하였다.

앤더슨 뉴만모형을 이용한 아동의 치과의료이용행태에 영향을 미치는 요인에 관한 연구

김수남,이흥수,김경회,김대업,박득희 大韓小兒齒科學會 1998 大韓小兒齒科學會誌 Vol.25 No.1

The purpose of this study is to provide framework for understanding children's dental utilization. In this paper Andersen-Newman's model is applied to the use of dental visits. This model consists of predisposing, enabling, and need components that describe a person's decision to use dental health services. One thousand, nine hundred seven children and their mothers were selected for the stufy. The children were fourth grade to sixth grade in elementary schools in Iksan city, Korea. Models are operationalized using stepwise multiple regression analysis and path analysis. The number of independent variables used in the anslysis was 39 in total, ie 32 predisposing components, 6 enabling components, and 1 need component. Children's Dental utilization was measured based on the number of visits. The data collceted by means of a questionnaire survey. In this study, the amount of variance by the model was 25 percent. Predisposing factors had the greatest effect on utilization. Number of restricted activity days caused by oral disease, having a regular dental care, and susceptibility on oral disease of children were found to have significant major effects on dental utilization of children. Mother's dental visits was most important factor affecting dental utilization of children.

제7차 교육과정에 따른 함수영역의 수준별 문항개발 및 평가방법

박대연,고안상,유흥상,김윤배 전주대학교 교육문제연구소 2000 敎育論叢 Vol.15 No.-

알루미나 세라믹스의 분위기 압력변화에 따른 마모특성에 관한 연구

박홍식,김용완,김형자,김영대 釜慶大學校 1996 釜慶大學校 論文集 Vol.1 No.2

This study was investigated to the tribology characteristics for the alumina ceramics(Al₂O₃) in the variation of ambient pressure. The sliding wear test was carried out under the condition of the various applied load, sliding distance and the ambient pressure with mate specimen made of STB2 stee. The results obtained are as follows : 1. As the ambient pressure decreases, the friction coefficient increases, becasue the protective layer made of absorption substance can not be fromed due to decrease of the amount of ambient gas. 2. The friction coefficient of purity 85% alumina is higher than that of purity 95% and 99.7% alumina because of the influence of heat accumulation. 3. As the applied load increases in each ambient pressure, the friction coefficient increases due to brittle fraction of alumina grain and great action of cohesion. However, the gap of the friction coefficient by the variation of the contact load is small in the vacuum. 4. The friction coefficient regarding the variation of sliding distance increases by on inital 60 meters of the sliding distance, however, the friction coefficient is almost constant after the sliding distance.

SrTiO₃의 미세구조의 대한 Nb 과 Cu 첨가제의 영향

조성걸,김대흥 국립경상대학교 공과대학 부설 첨단소재연구소 1992 尖端素材 Vol.2 No.-

Undoped, Nb-doped, and (Nb,Cu)-doped SrTiO₃specimens were made using oxide-mix process. Nb-doped specimens having Sr/(Ti+Nb)=0.986 showed grain size decrease as Nb concentration changed from 0.4 to 0.8 mol%. Dark blue color and low electrical resistivity were observed in all Nb-doped specimens. When 0.8 mol% Cu was added to 0.4 mol% Nb₂O?-doped composition, grain size decreased to 2 ㎛. However, grain growth inhibition was not found for specimens with 1.6 and 2.4 mol% Cu. Cu seemed to be distributed throughout the grains rather than segregated at grain boundaries and to be present as Cu⁴ion which compensated donor effect of Nb ions.