신장이식 환자에서 HCMV 항원혈증 검사의 임상적 유용성

김탁,성흥섭,박관태,김송철,김성한,최상호,김양수,우준희,박수길,한덕종,이상오 대한감염학회 2009 감염과 화학요법 Vol.41 No.2

Background : This study was performed to determine the cut-off value and the predictability of symptomatic human cytomegalovirus (HCMV) infection according to the peak value of HCMV antigenemia assay in kidney transplant recipients. Materials and Methods : We reviewed the results of HCMV antigenemia assay (Chemicon, CA, USA) in patients who received kidney transplantation at our institution from May 2003 through May 2008, and investigated the existence and the type of HCMV infection by the medical record review. Patients who underwent the test only once during the episode or those who received ganciclovir for more than 48hrs before the test were excluded. The receiver-operator characteristic curve was drawn and the point showing maximum likelihood ratio (LR) was chosen as the cut-off value of symptomatic HCMV infection. Results : A total of 689 episodes were screened and 134 episodes were enrolled. Thirty-three (24.6%) episodes were symptomatic HCMV infection, 23 (17.2%) episodes were associated with HCMV syndrome, and 10 (7.5%) episodes were tissue-invasive diseases. The maximum LR was 7.5 (95% confidence interval, 4.014.2) and the cut-off value was 29.5 cells/200,000 WBC. The sensitivity, specificity, Positive predictive value, and negative predictive value were 66.7%, 91.1%, 71.0%, and 89.3%, respectively. Conclusions : The cut-off value of symptomatic HCMV infection by the peak value of HCMV antigenemia assay in our study was similar with previous results, although the sensitivity was relatively low.

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.

소에서 盲腸擴張을 동반한 第4胃食滯 手術 1例

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.

정재의 시대적 변천과 전승보급에 관한 연구

김상덕(Kim Sang Duck) 한국체육철학회 1997 움직임의철학 : 한국체육철학회지 Vol.5 No.1

Chong-Jae as a court dance is dedicated to the king. That means contributing talent. It originated grom the shape of court dance music under the control of professional department, and was named 「bang Ark and Hayng Ark」 and 「A-Ark Chong Jae」 has the genre as a dance. In the times of 「Korea」, the respect of Buddism made a present to the king customary, directed to inflew 「Sin Ark of the sung」 and 「Tae Song A-Ark」, and the sting contribute organized The department of court music of the tang, which modified to be in harmony with our people`s emoting, dance and music admired the great achievement of the founding country, prayed the national peace in the early of 「Cho-Sun」 era. So to speak, It developed to make a display of the kings authority. And the completing of 「Hoonmin Jong um」 dirceted Chang Sa, which use 「Korea and Chinese characters in combingation. Since, the early of the 「Cho-Sun」 dynasty, the golden age of the civilization, the dance and music declined, and not reached the level of the first stage. It caused by the much invasion of the Japanese and with the help of the political and economical peace of the king Sook Jong, the court music revived under the rale of the King 「Young Jong」. To the modes ages from the king 「Soon Jae」, there was np dance and music system, introduced 「Chong Jae」, as it is, and became extinct Since the annexation of the Korean and Japan. And, 「Lee Wang Jik」 court dance department renamed court dance department, opened the national classical music institute in 1951. With the designation as a 「Intagible cultural assets」, the modern full-dresses reappearance of 「Chong Jae」 accomplish by 「Kim Chon Heng」 as a 「Chong Jae」 reappearance choregrapher theagh the performance of the national classical music Institute. This work of the reapperarcne done by the national classical music institute must be estimatel affirmatively. As a researcher, I examined the inflow and conservation theroughout the times with the process of historcal changes of 「Chong Jae」, according to the creative Korean dance and the flood of the inflow of foreign culture, I made some conclusion on the pressevation and transmission of 「Chong Jae」. First, the recognition both school education and the institytional system in the national -public organization must direct the chance of various learning in view of the preservation and trancsmission of 「Chong Jae」. Second, the estrangement of court dance on the ceremony of dnace in the dance stage and students dance contest, a group of positive participation must be groped. Third, there is dnace which designation 「intangible cultural assents」 in 「Chong Jae」. Especially, Ovserng the dance of a group 「Chong Jae」, composition dance equipment, I feel sure that It will help the exploitation of various composition, dance, properties and device in the scope of the stage effection in the 「ceremony of the korean creative dance」. In the view of inheriting and tradition the reappearance, reviral, transmiting and spread of 「Chong Jae」 have the meaning as it is. The reappearance and revival must be developed top the arctic value which is in harmony with the present age, consider the internationalization and globalization and Institutional devices are essential to hand it down to poeterity as a research naterials and a concera to cultural art is indispensible.

단일공법 복강경하 질식자궁절제술 110예의 고찰 및 다공법과의 비교

박병준 ( Byung Joon Park ),김용욱 ( Yong Wook Kim ),노덕영 ( Duck Yeong Ro ),김태응 ( Tae Eung Kim ),류기성 ( Ki Sung Ryu ),김장흡 ( Jang Heup Kim ) 대한산부인과학회 2010 Obstetrics & Gynecology Science Vol.53 No.7

목적: 통상적인 복강경기구만을 사용한 단일공법 복강경하 질식자궁절제술을 다공법 복강경하 질식자궁절제술과 비교하여 안전성 및 유용성을 평가하고자 하였다. 연구 방법: 2007년 4월부터 2009년 11월까지 인천성모병원에서 자궁근종 또는 자궁샘근증의 질환으로 단일공법 복강경하 질식 자궁절제술을 시행받은 환자 110명과 다공법 복강경하 질식자궁절제술을 시행받은 환자 110명, 총 220명의 환자를 대상으로 하였다. 우리는 모든 수술에서 통상적으로 사용되는 구부러지지 않는 일직선의 복강경기구를 사용하였다. 또한 단일공법 및 다공법 복강경하 질식자궁절제술 둘 다에서 수술자 (Kim, YW)의 이름을 따서 명명한 새로운 질단부 봉합 방법인 김씨 질구개 현수법 (Kim`s Vaginal Vault Suspension Method)을 사용하였다. 결과: 환자 나이, 수술 시간, 자궁의 무게, 혈색소 수치의 변화, 수혈 빈도, 수술 후 발열에서 두 군 간에 유의한 차이를 보이지 않았다. 환자들의 평균 나이는 46.7±7.0세(단일공법)와 45.5±6.3세(다공법)이었다. 평균 수술 시간은 87.2±21.0분(단일공법)과 83.3±20.3분(다공법), 평균 자궁의 무게는 261.4±139.7 g(단일공법)과 257.8±132.9 g(다공법), 평균 혈색소 수치의 변화는 1.1±0.7 g/dL(단일공법)와 1.2±0.6 g/dL(다공법)이었다. 두 군 모두에서 수술 중 장 또는 요로의 손상은 없었다. 두 군 모두에서 각각 한 건의 개복수술로의 전환이 있었다. 단일공법을 시행한 군에서 입원 기간이 유의하게 짧았다(2.6±0.6일 [단일공법], 3.3±0.7일 [다공법], P<0.05). 결론: 통상적으로 사용하는 구부러지지 않는 일직선의 복강경기구를 이용한 단일공법 복강경하 질식자궁절제술은 다공법 복강경하 질식자궁절제술에 대한 안전하고 유용한 대체 수술이 될 수 있다. Objective: To evaluate the safety and feasibility of single-port access laparoscopically assisted vaginal hysterectomy (SPA-LAVH) using conventional laparoscopic instruments compared to multi-port access laparoscopically assisted vaginal hysterectomy (MPA-LAVH). Methods: We reviewed the medical records of 220 patients with uterine leiomyoma or adenomyosis who underwent 110 SPA-LAVH and 110 MPA-LAVH in Incheon St. Mary`s Hospital between April 2007 and November 2009. We performed SPA-LAVH with conventional rigid straight laparoscopic instruments in all cases. We also performed a new vaginal cuff closure method, Kim`s Vaginal Vault Suspension Method, named after the operator (Kim, YW) in both SPA-LAVH and MPA-LAVH. Results: There was no significant difference in patients` age, operating time, uterine weight, hemoglobin change, frequency of blood transfusion, and incidence of postoperative fever between the two groups. The patients` mean age was 46.1±7.0 years (SPA-LAVH) and 45.5±6.3 years (MPA-LAVH). The mean operating time was 87.2±21.0 minutes (SPA-LAVH) and 83.3±20.3 minutes (MPA-LAVH). The mean uterine weight was 261.4±139.7 g (SPA-LAVH) and 257.8±132.9 g (MPA-LAVH). The mean hemoglobin change was 1.1±0.7 g/dL (SPA-LAVH) and 1.2±0.6 g/dL (MPA-LAVH). Neither bowel injury nor urinary tract injury occurred during the operation in the two groups. One of the SPA-LAVH and one of the MPA-LAVH cases were converted to abdominal total hysterectomy. The mean hospital stay time was shorter with SPA-LAVH (2.6±0.6 days [SPA-LAVH] and 3.3±0.7 days [MPA-LAVH], P<0.05). Conclusion: SPA-LAVH using conventional rigid straight laparoscopic instruments can be offered as a safe and feasible alternative to MPA-LAVH.

학기제 현장실습제도(Sandwich System)의 보다 효율적인 운영 및 개선 방안 연구

김상길,조덕호,이상호 大田産業大學校 2000 한밭대학교 논문집 Vol.17 No.1

The main purpose of this paper is to study methodologies of more effective management and improvement of the sandwich system for the Division of Advanced Materials Engineering in the Taejon National University of Technology (TNUT) to provide the result of on-the-job experience based on the semester and to utilize selected elements of the program in the next semester and other colleges and universities. The study uses questionnaire methodology by developing twenty-four questions to investigate and analyze the issues and problems of the sandwich education system managed for the thirst time at TNUT. The study also tries to find out the ways of improvement of the program. Participants of the study are students, faculty members of the Division of Advanced Materials Engineering at TNUT and industrial staff members who were participated of the sandwich education program. The study shows that students are not satisfied with the management system of the program, especially the lack of preparation, orientation as well as the communication channel between the staff members of the University Specialization Team, administered the program and the students. However, participated faculty members and industrial staff members highly evaluated the whole process of the program in general. For the improvment of the program students want to have industrial experiment in the better working places, such as providing the good working condition, payment, and the major-rebated efficient program. The result of the study shows that student are not ignore the importance and the outcomes of the program and the on the job experience while they are in school, but they want to change some management systems of the program. Faculty members participated are agree on the management system of the program, but they think student are not fully understand the values of the program. Industrial staff members are most favorable and they want to participate to the program atwain, if they have another chance, but they do not want to pay students during the practicum.

레이저 계측에 의한 맞대기 용접부의 스트레인 측정

성백섭,차용훈,박창언,김일수,김덕중,이연신,손준식 한국공작기계학회 2001 한국공작기계학회 춘계학술대회논문집 Vol.2001 No.-

Currently knowledge of strain in welds has mainly been obtained from strain gaging method; that is directly attaching most of the material to the gage. The very few non-contact method are still in the early stage. One of the non-contact methods is by the use of the laser that has high-level of the accuracy for the measurement, and this laser also has excellent characteristics on which many studies for its applications are focused throughout the many fields. The dissertation is on the measurement of the strain caused by the characteristics and the temperature changes of the TIG welded zone which is used with 3D ESPI system that is functionally modified through the laser ESPI system. This system employed the aluminum sheet-metal which are mainly used for the steel plate such as for the electronics, chemistry, food instrument and electronic appliances.

경추치상돌기 골절후 나타난 지연성척수병 2예 : Report of Two Cases

김영백,황성남,최덕영 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.8

We reported two cases of delayed myelopathy associated with odontoid fracture due to a nonunion and the resultant instability of the atlantoaxial joint. Both of two cases showed marked compression of cervical cord at C1 level by displaced odontoid process and overgrown fibrous tissue. We performed laminectomy of atals and posterior fusion from occiput to axis with autogenous iliac bone. We also reviewd the reported cases in the literature and surgical consideration.

종합병원 간호사의 부서이동 양상 및 직무만족도

김순덕,이성수,이병국 순천향대학교 산업의학연구소 1998 순천향산업의학 Vol.4 No.1

In order to investigate the characteristics of job transfer and job satisfaction of general hospital nurses and provide the nurse department the basic materials neccesary for efficient manpower management, 400 nurses were selected from two university hospital in chunan Choognam. The study subject was nurses who came from special nursing care unit such as intensive care unit and emergency room and general nursing care unit such as general surgery ward, orthopedic surgery ward and neurosurgery ward. The priod of this study was from February 2 to 28, 1998. The results of the study were as follows. 1. While 252 nurses(63.0%) had transfer experience, 148 nurses(37.0%) didn't have. Two hundred sixty five nurses(67.7%) wanted over 15 days for the preparation period before job transfer and 57.7% wished the periodical change of assignment and 19.5% wanted job transfer in present nursing unit. 2. While the cause of wanting job transfer were "defict of accomplishment and worth in job(84.6%)", "to acquire experience of other nursing unit(83.3%)", "unsuitableness of own's aptitude in job(73.1%)" respectively, the cause of unwanting job tranfer were "possibility of transfer to undesired nursing unit(87.9%)", "satisfaction of present nursing unit(84.8%)", "anxiety of new nursing unit(73.0%)" respectively. 3. The mean score of opinion of job transfer effect was 3.1. Among these opinions the mean scores of professional development, employee' common desire, and management were 3.3, 3.0, and 3.0 respectively. 4. The mean score of opinion of job satisfaction was 3.0. Among these opinions the mean scores of interaction, professional status, autonomy, and task requirements revealed to be high, and were 3.6, 3.6, 3.1 and 3.0, respectively, and those of pay, administration, and doctor-nurse relationship showed to be low, and were 2.7, 2.7, and 2.5, respectively. 5. According to position. work duration. nursing unit, there were statistical difference among job satisfaction such as pay, professional status, doctor-nurse relationship, administration, autonomy, task requirements, and interaction. 6. The spearman correlation coefficients of professional development category on the effect of job transfer with job satisfaction were administration (rs=0.159, p=0.0014), autonomy(rs=0.142, p=0.0043), and task requirement(rs=0.139, p=0.053), respectively, The spearman correlation coefficients of administration-management category on the efffect of job transfer with job satisfaction were administration(rs=0.276, p=0.0001), autonomy(rs=0.246, p=0.0001), and task requirement(rs=0.236, p=0.0001), respectively. the spearman correlation coefficients of employee' common disire category on the effect of job transfer with job satisfaction were autonomy(rs=0.243, p=0.0001), administration(rs=0.227, p=0.0001), and task requirement(rs=0.213, p=0.0001), respectively.

감각사시에 관한 임상적 고찰

김상덕,양연식,김재덕 圓光大學校 醫科學硏究所 1998 圓光醫科學 Vol.14 No.1

Background: Sensory heterotropia is defined as a secondary deviation following loss or severe reduction in visual function in one eye. Surgical results in sensory heterotropia are quite unpredictable. Overcorrections or undercorrections occur frequently, and surgical alignment is rarely stable. Methods: The authors designed a study based on medical records of 28 patients with sensory heterotropia. The study included the etiology of visual impairment, type of strabismus as the age of the onset of visual loss and surgical outcome. Results: The range of age was from 5 to 50 years old(mean age, 20.6 years) and onset of visual impairment was from at birth to 25 years old(mean age, 7.6 years). The etiologies were anisometropia (8 cases), corneal opacity (7 cases), optic nerve disease (6 cases), retinal disease (5 cases) and congenital cataract (2 cases). The direction of deviation in patients under 5 years of age were esotropia in 7 cases and exotropia in 4 cases. In patients over 5 years of age esotropia accounted for 1 case and exotropia for 16 cases. Immediately after surgery 20 cases were successful, 3 cases undercorrected and 5 cases overcorrected. On follow-up, 4 cases out of 20 presented recurrence, one case of consecutive exotropia in a esotropic patient and straight alignment in one overcorrected patient. Also recurrence was low in the eyes with limitation of motion after operation suggesting that limitation of motion may be a inhibiting factor of recurrence in patients with sensory heterotropia. Conclusion: Although our average follow-up is only 23 months, We feel that surgical results in patients with sensory heterotropia appear to be stable enough to allow the patients of good cosmesis.