Poster Session : PS 0831 ; Upper GI Tract : Clinical Factors to Predict Angiographically Detectable Non-Variceal Upper Gastrointestinal Bleeding in Patients Refractory to Endoscopic Treatment

( Tae Hwan Ha ),( Tae Hoon Oh ),( Sung In Yu ),( Min Kim ),( Jong Wook Kim ),( Won Ki Bae ),( Jae Hyung Kim ),( Seung Suk Baek ),( Mi Jin Ryu ),( Ye Na Choi ),( Ji Young Park ),( Eileen L Yoon ),( Tae 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Non-variceal upper GI bleeding (NVUGIB) is a common medical problem that has signifi cant association with morbidity and mortality. Angiographic detection and subsequent transarterial embolization (TAE) is a primary treatment option when medical and endoscopic treatments fail. We investigated clinical factors that could affect the success of the angiographic detection and prognosis after TAE in patients with NVUGIB refractory to endoscopic therapy. Methods: A retrospective analysis of the clinical data was done in patients with failed endoscopic treatment who underwent angiography for the treatment of acute NVUGIB between May 2002 and May 2013. Patients were divided into detection or non-detection groups according to the presence of bleeding stigmata in angiographic fi nding. Rebleeding defi ned as subsequent bleeding event within 7 days and mortality within 30days were analyzed as outcome parameters after TAE following detection in angiography. Results: A total 45 patients 37 (male, mean age, 65.9±14.9 years) were analyzed and classifi ed as a detection group (n=25, 55.5%) and non-detection group (n=20, 44.6%). Peptic ulcers were the most common cause of refractory NVUGIB. Larger transfusion amount (5.7±3.9 unit vs. 3.5±2.8 unit; P=0.03), prolonged aPTT level (34.2±17.3 sec vs. 21.8±13.8 sec; P=0.01) and short time interval between last endoscopy and angiography (17.5±25.9 hours vs. 34.3±59.5 hours; P=0.04) were found to be signifi cant factors for predicting angiographic detection. TAE was performed in all patients detected in angiography. Rebleeding (44%) was significantly associated with higher Rockall score (8.3±1.5 vs. 6.6±2.4; P=0.046) and mortality (12%) was signifi cantly associated with higher Rockall score (9.3±0.6 vs. 7.1±2.2; P=0.002) and higher level of BUN (55.3±47.4 vs. 27.6±17.4; P=0.01). Conclusions: Clinical characteristics associated with angiographic detection in patients with NVUGIB refractory to endoscopic therapy were severe bleeding, bleeding tendency and early angiographic intervention. The Rockall score is useful parameter for predicting rebleeding and mortality after TAE.

포괄수가지불제도 적용에 따른 산부인과 진료수입의 변화

황태연,유병철,정귀언,정수진,김성준,배기택,손혜숙,이종태,전진호,엄상화 인제대학교 2001 仁濟醫學 Vol.22 No.1

Objectives: Under the fee-for-service system, Korean hospitals have been suffering from the worsening profitability caused by law medical care fees. To overcome the difficulties, they have maximized the quantity of medical services and made relatively large investment in developing new medical services using high-priced medical equipment, medicines and medical supplies which were not covered by medical insurance system rather than reduced running costs. Materials and Methods: This study was made to analyze and forecast the revenue change of the department of Obstetrics and gynecology of an university hospital in Seoul, expecting the implementation of DRG system in 2000. Results: The results were as follows : 1.During the first two days of hospitalization. 41% of total medical service fee was occurred, which was thought that most of the check-ups and operations were made during this period. After two days of hospitalization, the new occurrence of medical service fee tended to reduce. 2.Out of total medical service fee, 67% of admission fee was occurred after 5 days of hospitalization. This was because medical service fees in obstetrics and gynecology department occurred during the first 5 days of hospitalization. 3.Out of fees for operation, treatment, medical supplies and blood transfusion. 71% was occurred during the first two days. 4. In case of fees for examination, 50% was occurred during the first two days. 5.A total of 53% of fees for medication and injection was occurred during the first 5 days. Conclusions: By the implementation of the DRG system, the income is forecast to increase by 800 won to 310,000 won by the disease group of obstetrics and gynecology department. To increase hospital income with the implementation of DRG system, the results of this study suggest that examinations should be done at out-patient departments before the hospitalization of patient, the discharge of patient should be noticed in advance to reduce the period of hospitalization, and admission appointment system should be implemented for the immediate operation and delivery.

체외순환 없이 시행한 관상동맥우회술의 조기성적

원태희,최세용,양인숙 이화여자대학교 의과대학 2005 EMJ (Ewha medical journal) Vol.28 No.1

Background : The advances in surgical techniques and stabilizing devices have made the off-pump coronary artery bypass (OPCAB) popular, and good results have been published. We analyzed the early results of OPCAB performed in our hospital. Materials and Methods : Between January 2004 and December 2004, 23 patients underwent OPCAB. There were 14males and 9 females with mean age of 62.6± 10.3years. Preoperative diagnoses were unstable angina in 13(57%), acute myocardial infarction in 9(39%), and stable angina in 1(4%). Preoperative angiographic diagnoses were three-vessel disease in 12 (52%), two-vessel disease in 8(35%), one-vessel disease in 1(4%), and left main disease in 2(9%). Results : The mean number of grafts was 2.6 ±0.9 per patient. Vessels accessed were left anterior descending artery in 23, diagonal branch in 14, obtuse marginal branch in 9, right coronary artery in 12, and posterior descending artery in 1. Left internal mammary artery were used in 22 patients and bilateral internal mammary arteries were used in 1 patient. There was no operative mortality. Postoperative complications were cerebral vascular accident in 1, postoperative bleeding which required operative management in 2, arrhythmia including atrial fibrillation in 5, and minor operative wound problem in 1. Pre-discharge graft patency was evaluated in 11 patients. One internal mammary artery graft was occluded in 11 internal mammary artery graft evaluated. The patency rate was 91%. Seventeen saphenous vein grafts were patent in 19 saphenous vein grafts and the patency rate was 89%. Conclusion : Our result of OPCAB is promising and OPCAB is suggested to be the ideal technique with less morbidity and mortality.

클러스터링 기법을 이용한 퍼지 모델링에 관한 연구

원태현,김문수,이용길,강석규 동의공업대학 2000 論文集 Vol.26 No.1

In this paper, a new approach to modeling of static and dynamic systems using clustering techniques. To express the various and complex behavior of systems, we combine multiple model method. The Gustafson-Kessel algorithm is used in partitioning of system, and Takaei Sugeno rule structure is adopted to form the fuzzy rules. According to simulation, the performance of fuzzy modeling technique is evaulated.

대구지방의 위암에 대한 병리조직학적 연구

홍석재,이태숙,최원희,이경철 영남대학교 의과대학 1985 Yeungnam University Journal of Medicine Vol.2 No.1

대구지방의 위암에 대한 병리조직학적 연구의 목적으로 대구 일원의 의료기관에서 수집한 위내시경 표본과 위절제수술 표본에 의해 위암으로 확진된 350예 및 130예의 조직학적 유형과 연령 분포는 다음과 같다. 1. 위내시경 표본 350예 중 선암이 344예(98.3%)로서 대부분을 차지하였으며 편평상피암과 미분화암은 불과 6예(1.7%) 뿐이었다. 선암 중에서는 tubular type가 215예(61.4%)로서 가장 많았고, 다음이 signet-ring cell type으로 92예(26.3%)이었다. 연령 분포는 50세대가 가장 많이 발생하여 120예(34.3%), 다음이 60세대로 81예(23.1%), 40세대가 76예(21.7%), 70세대가 33예(9.4%), 30세대가 32예(9.1%), 20세대가 8예(2.3%) 등의 순위였다. 2. 위절제수술 표본 130예중 가장 많은 조직학적 유형은 역시 선암으로 127예(97.7%)였고, 만성소화성 위궤양에서 발생한 것이 3예 있었다. 선암 중에서는 tubular type이 86예(66.2%)로 제일 많았고 다음이 signet-ring cell type였다. 연령분포는 50세대에서 50예(38.5%)로 가장 많이 발생하였고, 다음 60세대가 36예(17.7%), 40세대가 21예(16.2%), 30세대가 11예(8.5%), 70세대가 6예(4.6%), 그리고 10세대에서 1예(0.8%)있었다. For evaluation on the histopathologic studies, and age sex distribution of the gastric carcinomas in the Taegu Area, the gastrectomized and gastoroscopic biopsy materials were collected at the Department of Pathology, College of Medicine, Yeungnam University, and the analyzed results were as follows: 1. In total of 350 cases of gastroscopic biopsy materials adenocarcinomas are 344 cases (98.3%), squamous cell carcinomas and undifferentiated carcinomas are only 6 cases (1.7%). In adenocarcinomas the most of all are tubular type, 215 cases(61.4%). In age distribution the highest is the 50th age group, and 120 cases (34.3%), the next, 60th, 81 cases (23.1%), 40th, 76 cases (21.7%), respectively. 2. In total of 130 cases of gastrectomized materials adenocarcinomas are 127 cases (97.7%), and are the highest incidence, the next, carcinomas originated from chronic peptic ulcer of the stomach, and are 3 cases (2.3%). In adenocarcinomas the highest are tubular type, 86 cases (66.2%), the next, signet-ring cell type, 20 cases (15.4%). The highest age incidence of the age group is 50th, and the next, 60th, 40th, 30th, 70th and 10th age group, respectively.

수 종의 상피기원 종양 세포주에서 방사선 조사와 표피성장인자 투여에 따른 세포 주기의 변화와 apoptosis 유발에 관한 연구

한원정,허민석,이삼선,최순철,박태원 대한구강악안면방사선학회 2000 Imaging Science in Dentistry Vol.30 No.1

Purpose : This study was aimed to evaluate the cell cycle arrest and apoptosis induction after irradiation and epidermal growth factor(EGF) treatment in three human epithelial tumor cell lines (A43l, Siha, KB). Materials and Methods : Single irradiation of 2, 5 and 10 Gy was done on three cell lines with 5.38 Gy/min dose rate using Cs-137 irradiator at room temperature. Also, EGF of 10 ng/ml was added immediately after 10 Gy irradiation. Cell growth was evaluated by counting the living cell number using a hemocytometer at 1 day, 2 days, 3 days, 4 days and 5 days after irradiation. Cell cycle arrest and apoptosis induction were assayed with the flow cytometry at 8 hours, 12 hours, 1 day, 2 days, 3 days, 4 days and 5 days after irradiation. Results : Growth of irradiated three cell lines were inhibited in proportion to radiation dose, EGF treatment after irradiation showed various results according to cell lines. On all cell lines, G2 arrest was detected after 8 hours and maximized after 12 hours or 1 day. Amount of G2 arrest was positively dose dependent. However, EGF showed no significant change on G2 arrest. G2 arrest was recovered with time at 2 Gy and 5 Gy irradiation. However, at 10 Gy irradiation, G2 arrest was continued. Apoptosis was detected at 10 Gy irradiation. On EGF treated group after irradiation, A431 and Siha cell lines showed slightly increased apoptosis but there was no statistically significant difference. KB cell line showed no marked change of apoptosis induction. Conclusion : Irradiation effects on cell cycle arrest and apoptosis induction in three human epithelial tumor cell lines, however epidermal growth factor doesn't effect on. (Korean J Oral Maxillofac Radiol 2000; 30: 71-79)

편평세포암종 임파절 전이에 대한 인공 신경망 시스템의 진단능 평가

허민석,박태원,박상욱,유동수,이삼선,최순철 大韓口腔顎顔面 放射線學會 1999 Imaging Science in Dentistry Vol.29 No.1

Purpose: The purpose of this study was to evaluate cervical lymph node metastasis of oral squamous cell carcinoma patients by MRI film and neural network system. Materials and Methods: The oral squamous cell carcinoma patients(21 patients, 59 lymph nodes) who have visited SNU hospital and been taken by MRI, were included in this study. Neck dissection operations were done and all of the cervical lymph nodes were confirmed with biopsy. In MR images, each lymph node were evaluated by using 6 MR imaging criteria(size, roundness, heterogeneity, rim enhancement, central necrosis, grouping) respectively. Positive predictive value, negative predictive value, and accuracy of each MR imaging criteria were calculated. At neural network system, the layers of neural network system consisted of 10 input layer units, 10 hidden layer units and 1 output layer unit. 6 MR imaging criteria previously described and 4 MR imaging criteria (site I-node level II and submandibular area, site II-other node level, shape I-oval, shape II-bean) were included for input layer units. The training files were made of 39 lymph nodes(24 metastatic lymph nodes, 10 non-metastatic lymph nodes) and the testing files were made of other 20 lymph nodes(10 metastatic lymph nodes, 10 non-metastatic lymph nodes). The neural network system was trained with training files and the output level (metastatic index) of testing files were acquired. Diagnosis was decided according to 4 different standard metastatic index-68, 78, 88, 98 respectively and positive predictive values, negative predictive values and accuracy of each standard metastatic index were calculated. Results: In the diagnosis of using single MR imaging criteria, the rim enhancement criteria had highest positive predictive value (0.95) and the size criteria had highest negative predictive value(0.77). In the diagnosis of using single MR imaging criteria, the highest accurate criteria was heterogeneity (accuracy : 0.81) and the lowest one was central necrosis (accuracy : 0.59). In the diagnosis of using neural network systems, the highest accurate standard metastatic index was 78, and that time, the accuracy was 0.90. Neural network system was more accurate than any other single MR imaging criteria in evaluating cervical lymph node metastasis. Conclusion: Neural network system has been shown to be more useful than any other single MR imaging criteria. In future, Neural network system will be powerful aiding tool in evaluating cervical node metastasis.

Soft chelating irrigation이 GP/AH Plus로 충전된 근관의 sealing ability에 미치는 영향에 대한 평가

유이숙,김태균,이광원,유미경 대한치과보존학회 2009 Restorative Dentistry & Endodontics Vol.34 No.6

본 연구의 목적은 glucose leakage test를 이용하여 soft chelating irrigation이 근관 충전의 sealing ability에 미치는 영향을 평가하는 것이다. 발치된 45개의 단근치를 수집하여 치관부를 잘라내 치근이 총 13mm가 되게 하였다. 근관은 K3 NiTi 구동 기구를 사용하여 성형하고 #45/.06 taper까지 확대하였다. 3개의 실험군(n=13)과 2개의 대조군(n=3)으로 나누었다. 실험군은 다음의 세척 방법으로 처리하였다. 1군, 2.5% NaOCl로 세척; 2군, 2.5% NaOCl로 세척 후 17% EDTA로 최종 세척; 3군, 2.5% NaOCl과 15% HEBP 혼합 용액으로 세척, 근관은 gutta-percha와 AH Plus를 사용하여 측방가압으로 충전하였다. , 습도 100%에서 7일 동안 보관하고 glucose leakage model을 이용하여 치관부로부터 치근부 방향의 미세누출을 정량화하였다. 1, 4, 7, 14, 21, 28일 째 누출된 glucose의 농도를 spectrophotometry로 측정하였다. 분석 결과 모든 실험군에서 실험 기간 동안 누출이 증가하는 경향이 있었다. HEBP처리군은 실험 기간 동안 EDTA처리군과 유의한 차이를 보이지 않았다. HEBP처리군은 21일 이후부터 도말층으로 덮인 NaOCl처리군에 비해 유의하게 낮은 누출을 보였다. HEBP로 처리된 상아질은 EDTA로 처리된 상아질과 비슷한 양상의 폐쇄를 보였으나 도말층이 남아있는 상아질보다는 우수한 sealing ability를 나타냈다. 그러므로 약한 킬레이트제인 HEBP는 EDTA의 대안이 될 수 있을 것이다. The purpose of this study was to evaluate the effect of soft chelating irrigant on the sealing ability of root fillings by using a glucose leakage test. A total of 45 single-rooted teeth were selected for the study. The teeth were decoronated leaving a total length of 13mm. The root canals prepared using K3 NiTi rotary instruments to an apical dimension of size 45(0.06 taper). The specimens were then randomly divided into 3 experimental groups of 13 roots each and 2 control groups of 3 roots each. Specimen in each group were prepared with different irrigation protocols : group 1, 2.5% NaOCl; group 2, 2.5% NaOCl and 17% EDTA: group 3, 2.5% NaOCl and 15% HEBP. The root canals were filled with gutta-percha and AH Plus sealer using lateral condensation. After 7 days in , 100% humidity, the coronal-to-apical microleakage was evaluated quantitatively using a glucose leakage model. The leaked glucose concentration was measured with spectrophotometry at 1, 4, 7, 14, 21 and 28 days. There was a tendency of increase in leakage in all experimental groups during experimental period. HEBP-treated dentin showed no significant difference with EDTA-treated dentin during experimental period. From the 21th day onward, HEBP-treated dentin showed significantly lower leakage than smear-covered dentin. HEBP-treated dentin displayed a similar sealing pattern to EDTA-treated dentin and a better sealing ability than smear-covered dentin. Consequently, a soft chelator(HEBP) could be considered as the possible alternative to EDTA.

RAM 및 LCC의 제조시스템의 능력에 대한 영향

황흥석,박태원 한국경영과학회 2000 한국경영과학회 학술대회논문집 Vol.- No.1

제조설비의 운영은 적절한 생산제품의 품질(신뢰도 생산단가 등)을 유지하는 조건으로 유지되어야 한다. 본 연구에서는 제조설비의 적정운영조건을 구하기 위하여 제조설비의 RAM 및 순기비용 (LCC)이 제조설비의 성능에의 영향을 분석하고 최적대안을 구하였다. 이를 위하여 우선 설비의 RAM 및 LCC 산정모델을 개발하고 이를 이용하여 제조설비의 성능에 미치는 영향을 분석하기 위한 수리모델을 제시하였다. 이를 위한 전산프로그램을 개발하고 이를 이용하여 제조시스템의 성능 분석 사례를 들어 보였다. 또한 다양한 환경에서 제조시스템의 성능을 예측하기 위하여 시스템의 복잡성이 큼 문제를 분석하는데 적절한 GMDH방법을 사용하여 추정하였다. 이를 이용한 성능예측의 실 예를 들어 본 연구의 과정을 보였다.

근관 전색재의 방사선 불투과성에 관한 비교연구

김태민,김서경,황인남,황윤찬,강병철,윤숙자,이재서,오원만 대한치과보존학회 2009 Restorative Dentistry & Endodontics Vol.34 No.1

This study was performed to assess the radiopacity of a variety of root canal sealers according to the Specification concerning root canal sealers. Ten materials including Tubli-Seal™, Kerr Pulp Canal Sealer™, AH 26^(R), AH plus^(R), AH plus jet™, Ad seal™, Sealapex™, NOGENOU™, ZOB seal™, Epiphany™, and dentin were evaluated in this study. In the first part. densitometric reading of an each step of aluminum step wedge on occlusal film was performed at different voltage and exposure time. In the second part, ten specimens were radiographed simultaneously with an aluminum step wedges on the occlusal films under decided condition. The mean radiographic density values of the materials were transformed into radiopacity expressed equivalent thickness of aluminum (mm Al). The following results were obtained 1 Among the various conditions, the appropriate voltage and exposure time that meet the requirement density was 60 kVp at 0.2 s 2 All of the materials had greater radiopacity than 3 mm Al requirement of ANSI/ADA specification No. 57 (2000) and ISO No. 6876 (2001) standards. 3 The radiopacity of materials increased as thickness of materials increased. 4 The mm Al value of each specimen at 1mm in thickness has a significant difference in the statistics. It suggests that root canal sealers have a sufficient radiopacity that meet the requirement. 다양한 근관전색제는 방사선 사진상 주위 해부학적 구조와 구별될 만한 방사선 불투과성을 나타내야 한다 따라서 이런 물질들이 근관에 충전될 때의 방사선 불투과성 정도를 평가해야 할 필요성이 대두되고 있다. 본 실험에서는 다양한 근관전색제들의 방사선 불투과성을 평가하고자, 방사선 노출조건에 따른 aluminium step wedge에 대한 광학 밀도를 알아보고, 그 중 적절한 노출조건을 선택하여 수종의 근관 전색재의 방사선 불투과성 정도를 알루미늄 두께로 환산하여 비교해 보고자 한다. 방사선 불투과성의 기준을 위해 11개의 step으로 구성된 aluminum step wedge을 사용하여, 60kVP, 70kVp관전압 상태에서 각각 0.2, 0.3, 0.4초 그리고 0.2, 0.3, 0.33초의 꼭 노출시간으로 교합필름상에서 방사선 촬영후 적절한 노출 조건을 구하였다. 직경 5mm 각각의 두께 0.5, 1.0, 1.5, 2.0, 2.5, 3.0 mm인 10종 (Tubli-Seal™, Kerr pulp Canal Sealer™, AH26^(R), AHplus^(R), AH plus jet starter kit™, Ad seal™, Sealapex™, Nogenol root canal sealer™, ZOB seal™, Epiphany™)의 근관전색재 시편을 각 재료와 두께당 10개씩 제작한 후, 동일한 두께의 상아질 시편, aluminum step wedge와 함께 정해진 노출시간에 따라 방사선 촬영을 하였다. 모든 필름은 자동현상기로 현상하였다. 시편의 방사선 흑화도를 densitometer로 5회 반복 측정 후, 평균값을 구하여 알루미눔 두께로 환산하였다.얻어진 정보를 분석하여 다음의 결과를 얻었다. 1 관전압 60 kVp에서 노출시간 0.2, 0.3, 0.4초, 70 kVp에서 0.2, 0.3, 0.33초로 변화를 주어 방사선 촬영을 하였을 때 흑화도가 ISO No. 6876 규격에 가장 적합한 것은 60 kVP, 0.2초 일 경우였다. 2 측정된 근관 전색제의 방사선 불투과성은 2.29 mm Al (N0GEN0L)로부터 13.69 mm Al (AH Plus jet)까지 다양하게 나타났으나, 모두 ANSI/ADA specification (2000) 또는 ISO No. 6876 (2001) 규격이 제시한 최소한 3mm Al 이상의 방사선 불투과성을 지녀야 한다는 기준에 적합하였다. 3 재료의 두께가 증가할수록 방사선 불투과성은 증가하지만, 정비례하지는 않았다. 4 각 실험재료의 1 mm 두께의 시편에 대한 mm Al값들은 통계적으로 유의한 차이가 있었다. 이상의 결과는 본 실험에 사용된 수종의 근관 전색재는 모든 규격에 적합한 방사선 불투과성을 가지고 있음을 시사한다.