사후분해 시체에 대한 법의학적 접근

최영식,이상용,김유훈,조갑래,이봉우,양경무,정낙은,서중석,이한영,이원태,강현욱 大韓法醫學會 2000 대한법의학회지 Vol.24 No.2

Disposal of a homicide victim by dismemberment is rare, but individual cases are on record in most major medicolegal departments. Recognition of postmortem mutilation may be of importance in the interpretation of certain murders committed by sexual perverts and other mentally deranged individuals and sometimes performed for the sole reason of easier disposal of the body. Postmortem dismemberment is usually readily recognizable as such; The edges of the injuries are dry and lack evidence of bleeding. The joints may be disarticulated without fracture, or the use of an axe or saw may be evident from examination of bones. Parallel horizontal or oblique furrows in the bone surface are caused by skipping of the saw prior to establishing depth. Such patterns on the bone may assist in identifying the particular saw involved. So we report 25 dismembered corpses that autopsied in National Institute of Scientific Investigation. This paper can help in attempting to establish not only the first criminal investigation steps but also the medicolegal approach methods in unidentified and dismembered deaths.

中學 科學敎育의 探究學習에 대한 評價問項 開發 (Ⅱ)

閔庚德,楊洪準,李善行,鄭遠佑,이병교,金裕漢,羅長薰 경북대학교 과학교육연구소 1985 科學敎育硏究誌 Vol.9 No.-

This study was accomplished to develope the evaluation items for inquiry learning in the 2nd grade Middle School Science for the consecutive study of the evaluation items for inquiry learning in the 1st grade Middle School Science(U-Hang Ki et al, 1984). In this study, paper and pencil test items and performance test items are made by analyzing the abilities of inquiry according to the contents and four basic experiments from each unit in the 2nd grade Middle school science. These evaluation items were applied to tke five classes of the 2nd grade of middle school to test their validity. It is desirable that performance test schuld be used for the evaluation for the abilities of inquiry which can not be evaluated by paper and pencil test. In the evaluation methods of performance test, tester evaluation, peer evaluation and self-evaluation can be applied to the science class in a multi-student class. In higher grade, however tester evaluation is more desirable than peer and self evaluation. It is found that peer evaluation and self-evaluation make possible the perfect study by feedback.

Risk factors for progression to CKD 3 in IgA nephropathy

( Chung Hoon Yu ),( Jang Hee Cho ),( Owen Kwon ),( Kyung Deuk Hong ),( Mi Kyung Jin ),( Ji Young Choi ),( Se Hee Yoon ),( Chan Duck Kim ),( Yong Lim Kim ),( Sun Hee Park ) 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.-

Risk factors for progression to CKD 3 in IgA nephropathy

( Chung Hoon Yu ),( Jang Hee Cho ),( Owen Kwon ),( Kyung Deuk Hong ),( Mi Kyung Jin ),( Ji Young Choi ),( Se Hee Yoon ),( Chan Duck Kim ),( Yong Lim Kim ),( Sun Hee Park ) 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1

Background: IgA nephropathy (IgAN) is the most common primary glomerulonephritis in Korea. To investigate the risk factors for progression, we retrospectively analyzed the data of IgAN from a single center in Korea. METHODS: Three hundred and twenty nine patients (M: F 173:156, mean age 33.96) with biopsy-proven IgAN (January 2002 ~ December 2009) were available for analysis. Progression was defined as an occurrance of CKD stage 3 (eGFR<60 mL/min/1.73m2 by MDRD) or start of renal replacement treatment (RRT) due to ESRD. Cox regression analysis was used and presented as Odd ratio (OR; 95% CI). RESULTS: Number of patients with episodic gross hematuria, microscopic hematuria with proteinuria, nephritic syndrome and hypertension as an initial clinical presentation was 42 (12.8%), 203 (61.7%), 5 (1.5%) and 60 (18%), respectively. At presentation, mean creatinine and protein-creatinine ratio (PCR) by spot urine was 0.99±0.98 mg/dl and 970±130 mg/g. Number of patients with glomerulosclerosis in renal biopsy was 151 (45%). During mean follow-up of 43 months (range 12~101), 14 (4.3%) patients had begun RRT and 28 (8.2%) patients were diagnosed as CKD stage 3 and above. With univariant analysis, age at diagnosis (p=0.014, OR=1.049 CI 1.010-1.090), glomerulosclerosis on pathology (p=0.02, OR=7.885 Cl 2.074-29.982) and PCR >500 mg/g (p=0.013, OR=6.668, Cl 1.498-29.672) were associated with occurrence of CKD stage 3. Glomerulosclerosis (p=0.01, OR=1.55 Cl 1.071-2.257) and hypertension (p=0.025, OR=3.55 Cl 0.432-1.126) were associated with start of RRT. With multivariant analysis, age at diagnosis, glomerulosclerosis and PCR 500 mg/g were independent risk factor for occurrance of CKD stage 3 and above. CONCLUSIONS: Our study suggests that age at diagnosis, hypertension, proteinuria more than 500 mg/g and glomerulosclelosis on biopsy are major risk factors for progression to CKD 3 and above in Korean patients with IgA nephropathy.

A Case of Transient Central Diabetes Insipidus after Aorto-Coronary Bypass Operation

Yu, Chung-Hoon,Cho, Jang-Hee,Jung, Hee-Yeon,Lim, Jeong-Hoon,Jin, Mi-Kyung,Kwon, Owen,Hong, Kyung-Deuk,Choi, Ji-Young,Yoon, Se-Hee,Kim, Chan-Duck,Kim, Yong-Lim,Kim, Gun-Jik,Park, Sun-Hee The Korean Academy of Medical Sciences 2012 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.27 No.9

<P>Diabetes insipidus (DI) is characterized by excessive urination and thirst. This disease results from inadequate output of antidiuretic hormone (ADH) from the pituitary gland or the absence of the normal response to ADH in the kidney. We present a case of transient central DI in a patient who underwent a cardiopulmonary bypass (CPB) for coronary artery bypass grafting (CABG). A 44-yr-old male underwent a CABG operation. An hour after the operation, the patient developed polyuria and was diagnosed with central DI. The patient responded to desmopressin and completely recovered five days after surgery. It is probable that transient cerebral ischemia resulted in the dysfunction of osmotic receptors in the hypothalamus or hypothalamus-pituitary axis during CPB. It is also possible that cardiac standstill altered the left atrial non-osmotic receptor function and suppressed ADH release. Therefore, we suggest that central DI is a possible cause of polyuria after CPB.</P>

갱년기 장애에서 인태반 추출물 주사제의 효과 및 안전성에 대한 평가

박유란 ( Yu Ran Park ),김소라 ( So Ra Kim ),전균호 ( Gyun Ho Jeon ),김성훈 ( Sung Hoon Kim ),채희동 ( Hee Dong Chae ),김정훈 ( Chung Hoon Kim ),서창석 ( Chang Suk Suh ),이병석 ( Byung Soek Lee ),최훈 ( Hoon Choi ),박형무 ( Hyoung 대한폐경학회 2009 대한폐경학회지 Vol.15 No.3

연구목적: 현재 인태반추출물은 간 기능 개선 및 갱년기 증상 개선제로 허가되어 시판되고 있다. 하지만 아직까지는 각각의 효능에 대한 객관적인 검증이 거의 이루어지지 않았고 또한 이에 대한 기전 및 부작용 등에 대해 연구가 부족한 실정이다. 따라서 본 연구에서는 현재 널리 이용되고 있는 인태반 추출물 주사제의 갱년기 장애 증상 호전 효과를 평가하고 주사제의 유효성 및 안전성을 검증하고자 하였다. 연구재료 및 방법: 서울의 5개 기관을 방문한 만40세 이상의 여성 중 폐경이 확인되고 열성 홍조 증상을 호소하는 지원자를 모집하였다. 총 130명의 지원자를 대상으로 하여 이중 맹검법을 이용하여 무작위로 시험군과 대조군으로 나누었다. 이후 이중 맹검법을 이용하여 2주간 방문하여 시험군에는 인태반 추출물을 대조군에는 위약을 피하조직에 총 6회를 시행하였다. 이후 KI (Kupperman Index)점수, 열성 홍조 점수 개선 정도를 비교, 측정하도록 하였고 이에 대한 결과를 비교하였다. 이후 객관적인 수치의 비교를 위해 투약 전후의 E2, FSH 농도를 측정하여 이를 비교 하였다. 또한 인태반 추출물의 안정성을 평가하기 위해 투약 후 이상반응, 활력 징후 등을 WHOART 기준에 의해 측정하여 이상반응을 평가하였다. 결과: 주관적인 지표인 KI 점수는 유의하게 호전(P=0.0013) 되었으나 그 외 열성 홍조 변화량(P=0.8044)이나 객관적인 지표인 E2, FSH 농도는 변화가 없었다 (E2 농도, P=0.7665, FSH 농도, P=0.3577). 또한 투약 후 유의한 이상반응은 관찰되지 않았다 (χ2-test, P=0.7037). 결론: KI 점수의 경우 두 그룹간에 유의한 차이를 보였으나 열성 홍조 점수는 차이를 보이지 않았다. E2, FSH 농도도 또한 두 그룹간에 차이를 보이지 않았다. 인태반 추출물 사용시 의미 있는 부작용은 관찰되지 않았다. Objectives: In Korea, human placental extract (HPE) has been approved as a therapeutic agents for chronic liver diseases and menopause syndrome. However evidence-based studies about the effectiveness, mechanism of action, and side effects of HPE are incomplete. The aim of this study was to examine the effects of HPE on menopausal symptoms, and safety in middle-aged Korean women in a double-blind randomized controlled trial. Methods: Korean women >40 years of age, with menopausal symptoms and hot flushes were recruited as participants in 5 university hospitals in Seoul, Korea. The 130 women were randomly assigned as followed to a double blind test: the HPE group (n=66) received 6 subcutaneous injections of HPE for 2 weeks; the placebo group (n=64) received normal saline. The KI (Kupperman index) score, severity of hot flushes were and concentrations of E2 and FSH in serum were measured. The side effects of HPE were assessed. Results: The KI score was decreased significantly after 2 weeks of HPE treatment compared with the placebo group (P=0.0013); however, the severity of the hot flushes were not different between the two groups (P=0.8044). The E2 and FSH levels of the HPE group were not significantly increased at 2 weeks after HPE treatment compared with of the placebo group (E2 level, P=0.7665, FSH level, P=0.3577). No evidence of side effects were observed in either group (χ2-test, P=0.7037). Conclusion: The KI score in middle-aged Korean women improved after 2 weeks of HPE treatment, whereas the difference in hot flushes, and E2 and FSH levels did not change during the study period. No evidence of significant side effects were observed in patients treated with HPE. (J Korean Soc Menopause 2009;15:178-185)

주 담도 침습을 동반한 간세포암에서 간동맥 화학 색전술 후 성공적인 치료를 보인 폐쇄성 황달

류정훈 ( Chung Hoon Yu ),박정길 ( Jung Gil Park ),김규영 ( Gyu Young Kim ),황희영 ( Hee Young Hwang ),정민규 ( Min Kyu Jung ),배한익 ( Han Ik Bae ),김갑철 ( Gab Chul Kim ),조창민 ( Chang Min Cho ) 대한췌장담도학회 2014 대한췌담도학회지 Vol.19 No.1

Biliary invasion by hepatocellular carcinoma (HCC) is much less common. Patients manifest obstructive jaundice as the initial complaint, but most of them are inoperable. We report a case of completely improved biliary invasion in HCC after transcatheter arterial chemoembolization (TACE). A 61-year-old woman was referred for evaluation of jaundice. A biliary invasion of huge HCC was confirmed by image of abdominal computerized tomography (CT) and biopsy specimen. After improvement of jaundice by endoscopic retrograde biliary drainage and percutaneous transhepatic biliary drainage, she underwent TACE as a palliative treatment. Follow-up CT showed partial lipiodol uptake in hepatic tumor and its bile duct invasion. In follow-up endoscopic retrograde cholangiopancreatography, occluded cholangiogram showed neither luminal obstruction nor filling defect after removal of biliary stent. Our case suggests that obstructive jaundice, caused by inoperable huge HCC with biliary invasion, may be expected to resolve successfully biliary obstruction by a choice of TACE. Korean J Pancreatobiliary 2014;19(1):31-36

고효율 CO₂ Laser 개발연구 : SMPS 방식 펄스형 CO₂ Laser의 출력특성

鄭賢株(Hyun-Ju Chung),李東勳(Dong-Hoon Lee),南京勳(Gyung-Hoon Nahm),金度完(Do-Wan Kim),鄭永煥(Young-Hwan Chung),李有秀(Yu-Soo Lee),金熙齊(Hee-Je Kim),曺井守(Jung-Soo Cho) 대한전기학회 1999 전기학회논문지C Vol.48 No.11

성인 급성 신부전 환자의 예후인자 분석

정종훈,김영곤,유기동 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.4

Background:Acute renal failure(ARF) is characterized by rapid decline in glomerular filtration rate and retension of nitrogenous waste products. This syndrome occurs in approximately 5 percent all hospital admissions and up to 30 percent of admissions to intensive care units. ARF is diagnosed when screening of hospital patients reveals a recent increase in serum BUN(blood urea nitrogen) and creatinine. The mortality rate for ARF is approximate 40-60% and has changed little in past three decades. This lack of improvement in outcome, despite significant advances in medicine. The reasons of high mortality rate is not certain. This study intend to identify prognostic risk factors influencing survivals. Methods:We retrospectively analyzed 60 patients with ARF during 2 years period from Oct. 1996 to Oct. 1998 at chosun university hospital. Multiple factors which may influence mortality were evaluated. Results: 1)Of the 60 patients, 34 were male and 26 were female. The mean age was 55.8±15.9 years. 2)The cause of ARF is Drug, toxin, dehydration, infection, trauma, surgery, urinary tract obstruction, HFRS, rhabdomyolysis and bleeding. 3)Underline disease is observed in 52 case. DM, Hypertension, Malignancy, Pulmonary disease, Liver disease, Renal disease 4)The mortality rate is 31.7%. The major cause of deaths is DIC, infection and hepatic failure. 5)Based on the unpaired t-test, chi-squre analysis, albumin, total bilirubin, hemoglobin, thrombocytopenia, APACHE Ⅱ score, serum sodium, urine creatinine, number of multiple organ failure, cause of acute renal failure, pH, vital sign on admission, sepsis, DIC, oilguria, and hemodialysis were significant factors between survivors and nonsurvivors(p$lt; 0.05). 6)APACHE Ⅱ score on admission is good prognostic factor for patients with acute renal failure (p$lt;0.001). Conclusion:This results suggest that the evaluation of patients symptom, sign, laboratory data, APACHE Ⅱ score is important for patients with acute renal failure. the discriminant score by multiple analysis and APACHE Ⅱ score could relatively predict the mortality of ARF patients. however further evaluation and clinical apply of prognostic factors is required to confirm these results.

How Should We Assign Large Infiltrative Hepatocellular Carcinomas for Staging?

( Chung Gyo Seo ),( Sun Young Yim ),( Yoo Jin Lee ),( Tae Hyung Kim ),( Na Yeon Han ),( Yeon Seok Seo ),( Hyung Joon Yim ),( Ji Hoon Kim ),( Young Dong Yu ),( Dong Sik Kim ),( Soon Ho Um ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: Infiltrative gross morphology of hepatocellular carcinoma (HCC) is known to be associated with poor prognosis. To date, there has been no study that fully addressed the potential role of tumor morphology in staging HCC, although it requires further clarification. Therefore, we analyzed the prognostic impact of the infiltrative type HCC by evaluating patients who underwent liver resection for HCC, and attempted to clarify how to assign this HCC subtype in the current staging systems to increase their discriminatory ability. Methods: A total of 774 HCC patients who underwent curative liver resection were retrospectively reviewed and the prognostic significance of infiltrative type HCC was assessed using the Barcelona Clinic Liver Cancer (BCLC) and American Joint Committee on Cancer (AJCC) staging systems. The infiltrative type HCC is defined as a mass with foci varying in size which fuse to form a larger foci without a distinct margin or a mass with a permeative appearance which blends into the background of the cirrhotic liver with an indistinct margin. The cumulative incidence of OS was determined according to the AJCC T-stage and BCLC staging system and the impact of the infiltrative type HCC on each staging system was evaluated using Kaplan-Meier plots (log-rank test), censoring the patients who were lost to follow-up. The Akaike information criterion (AIC) and concordance index (c-index) were calculated to compare the prognostic powers of each staging systems. Results: Seventy-four patients (9.6%) had infiltrative HCCs with a higher proportion of multifocal tumors, larger tumors, vessel invasion, increased tumor marker levels, and advanced T-stages than those with nodular HCC (all, P<0.01). Infiltrative morphology was independently associated with lower overall survival (OS), but its impact was significant when the tumor size was ≥4cm (P<0.001). Under current AJCC and BCLC staging criteria, these large infiltrative HCCs were associated with significantly worse OS in early AJCC T-stages (T1b/T2, P<0.001) and BCLC stage A/B (P=0.01) but not in advanced AJCC (T3/T4) and BCLC C (Fig 1 & 2). The reassignment of this subtype to T3 and T4 increased the discriminatory ability of AJCC T-staging with lower AIC values (3086.9 and 3084 vs. 3103.6) and higher c-index (0.69 and 0.69 vs. 0.67), respectively (both, P<0.05) (Table 1). For BCLC staging sequential reassignment of large infiltrative HCC from BCLC A to BCLC B and from BCLC B to BCLC C also improved the prognostic performance. Conclusions: Large infiltrative type HCC should be assigned to the advanced stages beyond T1 or T2 of the AJCC staging or beyond BCLC stage A or B. We recommend assuming the large unifocal infiltrative type HCCs on surgical specimen as tumors with multiple foci and reassign them from AJCC-T1 and T2 to AJCC-T3, or assuming all large infiltrative HCCs staged AJCC-T1 to T3 as those with macrovascular invasion and reassigning them to AJCC-T4. Second, for BCLC staging, we recommend any large unifocal-looking infiltrative type HCCs staged BCLC-A on imaging studies to be reassigned to BCLC-B while definitely multifocal HCCs initially staged BCLC-B to BCLC-C. This enable finer stratification of HCC patients and provide more accurate prognostic competence.