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김준혁,백승은,오득영 대한수부외과학회 2019 대한수부외과학회지 Vol.24 No.4
Infectious costochondritis seldom occurs after breast reconstruction. The treatment requires wide debridement, appropri-ate wound cover, and antibiotic therapy. A 53-year-old female patient was referred due to an unhealed right breast wound. She had undergone right skin-sparing mastectomy followed by breast reconstruction with an implant. Pseudomonas ae-ruginosa was cultured from the wound discharge, and a computed tomography showed fluid collection underneath the pectoralis muscle with connection to the external opening as well as degenerated T4-T6 costal cartilages. Wide excision of infected tissue and costal cartilages followed by a pedicled latissimus dorsi musculocutaneous flap coverage were performed. The mastectomy wound allows a wider surgical view to prepare thoracodorsal vessels, and the harvesting the latissimus dorsi musculocutaneous flap can be more easily performed without excessive traction force or damage on pedicles. The coverage of pedicled flap was successful and the patient was injected antibiotics intravenously for 3 weeks without any postoperative complications.
김준혁,김나림,김예솔,오득영 대한미용성형외과학회 2021 Archives of Aesthetic Plastic Surgery Vol.27 No.1
Delayed breast reconstruction is challenging because it requires a large volume and symmetry, and the dual-pedicled deep inferior epigastric perforator (DIEP) flap is used with microvascular augmentation. However, candidate recipient vessels in patients who have undergone radiation therapy may be damaged, with uncertain patency. This report suggests a novel method, the dual-pedicled conjoined abdominal flap, in which a free DIEP flap is combined with a pedicled transverse rectus abdominis muscle (TRAM) flap. A 57-year-old female patient who had undergone modified radical mastectomy and radiotherapy 25 years previously was referred for breast reconstruction. A whole abdominal flap was needed, but supercharged anastomosis was very risky due to calcification and scarring of the internal mammary vessel. Therefore, the thoracodorsal vessels were anastomosed with a free left DIEP flap, which was combined with a right-pedicled TRAM flap. The reconstructed volume was sufficient, and the blood flow was intact. The patient presented a symmetric contour without any complications after 4 months. The dual-pedicled conjoined abdominal flap is reliable for delayed breast reconstruction that requires a large volume and skin replacement, especially in patients with radiation-injured recipient vessels. Even if microscopic anastomosis failure occurs, secondary rescue is made possible by the pedicled TRAM flap.
의학교육에서 기계학습방법 교육: 석면 언론 프레임 연구사례를 중심으로
김준혁,허소윤,강신익,김건일,강동묵,Kim, Junhewk,Heo, So-Yun,Kang, Shin-Ik,Kim, Geon-Il,Kang, Dongmug 연세대학교 의과대학 2017 의학교육논단 Vol.19 No.3
There is a more urgent call for educational methods of machine learning in medical education, and therefore, new approaches of teaching and researching machine learning in medicine are needed. This paper presents a case using machine learning through text analysis. Topic modeling of news articles with the keyword 'asbestos' were examined. Two hypotheses were tested using this method, and the process of machine learning of texts is illustrated through this example. Using an automated text analysis method, all the news articles published from January 1, 1990 to November 15, 2016 in South Korea which included 'asbestos' in the title and the body were collected by web scraping. Differences in topics were analyzed by structured topic modelling (STM) and compared by press companies and periods. More articles were found in liberal media outlets. Differences were found in the number and types of topics in the articles according to the partisanship and period. STM showed that the conservative press views asbestos as a personal problem, while the progressive press views asbestos as a social problem. A divergence in the perspective for emphasizing the issues of asbestos between the conservative press and progressive press was also found. Social perspective influences the main topics of news stories. Thus, the patients' uneasiness and pain are not presented by both sources of media. In addition, topics differ between news media sources based on partisanship, and therefore cause divergence in readers' framing. The method of text analysis and its strengths and weaknesses are explained, and an application for the teaching and researching of machine learning in medical education using the methodology of text analysis is considered. An educational method of machine learning in medical education is urgent for future generations.
김준혁,김여근,이한범 한국경영과학회 2007 한국경영과학회 학술대회논문집 Vol.2007 No.11
Many problems related to airline business belong to large-scale optimization problems, so that it is expected that the state-of-art optimization techniques are widely applied to making the airline operation effective and competitive. This paper introduces the concepts and mathematical models of various optimization problems in airline system. Airlines involve many activities that utilize airline resources such as aircrafts and crews to make profit. We view the airline activities in the planning and operational aspects. In the planning viewpoint, we discuss the flight schedule design problem that impacts on passenger demand directly. For aircraft and crews, we deal with fleet assignment, aircraft routing, crew pairing optimization, and crew assignment problem. In the operational viewpoint, we concern schedule recovery problems for aircrafts and crew using the method of reassigning available resources when airlines face with the unexpected situations.
벤야민 문예이론을 통한 의무기록사 읽기에 비추어 본 서사 의학의 요청 근거
김준혁 한국의철학회 2015 의철학연구 Vol.19 No.-
환자-의사 항의 비대칭적 권력관계는 현대 의학의 근간이다. 시선에 얽힌 권력의 문제는 현대 의학이 지니는 문제의 계열들을 타파하기 위한 출발점이 되며, 서사 의학의 간주관성은 이를 극복하기 위한 실마리가 된다. 벤야민은 레스코프의 소설을 비평하면서 그에게 ‘이야기꾼’이라는 명칭을 붙였다. 이야기꾼이란 경험을 전달해 청자가 이를 자신의 것으로 구축할 수 있게 만드는 능력을 갖춘 자이다. 그러나 이야기의 몰락은 의사소통의 변화와 함께 찾아왔으며, 그 시초는 소설이고 그 종국은 정보이다. 의무기록을 하나의 이야기가 구성되는 작업으로 본다면, 의무기록사 또한 경험의 상실, 그리고 신체성의 상실이라는 관점에서 읽어낼 수 있다. 의사는 환자의 정보를 구축, 구성하여 체계적으로 기록하고 이를 정리하는 기술을 도입하여 환자의 신체를 더 명확하게 확인하려고 하나, 이는 오히려 의료에서 환자의 신체성을 소멸시키는 결과를 낳았다. 서사 의학은 이런 의무기록의 신체성 상실에 혁명을 가져올 힘이다. 그러나 이 힘이 다시 가짜 권위에 얽혀 오히려 신체성을 소멸시키는 방향으로 나아가지 않기 위해서는 기표화와 고정화의 운동을 뛰어넘어 경험을 전달할 수 있는 이야기의 자리를 확보하기 위한 끊임없는 탈주, 그 차이 생성의 추구가 필요하다.