근막 결손의 복원과 자궁천골인대 고정을 통한 전자궁적출술 후 질탈출의 성공적 교정

문화숙(Hwa Sook Moon),최진국(Jin Koo Choi),김경서(Kyung Seo Kim),박근식(Kyun Sik Park),황지영(Ji Young Hwang),문성은(Sung Eun Moon),한지원(Ji Won Han),김상국(Sang Gook Kim),김상갑(Sang Gap Kim) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.7

목적 : 본 연구는 전자궁적출술 후 질탈출을 부위-특이적인 결함의 개념에 입각하여 치골경부 근막과 직장질 격막의 연결을 통한 골반내 근막의 복원과 자궁천골인대 고정술을 이용한 질탈출의 성공적인 수술적 교정의 방법과 결과를 보고하고자 한다. 연구 방법 : 1999년부터 2001년 8월까지 자궁적출술 후 질궁탈출 증상으로 문화병원 산부인과를 내원, 탈출된 질의 근막을 재건시킨 다음, 이를 자궁천골인대에 고정시킴으로써 질의 부위-특이적인 교정술을 받은 3명의 환자를 대상으로 하였다. 3명중 1명은 개복술을 하였고 2명은 내시경 수술을 하였다. 결과 : 환자의 연령 분포는 49-67세였으며, 수술시간은 평균 113분 (105-125)이었다. 세 환자 모두 수술 후 질의 상태가 해부학 및 기능적으로 정상이었으며, 9일째 특이사항 없이 퇴원하였다. 수술 후 HRT를 시행한 1명을 포함한 3명 모두 각각 24개월, 12개월, 7개월간의 추적 검사에서도 특이한 합병증이나 재발 없이 좋은 경과를 보였다. 결론 : 골반 근막 결손의 복원과 자궁천골인대 고정술은 전자궁적출술 후 질탈출의 교정에 매우 안전하고 효과적이며, 기능적인 방법으로 사료되며, 자궁천골인대를 질탈출 교정에 이용한 연구는 본 연구가 국내에서 처음이다. Objective : To report the method and efficacy of the site specific-defects repair in the endopelvic fascia and uterosacral ligament suspension for the correction of posthysterectomy vaginal vault prolapse. Methods : This study was performed in 3 patients with posthyterectomy vaginal vault prolapse who underwent the surgery for the reconstruction of endopelvic fascia and the correction of vault prolapsed vagina by using uterosacral ligament suspension at the department of Obstetrics and Gynecology in Moon-Hwa Hospital. Among them, 1 patient was treated by laparotomy, and 2 patients were treated by laparoscope. Results : The age of patients ranged from 49 to 67 years. The mean operation time was 111 minutes (105-120 minutes). The status of postoperative vagina was normal in all 3 patients, who were discharged 9 days after operation without symptoms. No complication or recurrence were found in them despite long-term follow-up for 24 months, 12 months, 7 months, respectively after operation. One patient has been treated with HRT therapy. Conclusion : The reconstruction of the defect of endopelvic fascia and uterosacral ligament fixation may be very safe, effective, and functional in the correction of vaginal vault prolapse. This study reports the treatment of vaginal vault prolapse using uterosacral ligament within Korea for the first time.

간호실무에서 신봉이론(Espoused theories)에 대한 탐색적 연구

서문자,김혜숙,이은희,박영숙,조경숙,강현숙,임난영,김주현,이소우,조복희,이명하,지성애,하양숙,손영희,권성복,김희진,추진아 성인간호학회 2001 성인간호학회지 Vol.13 No.1

As a nursing practice involves nurses' actions in a specific context of health care, this study has focused on exploring the espoused theories in nursing practice within the action science perspectives, Espoused theories are the belief, principles, and rationale expressed by the practitioner as guiding her/his actions in a situation of practice. The data were analysed qualitatively and 25 elements of espoused theories of nursing action were identified and clustered into 6 categories. The 25 elements of espoused theories are as follows: The clinical nurse worked in wholistic and individual nursing, focussed on the patient's needed, comfort and supportive nursing (5 theories of nursing goal) ; excellent skills, knowledge based, assessment and data collection, explaining, educating or a scientific basis(6 theories of nursing intervention): advocacy, value oriented, treatment, account- ability and commitment(4 theories of nursing ethics) ; human respect. partnership, trust(3 theories of patient-nurse relationship) : knowledgable, accumulated clinical experiences and personally lived experiences. positive perspectives(4 theories of nurse), role of intervention. rewarding peer relationship(3 theories of situations) The above mentioned espoused theories are similar to that of nursing textbooks which students learned through basic nursing education and almost the same as the Acts ofa Nurse in Korean. However, we are doubtful whether nurses actually do as they think. Therefore. it is recommended to review the theories-in-use in order to and any discrepancies between the espoused theories and the reality of nursing actions

복지거제를 위한 자원봉사 활성화 방안

문선화,류기형,박병현,배화숙 부산대학교 사회복지연구소 2000 社會福祉硏究 Vol.10 No.-

急峻펄스 電壓을 利用한 强力오존發生裝置開發에 관한 硏究

文在德,吳哲洙,鄭華淑 경북대학교 1985 論文集 Vol.40 No.-

The power efficiency of ozone generation can be substantially improved by modifying a direct discharge wire of a wire-to-cylinder type ozone generator to a helical strip line. and using a fast rising pulse voltage on it. It is raised 1.3 times up of ozone yield compared with that of 60 gO_3/KWh of the industrial silent discharge type ozone generator. Parametric studies also made to get the optimum design of ozone generator tested. The generated ozone concentration had a peak value with proper increasing the crest pulse voltage, the quantity of a pulse forming condenser capacity of the pulse generator, and the interelectrode spacing of self triggered stainless steel spark balls. It is found that the optimum strip line length of the ozone generator tested was about 2m in view point of energy consumption. And, input and terminal impedance also effected greatly to ozone generation, the generated ozone concentration were increased when the input impedance had been 25Ω while the terminal had been opened.

Immunoturbidimetric assay를 이용한 철결핍 및 만성질환에 의한 빈형에서 가용성 트란스페린 수용체 측정의 진단적 유용성

박영진,박건,박상묵,최영화,장숙진,문대수 조선대학교 2001 The Medical Journal of Chosun University Vol.26 No.2

Background : Soluble transferrin receptor (sTfR) has been known to be a good marker for evaluating iron deficiency anemia (IDA) and anemia of chronic disease (ACD) without bone marrow aspiration. The sTfR has been measured with enzyme linked immunosorbent assay (ELISA). However, Immunoturbidimetric (IT) assay for measuring sTfR was recently introduced. Author try to use clinical application and measure sTfR using IT assay. Methods : IDA group (26 patients, ferritin < 12.0 μg/L), ACD group (20 patients, ferritin > 60.0 μg/L), Iron depletion and control group (30 normal persons) were classified. Hemoglobin, RBC indices, serum iron, serum transferrin, serum ferritin, total iron binding capacity were measured and calculated. Serum sTfR measured with IT assay using automated chemical analyzer. Those sTfR levels of each other group were compared. The correlations between iron parameters and sTfR were studied in other group. Results : The sTfR receptor levels were prominently higher in IDA group (5.2 ± 2.2 nmol/L) than in ACD group (1.1 ± 0.8 nmol/L), and normal control group (1.4 ± 0.3 nmol/L). The sTfR levels between ACD group and control group was not different. The correlations between sTfR and Hb levels in IDA group was in good inverse line. Other iron parameters and sTfR levels were not correlated in other groups. Conclusion : The results indicate that IDA can be differentiated efficiently from ACD with IT method to measure sTfR.

2003년 국내 중증급성호흡기증후군 진료 현황 및 문제점 분석

이진수,김은실,정문현,백제중,정선화,안주희,최영화,이선희,고철우,김성범,김민자,박승철,기현균,송재훈,최상호,김양수,이상오,조용균,박영훈,정숙인,김연숙,이흥범,손창희,장성희,정희진,김우주 대한감염학회 2004 감염과 화학요법 Vol.36 No.3

목적 : 2002년 말 중국에서 SARS가 발생한 이후 국내에서도 2003년 10월까지 총 3명의 추정환자, 17명의 의심환자가 보고되었다. 향후 추가적인 SARS의 유행이 우려되는 상황에서, 그간의 SARS 환자 진료에 있어서의 실질적인 준비사항, 진료 현황 등에 대한 조사를 통해 문제점을 파악하여, 향후 더 나은 대비가 될 수 있도록 개선점을 제시하고자 하였다. 재료 및 방법 : SARS로 의심되는 환자를 진료 경험이 있는 병원의료진을 대상으로 2003년 10월에 설문조사를 실시하였다. 설문에는 SARS 환자 진료 시의 실질적인 조치, 진료 현황, 병실, 응급실 및 외래에서의 격리 시설과 준비사항, 보건당국의 관리와 지원에 관한 사항을 포함하였다. 결과 : 대상이 되는 22개 병원 중 17개(17/22, 77.2%) 병원이 설문에 응하였다. SARS 환자를 위한 격리실은 응급실, 외래, 일반병실 및 중환자실에서 각각 9개(9/17, 52.9%), 5개(5/17, 29.4%), 15개(15/16, 93.7%), 4개(4/16, 25%) 병원에서 음압처리가 되어있지 않은 일인실 혹은 다인실이 사용되었고, 1개(1/16, 6.3%) 병원에서만 일반병실에서 음압격리실이 운영되었다. 입원환자의 진찰 시 개인보호구의 착용은 거의 모든 의료기관에서 이루어졌다. 보건당국에서 SARS지정병원의 시설 등을 사전에 확인한 곳은 1곳(1/12, 8.3%)이였고, 14개 병원(14/15, 93.3%)에서는 보건당국에 의뢰한 검사결과를 통하 받지 못하였다. 결론 : 의료기관에서 SARS 환자용 격리실뿐만 아니라 기존의 격리실 설비 등이 미흡하였으며, 특히 중환자실 및 외래의 준비가 더욱 부족하였다. 보건당국의 의료기관에 대한 종합적인 지원이 부족하였고, 병원과의 원활한 연계가 잘 이루어지지 않았다. SARS 만이 아닌 격리를 필요로 하는 질환의 적절한 진료를 위해 향후 병원 시설의 정비와 정부차원에서의 보다 구체적이고 실질적인 대책마련이 필요하다. Background : There was an worldwide outbreak of the Severe Acute Respiratory Syndrome (SARS) originated from China in late 2002. During that period three cases of suspected SARS and 17 cases of probable SARS were reported in Korea. With the concerns about the reemergence of SARS-coV transmission, it is important to be prepared for any possibility. So, this study is aimed to analysis the past measures in managing SARS and propose the amendatory plans to improve the preparedness. Materials & Methods : Questionnaires were collected among clinicians with any experience in managing the probable or suspected SARS cases in Oct. 2003. 17 out of 22 hospitals responded to the questionnaire. The contents in the questionnaire were practical activities, personal equipments, response plans, isolation facilities in emergency centers, outpatient clinics, general wards and intensive care units, and relationship with the public health department. Results : The dedicated isolation rooms in emergency centers, outpatient clinics, general wards, and intensive care units were prepared in 9 (9/17, 52.9%), 5 (5/17, 29.4%), 15 (15/16, 93.7%), and 4 (4/16, 25.0%) hospitals, respectively. Except for one hospital that newly made negative pressure room for SARS, single or multi-bed rooms without airborne infection control were used in all the other hospitals. The personal precaution principles were kept quite well in general wards. Before the designation of SARS hospital by the public health department prior evalution to see if the hospital was suitable for managing SARS was conducted in only 1 (1/12, 8.3%) hospital. The results of laboratory diagnosis were reported back in 1 (1/15, 6.6%) hospital. Conclusions : The isolation facilities which can control airborne infection were almost deficient not only for SARS but also for other respiratory transmissible diseases. For the infection control of transmissible diseases including SARS, more investment is needed on medical facilities and comprehensive support from the public health department required.

척추관 협찬증 환자 진료 프로세스 개발

이환모,김호중,김긍년,안풍기,천자혜,김양수,신혜선,김인숙,정혜경,김영아,채형기,박인영 한국의료QA학회 2009 한국의료질향상학회지 Vol.15 No.2

연구배경: 수술적 치료가 필요한 척추관협착증 환자들은 주로 60세 이상의 고령환자로장기간의 입원 시 기회 감염의 증대와 불필요한 의료비의 증대를 가져오게 되며, 수술후환χ}들의 재원일수의 증가는병원의 병상가 동률을감소시키고, 전공의에게는불필요한 업무를 증가시킨다. 연구목적: 비용·효과면에서 최적화된 진료지침의 개발은 불필요한 의료비의 감소및 Hospital Induced Complication을 줄여 환자만족도를증진시킬 수 있으며, 각 환자에 대한전공의 업무를 줄일 수있다. 의료기관: 서울특별시에 소재한 2,075병상의 종합전문 요양기관 연구방법: 정형외과및 신경외과의 척추관협착증환자 의 처방을 비교하여 최적의 표준진료지침을 개발하고 최종적으로 CP Master Program (EMR 프로그램)에 입력하여 환자에게 적용하였다. 연구결과': CP 적용전, 후비교를통해 재원일수는 3.8일 이 감소하였으며, 이에 따라 병상가동률 및 진료수익이 증가했으리라고 예상되며 현재 비교검토중이다. 또한,CP 개발및 CP Master Program의 사용을 통한 전공의 업무감소에 대해 검토하고 있다.

Repair of old fourth degree obstetrical perineal laceration

( Hwa Sook Moon ),( Sang Gap Kim ),( Jin Kuk Choi ),( Gun Sik Park ) 대한산부인과학회 2015 대한산부인과학회 학술대회 Vol.101 No.-

RE-10 : Creation of a neovagina using vulvar tissue in situ in patient with mullerian agenesis; A case report

( Hwa Sook Moon ),( Sang Gap Kim ),( Jin Kuk Choi ),( Gun Sik Park ),( Ja Seong Koo ),( Hyun Sik Youm ) 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.99 No.-

Mullerian agenesis is a rare congenital anomaly of the female genital tract with an incidence of 1 in 4000 female births and accounts for approximately 10% of cases of primary amenorrhea. Affected individuals have absence of the vagina and uterus with the normal 46XX female genotype as well as functional ovaries and the development of normal secondary sexual characteristics. Both surgical and non-surgical techniques have been suggested for neovagina creation in patient with mullerian agenesis. Among them, the most widespread non-surgical techniques are the Frank technique and its modification by Ingram, while the surgical techniques include McIndoe operation, laparoscopic Davydov procedure, and laparoscopic Vechietti procedure. We present a case of neovagina creation using vulvar tissue in situ in a 23-year-old female with mullerian agenesis. This simplified technique is a safe and effective treatment avoiding the morbidity associated with other grafting techniques commonly used in practice.

Utero-ovarian ligament pregnancy

( Hwa Sook Moon ) 대한산부인과학회 2020 대한산부인과학회 학술대회 Vol.106 No.-

Objective: Present an unusual case Target: Adanced practicioners Methods: A 34-year-old woman, G3P2A1L2 presented with amenorrhea for 6+1weeks. She had no symptoms and vital signs were in normal range. She had history of left cornuotomy and left salpingectomy due to left interstitial pregnancy 12years ago. And she had history of two cesarean deliveries performed 8years and 2years ago. Transvaginal ultrasound demonstrated empty uterine cavity and 2.09 x 1.70 cm sized mass containing cyst at left side wall of uterus. On pelvic magnetic resonance imaging (MRI), there was an about 1.6 x 1.6 cm sized gestational sac like structure in left lateral aspect of uterus. Her serum b-hCG level was 23,924 mIU/mL. The initial clinical diagnosis was left interstitial pregnancy and she underwent operative laparoscopy. At the time of surgery, uterus and both ovaries were normal appearance, a mass was detected at left utero-ovarian ligament. Exploration of the whole abdomen was performed and there was no additional abnormality. Incision was made on bulged left utero-ovarian ligament after diluted vasopressin injection. Its contents were evacuated and sutured. Right tubal ligation was done for permanent contraception. Results: The operation time was 40 minutes with blood loss of about 20mL. The patient recovered well. There was no intraoperative or postoperative complication. The final histological diagnosis was utero-ovarian ligament pregnancy. The serum b-hCG level fell to 2,037 mIU/mL on postoperative day 3 and 663.5 mIU/mL on postoperative day 11. Postoperative ultrasound revealed no abnormal finding at the site of operation. Conclusion: Utero-ovarian ligament pregnancy is an extremely rare form of ectopic pregnancy but potentially life-threatening and often misdiagnosed condition. It may occur with a history of gynecologic surgery. This condition is a diagnostic challenging, and laparoscopy is required for the diagnosis.