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.

급성신부전증 이환견에 대한 복막투석 치료 1례

김건우,이병희,김유수,심재현,김지용,이영원,김덕환,송근호 충남대학교 수의과대학 동물의과학연구소 2004 動物醫科學硏究誌 Vol.12 No.-

A fourteen-month-old intact female Poodle was referred to the Veterinary Teaching Hospital, College of Veterinary Medicine, Chungnam National University. The patient was presented with history of vomiting, inappetence, ataxia, insomnia, tachypnea and convulsion for 5 days. Biochemical examination revealed BUN (254.2 mg/dl), creatinine (9.22 mg/dl) and phosphate (14 mg/dl). Epithelial cells of urinary tract, neutrophils, macrophages, a large number of gram negative and smaller number of gram positive bacteria were presented on urine test. Ultrasonographic findings show hyperechogenic kidney and indistinguishableness of renal cortex and medulla. Based on the results of examination described above, this case was diagnosed as acute renal failure with interstitial nephritis by urinary tract infection (UTI). Treatments with fluids therapy, diuretics, and peritoneal dialysis during hospitalization showed good results with no clinical signs.

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.

개에서 발생한 폐수종의 치료 증례

김유수,심재현,김건우,김지용,이병희,송근호,이영원,김덕환 충남대학교 수의과대학 동물의과학연구소 2004 動物醫科學硏究誌 Vol.12 No.-

A 9 months intact male American bull dog with chief complaints of dry cough, dyspnea and fever was referred to the Veterinary Teaching Hospital, Chungnam National University. Based on the findings of physical examination, radiological examination, and blood and blood chemical examinations, the present patient was diagnosed into pulmonary edema secondary to primary bacterial and aspiration pneumonia. The patient was hospitalized and treated with buscopan, cephazolin and furosemide for 1 week. His activity and appetite was returned to normal and thoracic radiographs revealed that Jung was recovered to the normal condition after treatment for 7 days. The present patient was a case with pulmonary edema showed favorable therapeutic responses to proper medication.

면양에서 개량된 제1위 누관 형성술 1례

김명철,김종만,김용국,김덕환,이영원 충남대학교 수의과대학 동물의과학연구소 1999 動物醫科學硏究誌 Vol.7 No.-

We performed rumen fistula operation in a sheep. In sheep, the procedure for a rumen fistula is quite successful, but choice of an appropriate cannula is of prime importance. The sheep was anesthetized by xylazine(0.1 ㎎/㎏ IM) administration 5 minutes after administration of atropine sulfate(0.1 ㎎/㎏ IM). We inserted rubber cannula in rumen incised and put rubber ring after employing purse-string suture in rumen. We marked the area for the puncture incision in the body wall through which the cannula is drawn. We drew the cannula as near the transverse process of the lumbar vertebrae as possible to minimize leakage. We isolated the cannula by fixing the stainless washer which has small holes. The sheep was given postoperative penicillin(20,000 IU/㎏ IM) to prevent secondary infection for 3 days. There were not observed the leakage of rumen contents, the entering of rubber cannula into abdominal cavity, and necrosis on incision site and skin, over months after surgery.

韓國 古典小說에 나타난 道仙的 生死觀

金容德 漢陽大學校 人文科學大學 1983 人文論叢 Vol.5 No.-

The aim of this paper is to survey the Taoistic view of birth and death in the Korean classic novels. The main concern lies in the study of birth and death expressed in the beginning and conclusion of the works. There are four types of Taoistic view of birth and death; one views birth and death as the same, another views life as eternal, another views birth and death as phantastic, the other views birth and death as a cycle cosmos. These views are described as a subject, a biographt, or a theme of the works. The Taoistic view of birth and death are mostly a subject matter of the work when it is dealt with in the novels. The exemples of a subject matter are following; Fifst, a star, a dragon and a fairy are advented on the earth. Second, a flower and a bead are personified. Third, the dead can be resurected by a panacea. Biography is the expression of desire to be immortal. Every human being wants to live for a long time, which is depicted in the novels. In the works 'Choigounjeon' (崔孤雲 傳) and 'Jeonuchi Jeon' (田禹治 傳) are representitive cases. The theme is the expression of idea to transend birth and death, which is the main thought of 'Noza'(老子) and 'Chany Ja'(莊子) This concept consists of the theme of novels, which can be seen in such works as 'Kuunmony'(九雲夢) and 'Ogrunnoy' (玉樓夢) The Korean classic novels necessarily deal with birth and death, so that I believe this paper dealing with the problem will serve to understand the essence of them.

Henry Ⅵ삼부작의 구성

김용덕 동아대학교 인문과학대학 영어영문학과 1989 동아영어영문학 Vol.5 No.-

Historical critics propose, based on the Elizabethan World Order, that these plays are primarily moralistic tracts in dramatic format in consonance with conventional Tudor attitudes and Machiavelli argues that the exercise of power is independent not only of theology but of morality as well. A detailed analysis of the plays shows that far from reflecting and political ideology or any partisan moral outlook the plays are committed to dealing with the moral effects of power. In 1 Henry Ⅵ the structure of the play is built upon a clash between "chivalric patriotism and Machiavellian egocentricity" and the carefully designed soliloquies and asides give coherence to the fundamental theme. Shakespeare establishes in the minds of his audience a cause-and-effect relationship and the pattern of human motivation through the simple device of having an incident of discord followed by an announcement of loss. In 2 Henry Ⅵ Shakespeare achieves a more dramatic coherence by centering the action on two individuals -the fall of Gloucester and the rise of York. Unlike in Hall the personal motives underlying York's destructive Machiavellism surface in the opening scene and Shakespeare deliberately emphasizes Henry Ⅵ's role in creating political chaos. In 3 Henry Ⅵ Shakespeare achieves thematic unity through a series of scenes which force the audience alternatively to respond with antipathy to pro-Lancastrian and pro-Yorkist figures, based on the external pattern of repugnance to the physical atrocities of war and man's brutality. By juxtaposing Henry's increasing moral sensitivity with Richard's stylized Machiavellism, Shakespeare provokes increasing sympathies for the victims of the struggle and reinforces the theme of moral anarchy due to Machiavellian Realpolitik. The dilemma between the two antithetical forces - humanity and power - forms the tension of Shakespeare's history plays. The theme of 1, 2, 3, Henry Ⅵ is the morally corruptive influence of power. This is the Machiavellian divorce of public from private morality which manifests itself in Lancastrian and Yorkist concerns with power. In the process of this thematic development, human motivations are stressed more than either Providence or Fortune, and the conflicts in personalities and the values they represent are embodied within the plays providing their unity.

오스카 와일드의 Vera;or, The Nihilists의 구조와 주제

김용덕 東亞大學校 2001 東亞論叢 Vol.38 No.-

This is an attempt to study the thematic structure of Oscar Wilde's romantic tragedy; Vera; or, The Nihilists by a close examination of each play, on the assumption that the term 'structure' includes both content and form. Vern is the first example of Wilde's interest in the bizarre and individualism which produced Dorian Gray and Salome. Each of the five scenes of Vera is a genuine unit in spite of the weakness in characterization and plot construction that are caused by Wilde's inexperience as a dramatist; each has its own climax; and each leads inevitably into the one that follows. Act I, for all its improbability, lays the basis for the action, and the climactic assassination of Act II places the heroine in her classic dilemma of love or honor. In Act III she resolves it in favor of honor, and in Act IV we have the expected peripetea, and love conquers all. Vera's suicide is the supreme act of the Romantic individual's will. Vera, for whom life is at first valuable only as a form through which to realize her ethical and social idealism, makes her own life perfect by ending it at the perfect moment. Vera; or, The Nihilists was Oscar Wilde's first performed play, a work, as Wilde described it, "not of polities but of passion," expressing "cry of peoples for Liberty." Liberty as subject --and the rhetoric of republicanism that made liberty a catchword --came naturally to Wilde, as son of the Irish patriot Speranza and as an aesthetic individual. But Wilde was also professionally ambitious. By writing a wordy tragedy of self-sacrifice with Russia and the Nihilist movement as background, Wilde hoped to appeal to popular taste in the theatre and to capitalize on public interest in current affairs, with a woman as the hero. Wilde's feminism is one of the least commonly recognized aspect of his progressive ideas. He was, however, a consistent champion of women's rights both in his life and his work, supporting all the primary demands of late nineteenth-century feminism. His doctrine was in essence that of a utopian anarchist, preaching the doctrine of individualism and aestheticism. Wilde always liked to create manly women and womanly men, as a challenge to the stratified thinking of his day and demonstrates that the gender-antitheses of the age were almost meaningless through the characterization of female leads. Many critics have complained about Wilde's indebtedness and adherence to a tradition that was already established in drama; romantic tragedy, post-romantic French drama and the plays of his English contemporaries. Our superficial understanding of his plays might lead to the false conclusion that his achievement lay merely in putting together melodramatic situations, using techniques from the French well-made play and romantic tragedy, and projecting them onto a background of social criticism in the problem play. The real problem of his plays is the tension between the individual and society, between public and private life, between established norms and their deliberate violation. The subject-matter and the conflict in Vera, however, lies in not only her classic conflict between her love for an individual named Alexis and her loyalty to a cause involving others, that is, nihilism but rather in the classic motif of the character ton psychically between equal and opposing internal forces - a theme implied by the play's title itself. Ultimately the natural physical consummation of their love is replaced by the heroine's suicide, in which she faces the knowledge of her real desires and of her true nature, fulfilling herself independently of the pressure to conform. Through the aesthetic of the play, Wilde communicates what he understood about the transgressive power of love and commitment in human relationships. What makes the play an integral step in Wilde's transgressive aesthetic is the character of Vera, In sum, Vera is a non-traditional woman who is in a process of self-discovery, which will lead her to an individualism connecting her with the larger life of humanity.

3 Henry VI의 구조

김용덕 동아대학교 문과대학 영어영문학과 1986 동아영어영문학 Vol.2 No.-

일부 농촌부인의 자궁경부암 집단검진시 수진과 관련된 결정요인의 분석연구

金順德,廉容泰,李明淑 고려대학교 의과대학 1988 고려대 의대 잡지 Vol.25 No.3

Among the females in Korea, cervical cancer is the most common malignant tumor. Exfoliative cytology is a highly sensitive and inexpensive screening technique for cervical cancer and its precursors. The detection and eradication of the precursors have led to a significant fall in cervical cancer incidence and mortality rates in those areas of some developed countries in which there has been widespread and prolonged use. Interviews were carried out during the period from December,1986 to March, 1987 to study the determinants of the positive health seeking behavior of married women living in Jeomdong Myon, Yeoju Kun, Kyonggi Province focusing on the cervical cancer screening. Interviewed were 291 married women who participated in the cervical cancer screening and 249 who didn't. The path analysis and the discriminant analysis were used to identify major determinants for the health behavior concerned with cervical cancer screening. The results of this study were summarized as follows: 1. Belief, motive and action levels to the cervical cancer screening were 87.5%, 70.2% and 53.9% each. Belief and motive levels were 95.5%, 62.8% in the participants of the screening, and 78.2%, 33.3% in nonparticipants. 2 Determinants for the belief were age, regular health check up, benefit, susceptibility, level of knowledge, marital status, and interpersonal interaction. These determinants were able to explain 28.5% of the belief. 3. Determinants for the motive were belief, symptom, acquaintance who participated in cervical cancer screening, benefit, age, regular health check up, interpersonal interaction, acquaintance of cancer cases other than cervical cancer, and level of knowledge. These determinants were able to explain 26.9% of the motive. 4. Determinants for the action were occupation, age, symptom, belief, marital status, acquaintance who participated in cervical cancer screening, motive, some basic medical equipment kept in home, interpersonal interaction, acquaintance with cervical cancer patient, and mass media communications. These determinants were able to explain 37.8% of the actions. The variables having indirect effects on the actions through the belief and motive were susceptibility, benefit, level of knowledge, acquaintance with cancer cases other than cervical cancer, and regular health check up. 5. The belief was able to explain 18.2% of the motive, belief and the motive was able to explain 9.8%of the action. 6. The hit ratio was 78.82% for the prediction of the action in the discriminant analysis with the discriminating variables.