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심부하복벽동맥 천공지 유경 피판을 이용한 이영양성 수포성 표피박리증에 합병된 서혜부 편평 세포 상피암의 치료 - 증례 보고 -
김경필,김지훈,김의식,황재하,김광석,이삼용,Kim, Kyung-Pil,Kim, Ji-Hoon,Kim, Eui-Sik,Hwang, Jae-Ha,Kim, Kwang-Seog,Lee, Sam-Yong 대한미세수술학회 2010 Archives of reconstructive microsurgery Vol.19 No.2
Purpose: Epidermolysis bullosa is a rare genetic disease, characterized by the presence of extremely fragile skin and formation of recurrent blister resulting from even a minor mechanical injury. Squamous cell carcinoma (SCC) is recognized as a complication of the chronic scarring associated with dystrophic epidermolysis bullosa (DEB). When a soft tissue defect happens in a patient with epidermolysis bullosa, it is difficult to cover it with a skin graft or a flap. We describe the successful use of a pedicled deep inferior epigastric perforator flap for the reconstruction of SCC associated with DEB in the groin. Methods: A 29-year-old man diagnosed with DEB at birth sustained an ulcer increasing in the right groin for the last 7 months. Under general anesthesia, the mass lesion and lymph nodes were removed and the resulting defect was covered with a pedicled deep inferior epigastric perforator flap. Results: The flap survived completely and his postoperative course was uneventful. Histopathological examination revealed a SCC in the right groin and malignant tumor cells in the removed lymph nodes as well. Additional positron emission tomogram showed a malignant lesion in the ileocecal area with regional lymph node metastasis. The patient was referred to an oncologist for chemotheraphy, but the patient refused to take it. During a 4-month follow-up period, there was no recurrence in the right groin. Conclusion: We suggest that perforator flaps can be considered as a reliable alternative for the reconstruction of soft tissue defects in a patient with DEB.
김영삼 정부 이후의 국방문민화: 국가안전보장회의를 중심으로
김경필 ( Kim Kyung-pil ),남윤철 ( Nam Yuncheol ) 고려대학교 한국사회연구소 2021 한국사회 Vol.22 No.2
이 글은 선출된 대통령의 책임하에 군이 아닌 비군인 출신 민간인들이 국방/안보정책을 기획하고 시행하는 것을 국방문민화라 규정하고, 문민정부 등장 이후부터 박근혜 정부까지의 국방문민화를 설명한다. 국방/안보정책 기획과 시행, 조율의 핵심 기구인 NSC에 주목해서 이것의 제도화와 정책결정 개방도를 기준으로 각 정부의 국방문민화 수준을 분석하고, 정부별 핵심 국방/안보정책에서 이것이 어떻게 발현되었는지 살펴본다. NSC가 활성화되고 확장된 것은 김대중, 노무현 정부 시기였다. 경제위기 상황, 군과 국방부, 야당의 반대에도 불구하고 이들은 정치적 타협과 대통령령 개정을 통해 국방문민화를 진척시켰다. 그래서 청와대는 NSC 주도로 대북정책이나 군 지휘 및 통솔 방향의 변화, 국방개혁, 전시작전통제권 전환 등을 추진할 수 있었다. 이명박, 박근혜 정부 시기에는 국방문민화가 약화되었다. 이명박 정부는 작은 정부를 추구하며, NSC를 사실상 해체했고, 정책기획 및 결정에서 군의 영향력이 강화된반면, 정책 조율은 잘 이루어지지 못했다. 박근혜 정부는 국가안보실을 도입하고 NSC를 재구축했지만, 정책결정은 과거보다 폐쇄적으로 이루어졌다. 군 출신들이 정책결정에서 중요한 위치를 차지하며, 주요 국방/안보 정책은 군의 선호와 일치하거나 군의 자율성을 증진시키는 방향으로 시행되었다. This paper explains the civilian control over the military in security and defense policymaking from the Kim Young-sam administration, the first civilian government after democratization, to the Park Geun-hye administration. An important body in South Korea's civilian control is the NSC, which can be in charge of planning, implementing, and coordinating security and defense policies. In this paper, the level of civilian control is explained based on the institutionalization of the NSC and the degree of openness in policy decision-making. The activation and expansion of the NSC took place during the Kim Dae-jung and Roh Moo-hyun administrations. Despite the economic crisis and opposition from the military, the Ministry of National Defense, and the opposition party, they strengthened civilian control through political compromises and amendments to the Presidential Decree. Therefore, the Blue House was able to promote a change in policy toward North Korea, a change in the direction of military command and leadership, defense reform, and transfer of wartime operational control, led by the NSC. During the Lee Myung-bak and Park Geun-hye administrations, civilian control was weakened. The Lee Myung-bak administration pursued a small government and disbanded the NSC. While the military's influence in policy planning and decision-making was strengthened, policy coordination was not been well achieved. The Park Geun-hye administration introduced the National Security Office and re-established the NSC, but the policy-making process was more closed than in the past. Former military generals occupied important positions in policymaking, and major security and defense policies were implemented in a way that was consistent with military preferences or promoted military autonomy.