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김덕환,Duk Hwan Kim 대한소화기암연구학회 2023 Journal of digestive cancer reports Vol.11 No.1
Since the 1990s, serrated polyps have been established to contribute to intermediate cancer development, and their importance has begun to be recognized. Serrated polyps are morphologically difficult to detect through endoscopy, and an effective resection method has not been established. Among serrated polyps, studies on sessile serrated lesions, with a relatively high risk of colorectal cancer transformation and detected with difficulty, are in progress. Studies to date describe the endoscopic features as mucus cap, surface debris or stool, attenuation of underlying vasculature, cloud-like surface, dark spots in crypts, and ill-defined irregular border. Additionally, it is expected that relatively large serrated polyps can be safely removed through cold snare resection. A plan for an effective management of serrated polyps through continuous research in the future is warranted.
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김덕환 ( Duk Hwan Kim ),조영덕 ( Young Duck Cho ),김정윤 ( Jung Youn Kim ),윤영훈 ( Young Hoon Yoon ),이성우 ( Sung Woo Lee ),문성우 ( Sung Woo Moon ),최성혁 ( Sung Hyuk Choi ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.4
Purpose: Trauma is one of the major causes of maternal and fetal mortality, and the most common cause of maternal trauma is a traffic accident. In Korea, data about traffic accidents in pregnant women are not widely collected and classified so far. Hence, we studied and analyzed the characteristics of injured pregnant women by the traffic accidents. Methods: From January 2002 to August 2011, pregnant women who were in traffic accidents visiting Emergency Department were studied. Pregnancy out come and the degree of the damage were determined through the retrospective analysis of the medical records. Results: The pregnant women who visited after traffic accidents were total 204 patients. Among them, 176 patients had no complication related to the traffic accidents, 28 patients had complications. The incidence of the complications in the 3rd trimester pregnants was statistically significant higher than that in the other trimesters. The analysis based on the mechanism shows more complications in the pedestrian injury. In the survey by the type of the vehicles, the complications from the trauma associated with a car had lower incidence. The patients arrived at the emergency center by walking had greater numbers than who arrived by an ambulance in the groups occurred the complications. The patients suffered complications who complained pain in trunk especially in abdomen and pelvis than in extremities and complained vaginal discharge, and those showed a statistically significant greater incidence. Conclusion: When pregnant women were injured by the traffic accidents, the factors related to the poor pregnant prognosis were trimester of pregnancy, means of visiting the emergency center, trauma mechanism, and complaining symptoms. Therefore, these factors may be used as a prognostic tool to predict an incidence of complications, length of hospital stay and rate of complications and can be used to plan for treatments. (J Trauma Inj 2012;25:132-138)
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김덕환 ( Kim Duk Hwan ) 아시아문화학술원 2018 인문사회 21 Vol.9 No.2
중국 희곡 4대가의 한 사람인 마치원은 젊은 시절에는 정계에 진출하여 자신의 뜻을 펼치겠다는 야심찬 포부를 가지고 있었으나 식민통치의 환경을 극복하지 못하고 좌절하여 울분을 마음으로 삭여야만 했다. 이렇게 사회의 최하층으로 전락한 작자의 눈에 비친 ‘소상팔경’의 모습은 기존의 상류층 지식인들이 감상적으로 자연을 묘사한 것과는 다른 차원의 예술적 경지를 나타내었기 때문에 그의 「소상팔경」에 대한 분석은 문학적으로 뿐만 아니라 사회학적으로 상당히 중요한 의미를 가진다. 따라서 본고는 제도적 신분의 차이로 인해 다르게 표현된 ‘소상팔경’의 아름다운 모습을 상호 비교적 관점에서 분석하여 그 의의와 가치를 도출하는 데 주안점을 두었다. 신분적으로 평민과 귀족, 문학적으로 정통문학과 통속문학의 표현적 차이는 시공을 뛰어넘어 인간의 개성과 감성을 분석하는 중요한 척도가 되며, 아울러 이 연구는 현재까지 여전히 우리나라와 일본 등지에 영향을 미치고 있는 각 지역의 ‘팔경’과 ‘팔경문학’을 제대로 이해하는 데도 소중한 자료로 활용될 수 있을 것이다. Ma Zhi-yuan could not overcome the environment of the time caused by the colonial rule, frustrated over the failure of his ambitious goal of political success that he had in his younger days and so had to swallow his grudge merely to himself. The eight views of Xiaoxiang, to the eyes of the author who descended to the lowest class of the society, appeared different from what the intellectuals of the pre-existing upper class described. Therefore, analyzing his work of the eight views of Xiaoxiang, which has another artistic horizon, has a particular significance regarding sociology as well as literature. Given this background, this paper aims at examining the beautiful aspects of the scenery expressed inconsistently owing to the difference in social standing and deducing the meaning and value of the work. The different representation methods between commoner and nobility in the status and between classical and popular works in literature become an important barometer in studying the human individuality and emotion beyond time and space.
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크론병과 연관된 복강 내 농양에서 비수술 치료의 효용성
김덕환 ( Duk Hwan Kim ),천재희 ( Jae Hee Cheon ),문창모 ( Chang Mo Moon ),박재준 ( Jae Jun Park ),한송이 ( Song Yi Han ),김은수 ( Eun Soo Kim ),정문재 ( Moon-Jae Chung ),이진하 ( Jin Ha Lee ),정민규 ( Min Kyu Jung ),이수현 ( Soo H 대한소화기학회 2009 대한소화기학회지 Vol.53 No.1
목적: 기존의 크론병과 연관된 복강 내 농양 치료는 수술 방법이 최우선으로 여겨져 왔으나, 최근 비수술 방법의 치료 성적이 수술 방법 못지 않게 나타나고 있다. 이에 수술 치료와 비수술 치료의 임상 효용성을 비교하였다. 대상 및 방법: 1996년 2월부터 2008년 2월까지 크론병으로 인해 단일 기관에 입원한 환자를 대상으로 의무기록을 후향 분석하였다. 치료 효과로서 각 치료군 간의 치료 반응률과 재발률을 비교하였다. 결과: 총 339명의 입원 환자 중 43명(12.7%)의 환자가 복강 내 농양으로 입원하였으며, 이들 중 독립된 진단을 포함할 경우 47회의 발병이 있었다. 18예(38.3%)는 수술을 시행하였으며, 29예(61.7%)는 비수술 치료(항생제 단독 혹은 경피 배액술의 병합)를 시행하였다. 수술군과 비수술군 간의 치료 반응률과 재발률은 각각 100%/22.8% 대89.7%/30.8% (p=0.11/1.00)였고, 비수술 치료를 시행한 환자군 중 3예(10.3%)는 치료에 반응을 보이지 않아 수술을 시행하였다. 비수술 치료군에서 정중재원 일수가 유의하게 단축된 것으로 나타났다(12일 대 29.5일, p=0.02). 결론: 이번 연구에서 크론병과 연관된 복강 내 농양에서 농양의 위치에 따라서 비수술 치료는 수술 못지 않게 효과적이며 재원일수를 유의하게 단축시킬 수 있었다. Background/Aims: This study was conducted to compare the clinical efficacy between surgical and nonsurgical treatments for patients with Crohn`s disease-related intraabdominal abscess. Methods: A retrospective review of medical records was performed for patients admitted to a single institution due to Crohn`s disease-related intra-abdominal abscess from February, 1996 to February, 2008. Clinical outcomes were compared between surgical and nonsurgical groups in terms of treatment responses and recurrences. Results: A total of 47 episodes of intra-abdominal abscesses in 43 patients (12.7%) were identified from 339 patients with Crohn`s disease. Of these, initially, 18 cases (38.3%) underwent surgical treatment and 29 (61.7%) were treated medically (antibiotic treatments with or without percutaneous drainage). The overall treatment response rates of surgical and nonsurgical group were 100% versus 89.7% (p=0.11) and recurrence rates were 27.8% versus 30.8% (p=1.00). Three patients in nonsurgical group (10.3%) showed no response to therapy and ultimately received surgical drainages. The median length of hospitalization in nonsurgical group was shorter than in surgical group (12 and 29.5 days, respectively. p=0.02). Conclusions: Nonsurgical treatment might be as effective as surgical treatment for the treatment of Crohn`s disease-related intraabdominal abscess, especially considering shorter hospital stay. (Korean J Gastroenterol 2009;53:29-35)
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논문(論文) : 백박(白樸)의 산곡(散曲) 연구(硏究)
김덕환 ( Duk Hwan Kim ) 한국중문학회 2010 中國文學硏究 Vol.40 No.-
白樸爲元曲四大家之一、散曲和雜劇的代表作家, 同時又長于塡詞, 有≪天뢰集≫傳世. 淸末王國維在≪宋元戱曲史≫中說: 「元代曲家, 自明以來, 稱關馬鄭白. 然以其年代及造詣論之, 寧稱關白馬鄭爲妥也.」 由此可知他的散曲歷來爲人稱道, 而且他在元曲發展過程中的地位及其影響如何. 白樸的雜劇世人硏究較多, 詞的硏究, 這幾年也逐漸被人重視, 發表的論著也日益增多, 唯有散曲只有흔少的、零星的硏究文章. 據隋樹森所編≪全元散曲≫, 白樸的散曲共有四十一首(小令三十七首、套數四首), 其中六首小令疑不是他之作. 白樸的散曲, 按題材和思想內容, 大體上可以分爲四種類型, 卽嘆世、自然風景、男女戀情、藝人情態與技藝. 其中表現自然風景和男女戀情的作品在白樸的散曲中占相當的比重. 綜觀白樸散曲的內容, 我們可以得出如下的結論: 第一、嘆世之作流露出了與世無爭, 隨遇而安, 期于適意的思想情緖. 第二、自然風景之作抒發了對大自然的熱愛, 對生活的熱愛, 有靜有動、寓情于景. 第三、男女戀情之作生動的寫出了戀念的情狀和心情, 文字非常通俗, 情調非常輕송, 可謂雅而不俗、樂而不淫之作. 第四、藝人情態與技藝之作細緻而又饒有神韻, 風格淸俊, 文字爽利. 但是白樸散曲所表現的內容比其詞相對狹窄, 這與詞和散曲的體裁、傳統文風有着密切的關係. 白樸的散曲多格幷存, 淸麗之作頗多, 也不乏豪放之作. 而由于其中不少攬入了詞境, 使得其曲的主導傾向是雅化(詩詞化). 白樸出身名門仕宦之家, 身受儒家傳統的敎育, 所以他以傳統文學的言語形式對散曲的俚語加以某種改造, 給以通俗爲特徵的散曲輸入了雅化的因素. 因而可以說, 白樸將詩詞中的用典和融化前人詩意的方法運用于散曲, 帶來了其散曲雅化的主導傾向, 將散曲拉入了詩詞化的軌道. 白樸對現實生活中的是是非非、矛盾紛爭, 都采取袖手傍觀、聽之任之的態度, 而寧愿在吟詩讀書中消磨歲月, 卽使過着淸貧的生活, 也感到風流自在. 他在嘆世之作表出了這種「玩世滑稽、詩酒優遊」的處世原則.
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