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- 저자 : 민진식(Jin Sik Min) (검색결과 159 건)
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민진식,Min, Jin-Sik 한국과학기술단체총연합회 1997 과학과 기술 Vol.30 No.8
우리나라 의료보험이 실시된지 20년이 되었지만 그동안 개선이나 보안이 안돼 국민과 의료기관의 불평과 불만이 쌓여 뿌리를 내리지 못하고 있다. 양질의 의료서비스로 의료보험을 개선하기 위해선 1)합리적 의료보험수가 조정 2)수가의 현실화 3)진료비 심사기구 독립 4)사회보험성의 의보제 도입 등이 절실하다.
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민진식(Jin Sik Min),지훈상(Hoon Sang Chi),김명욱(Myung Wook Kim),홍정(Jeong Hong) 대한소화기학회 1987 대한소화기학회지 Vol.19 No.1
N/A Acute acalculous cholecystitis is an acute inflammation of the gallbladder, in the absence of stone, and it comprises 4 to 8% of all cases of acute cholecystitis, and it has a tendency to occur after other disease, especially major trauma, burn or operation. Typical findings of pain, tenderness, and a mass in RUQ are infrequent, and the diagnosis rests on a high index of suspicion and ultrasonography. It has the highest mortality and morbidity of all benign conditions affecting the gallbladder, but its incidence is actually increasing due to increasing age of patients, more extensive and invasive therapeutic procedure, prolonged survival of gravely ill patients increasing the chances of initiation of the disease. Awareness of this disease, knowledge of its clinical features, and early surgical intervention are important facets of successful management. This study was done to determine the features of acute acalculous cholecystitis and to evaluate our experiences in its management at over the years 1976 to 1986. The results are summarized as follows; 1) Among 1,782 patients who needed cholecystectomy due to biliary tract disease, acute cholecystitis was found in 463 patients (26.3%), and acute acalculous cholecystitis comprised 8.9% (41 cases) of all cases of acute cholecystitis. 2) The sex ratio of male to female was 1:1.3, and the age of patients varied from 6 to 81 years, the average age was 50 years. 3) The most common clinical symptoms were RUQ pain which were observed in 35 cases (85.4%), and the most common physical findings were RUQ tenderness which were observed in 37 cases (90. 2%). 4) On laboratory examination, leukocytosis was found in 28 cases (68.3%) of all patients, and abnomalities in liver function test were observed in 22 cases (53.7%), among them alkaline phosphatase was most prominent. 5) Abdominal ultrasonography was used as an important diagnostic method in 23 cases (56.1%), and it revealed accuracy of 82.6%, and other procedures such as oral GR cholangiography, IV cholangiography and ERCP (Endoscopic retrograde cholangiopancreaticogram) were performed in 3 cases, but not dignostic. 6) Cholecystectomy was used as main procedure in 36 cases (87.8%), and supplemental procedures such as operative cholangiogram, T-tube choledochostomy were performed for passed stone in 31 cases in cholecystectomized patients. Cholecystostomy was performed in 5 cases (12.2%). 7) Gangrenous changes in gallbladder were observed in 15 cases (36.6%), and 8 cases of perforation were found among them. 8) Possible predisposing factors were observed in 22 cases (53.2%), and arrhythmia was most common among them (27.3%). 9) Acute acalculous cholecystitis developed in postoperative period were 5 cases; 2 cases after non-billary abdominal surgery, 2 cases after orthopedic surgery, 1 case after vascular surgery, and mean duration of symptoms were 19.4 days after operation, possible relationship between first meal after operation and onset of symptoms were observed in two cases. 10) Positive bile cultures were obtained in 20 cases, and E. coli was the most common one (49%), and positive blood cultures were obtained in 7 cases (43.8%), and K. pneumonia was the most common organism. Positive culture from both bile juice and blood were observed in 5 cases of 12 cases. 11) Salmonella typhi were cultured from bile juice in 4 cases, in addition, two cases of positive Widal test were observed. 12) Postoperative complications were observed in 12 cases (29.3%), and pneumonia was the most common one (58.3%), and postoperative mortality was in 5 cases (12.2%), and main cause of death was sepsis with ARDS. 13) Mean duration of symptoms were 8.7 days in patients with uneventful postoperative course, 13.4 days in patient with complicated postoperative course, 16.8 days in mortality cases. So, if a patient with predisposing factors such as postoperative state or major trauma shows high fever and abdminal signs, acute acalculous cholecystitis must be consi
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직장 및 항문암의 임상적 고찰 - 부위에 따른 수술식과 추적조사 중심으로 -
민진식(Jin Sik Min),김춘규(Choon Kyu Kim),권국환(Kuk Hwan Kwon),이경식(Kyong Sik Lee) 대한소화기학회 1984 대한소화기학회지 Vol.16 No.2
N/A Operations for carcinoma of the anus and rectum are considered on the anatomical locations, most importantly the lymphatic drainage. The lymphatic drainage of the rectum below 6-7cm from the anal verge may either be cephalad or caudad. Above this level, the drainage is cephalad, unless blocked by extensive lymphatic metastasis. Abdominoperineal resection has been the generally accepted procedure for carcinoma of the anus and lower two thirds of the rectum, and anterior resection with primary anastomosis are the most often used for carcinoma of the upper rectum. But recently, the case of sphincter saving procedures, anterior resection and pull-through operation, for lesions in the middle third, has increased significantly, theoretically offering as good a chance for long term survival as does abdominoperineal resection. In this regard, the author has reviewed 9 cases of anal cancer and 210 cases of surgically resected adenocarcinoma of the rectum from Jan. 1971 to Dec. 1982 at Severance Hospital, Yonsei Medical Center. The objectives of this paper are to study the recent trends toward sphincter saving procedures and the survival rate of carcinoma of the anus and rectum, especially in the middle third of the rectum. The results are as follows: 1) In all 9 cases of anal cancer, abdominoperineal resection was performed. For 3 cases, inguinal node dissection was performed synchronously. Follow up was possible in 8 cases; one had live 4 years, two had live over 2 years, and five had live over 1 year. 2) Lesions in rectum are divided according to the distance from the anal verge, with 99 patients having had a lesion located less than 6cm from the anal verge; in 89 patients, the lesion was between 6 and 11. 9 cm: in the remaining 22 patients, the lesion was more than 12 cm from the anal verge. 3) The distribution according to TNM classification by the Manual for Staging of Cancer was as follows: stage I, 1.9%, stage Ib 21.4%, stage II 30.5% stage III 37.6% and stage IV 8.6% 4) The type of operation was as follows: abdominoperineal resection 72%, anterior resection 21.4%, pull-through op=I ation 4.7%, and Hartmanna procedure 1.9%, The use of sphincter saving procedures, antorior resection and pulI-through operation, has increased recently: in 7l-76 21.1%, I '77-'82 29.1%. 5) The types of operation ac:cording to the distance from the anal verge were as follows: in the lower third; abdominep.rineal resection was performed in 99%, in the middle third; abdominoperineal resection in 1.1%, anterior resection in 31.5%, pull-through operation in 11.2%, and Hartmanns procedure in 1.1%, in the upper third; the anter ior resection was performed in 72.8%. In the middle third, the sphincter saving procedures, anterior resection and pull-through operatian, has increased significantly: in '71-'76 32.3%, and in '77-'82 49.1%. 6) The actuarial 5 year survival rate was 46.4%. The 5 year survival rate according to TNM classification was as follows: stage I, 100%, stage Ib 64.9%, stage II 55.6%. stage III 26.3% and stage IV 5.7%. The 5 year survival rate according to the distance from the anal verge was as follows: in the lower third 44.2%, in the middle third 48.1% and in the upper third 52.9%. The 5 year survival rate according to the type of operation was as follows: abdominoperineal resection 44.7% anterior resection 53.2%, pull-through operation 31.3%, and Hartmann' procedure 24.8%. 7) In the middle third, the 5 year survival rate according to the TNM classification was as follows: stage Ib 62.7%, stage II 59.4%, stage III 25.4% and stage IV 17.6%. The 5 year survival rate according to the type of operation was as follows: abdominope- rineal resection 49.5% anterior reaection 54.9%, pull-through operation 31.3%, and Hartmanns procedure 0%. In this regard, the abdominoperineal resection are generally accepted procedure for carcinoma of the anus and lower rectum, and anterior resection are the most often used for carcinoma of the upper rectum. Rut
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민진식(Jin Sik Min),김남규(Nam Kyu Kim),손승국(Seung Kook Sohn),이한영(Han Yong Lee),이기범(Ki Bum Lee) 대한소화기학회 1985 대한소화기학회지 Vol.17 No.2
Multiple familial polyposis has been reported as a rare disease, characterized by numerous adenomatous polyps in entire colon and rectum. It also has been discribed as inherited disease(Mendelian dominant trait) and established as the most clearly defined precancerous lesion. Clinical significance lied in that 2 point such as inheritancy and precancerous lesion. If the patient were untreated, adenomatous polyp was developed to ca eventually in 100%. So, prophylactically early detection and treatment was thought to be very important. Recently, in multiple familial polyposis, a some adenomatous polyp was noted at other gastrointestinal tract during follow up study and other malignancy such as hepatoma, periampullary ca occurred as higher incidence than general population. Multiple familial polyposis was easily diagnosed by family history and barium enema. The histologic confirmation of adenomatous polyp by sigmoidoscopic biopsy was also needed. Recently, we have experienced 2 cases of multiple familial polyposis in brothers and then reported with review of literature.
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민진식(Jin Sik Min),김승호(Seung Ho Kim),노성훈(Sung Hoon Noh),황영남(Young Nam Whang),최규식(Kyu Sik Choi) 대한소화기학회 1988 대한소화기학회지 Vol.20 No.1
Cystic lymphangioma of mesentery is rare and is usually described as isolated case reports. The exact etiology is obscure but is thought to be related to an abnormal development of lymphatic sacs with failure of communication with the central system. Clinical and laboratory findings are non-specific and ultrasonography, computed tomography and recently magnetic resonance imaging are introduced as valuable methods for assessment of abdomi- nal mass. Recently, authors experienced one case of cystic lymphangioma of duodenal mesentery which was operated under the impression of cystic tumor of pancreas tail by ultrasonographic and computed tomographic findings and herein report with literature review.
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