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국내외 외과전공의 수련교육제도 비교 - 수련목표와 교육과정을 중심으로 -
정철운(Chul-Woon Chung),이경포(Kyung Po Lee) 한국의학교육학회 2002 Korean journal of medical education Vol.14 No.1
Purpose: The role of graduate medical education (GME) has become more important at the flood of knowledge and technical development. The korean board system in general surgery has a short history and has been developed mostly by the executive authorities rather than by autonomous civil organizations which is the case in america and europe. The aim and curriculum of our residency education is not yet well established, so that there requires the need to evaluate and analyze the training system of other well-established countries. Methods: The structures of residency education and their characteristics in U.S.A., England and Germany were reviewed from the literatures and internet sites in terms of aims and objects of learning during the training period. The korean system was compared to these characteristics. Results: Comparing the residency training programmes of U.S.A., Germany and England to our system there found some characteristic points as following that would be recommendable to be adopted for the renewal of our training programme. 1) Autonomous civil organizations endeavor for the regulations of educational goal, requirements and their accreditation. 2) The understanding of basic sciences that provide the fundamental principles of surgery was emphasized during the education. 3) Modern surgical techniques as a part of minimal invasive surgery can be easily acquired during the training course. 4) Participation in emergency medicine and intensive medicine was almost mandatory. 5) Interdisciplinary training and effective rotation schedule were highly recommended. All these characteristics could be actively integrated into our education, if we elaborate more well-established educational goal and curriculum for the residentship.
이경식(Kyong Sik Lee),김충배(Choong Bai Kim),이경포(Kyung Po Lee),이상훈(Sang Hoon Lee) 대한소화기학회 1987 대한소화기학회지 Vol.19 No.2
Intussusception in adults is relatively rare and usually occurs secondary to tumors or other underlying causes. It appears that the incidence of associated malignancy is increasing compare to the past. The characteristics of adult intussusception is multiple attacks of partial intestinal obstruction and its chronic course. However, preoperative diagnosis is often difficult due to its vague and variable clinical picutres. The treatment principle is operative intervention to its causative lesion. During the past 20 years, from Jan. 1967 to Aug. 1987, 38 adult patients had documented adult intussusception at Yonsei Medical Center; 24 instances of intussusception originating in the small intestine and 14 instances originating in the colon. The etiologic factors were found in 27 cases (71%). Of the 14 colon intussusception, 3 cases were associated with malignancy and 6 out of 24 small bowel intussusception were result from the malignancy. The most common malignancy found was malignant lymphoma. Surgical intervention was carried out in all of these 38 cases; 26 cases underwent surgical resection and remainder was reduced manually after surgical exploration.
박진택(Jin-Taek Bak),강봉수(Bong-Su Kang),이경식(Kyung-Sik Lee),이경포(Kyung-Po Lee),김승기(Seung-Ki Kim) 대한종양외과학회 2013 Korean Journal of Clinical Oncology Vol.9 No.2
Purpose: Expression of hormone receptors in breast cancer is one of the most important factors in determining its therapeutic plan and prognosis. Various studies have been ongoing regarding resistance in anti-hormone and target therapy of primary and metastatic breast cancers, and hormonal receptor mutation has been pointed out as one of the possible reasons. The purpose of this study was to analyze hormonal receptor changes in primary and metastatic breast cancer patients and to investigate possible influential factors. Methods: Out of 1,620 breast cancer patients who were surgically treated from 1997 to 2013, 38 patients were selected whose tissue samples were adequate for detecting presence of hormonal receptor expression. The presence of estrogen receptor (ER), progesteron receptor (PR), human epidermal growth factor 2 (HER2) receptor mutations were retrospectively analyzed by immunohistochemical staining and fluorescence in-situ hybridization. Results: The positive rate of ER, PR, HER2 receptors were 50%, 47.3%, and 24.3% respectively. In comparison to primary breast cancer, the rate of receptor mutations in recurred and metastatic tissues were 23.6%, 26.3%, and 6.6%; the rate of changes in receptors from positive to negative and negative to positive showed no statistically significant difference. Conclusion: The expression of hormonal receptors in breast cancer tissue is considered as one of the significant factors in pathologic findings, and it is crucial in determining the course of treatment. Recently, performing a tissue biopsy of metastatic lesion in addition to surgically removing the primary cancer has been in trend. Since there are various treatment options for breast cancer including hormonal therapy, chemotherapy, surgery and target therapy, a biopsy of metastatic lesion should be carried out actively in order to increase the specificity of tissue pathology.
복강경하 위소매절제술 후 합병증의 조기 발견에 있어 임상 지표의 중요성
강성일(Sung Il Kang),한상문(Sang Moon Han),김원우(Won Woo Kim),이경포(Kyung Po Lee),이경식(Kyung Sik Lee) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.5
Purpose: The significant drastic complications of performing laparoscopic sleeve gastrectomy (LSG) in morbidly obese patients are gastric staple line leakage and bleeding. The aim of our study is to evaluate the efficacy of the clinical data for detecting postoperative complications after LSG. Methods: The study enrolled 150 consecutive patients who underwent LSG from January 2003 to July 2006. When abnormal data (heart rate ≥110/min, or temperature ≥37.5℃) was detected on postoperative day 1, then laboratory tests (blood, urine, chest X-ray and abdominal sonogram) and water soluble gastrografin UGIS were performed to detect the postoperative complications after LSG (group A). The patients who had normal postoperative clinical data (group B) were compared with group A. Results: Of the 150 patients who underwent LSG, 9 patients (6%) had postoperative complications. Two patients had major complications: 1 case of leakage (0.6%) and 1 case of delayed bleeding (0.6%), and 4 patients had minor complications in group A. But no major complications were detected in group B (P<0.01). The heart rate and body temperature in group A were significantly faster and higher than those in group B (P<0.01). Especially, 2 patients who had major complications had severe tachycardia over 120 beats per minute (bpm). However, when the body temperature of a patient was elevated, there was no high grade fever in all the cases (>39℃). Conclusion: Evidence of tachycardia or a high body temperature may be useful to detect major complications after LSG. We also recommend performing laboratory test and UGIS when clinically indicated.
한상문(Sang Moon Han),김원우(Won Woo Kim),정철운(Chul Woon Chung),이경포(Kyung Po Lee),이경식(Kyung Sik Lee) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.72 No.6
Adult onset Still"s disease (AOSD) is a rare systemic inflammatory disorder of an unknown etiology, and its major clinical manifestations include high spiking fever, polyarthralgia, salmon-colored evanescent rash and neutrophilic leukocytosis. We describe here a 41 year old woman with AOSD who presented with non-remitting high fever, polyarthralgia, sore throat, skin rash, splenomegaly, thrombocytopenia, neutrophilic leukocytosis, hyperferritinemia and coagulopathy with disseminated intravascular coagulation (DIC). The patient had a history of laparoscopic cholecystectomy due to acalculous cholecystitis prior to admission. We suspected sepsis due to bile peritonitis after the previous laparoscopic cholecystectomy. Yet we could not detect infectious organisms on the cultures or serologic studies. Finally, we suspected AOSD-associated hemophagocytic syndrome (HS). So, intravenous immunoglobulin and pulse methylprednisolone treatment brought about transient improvement of the fever and the neutrophilic leukocytosis, but the disease progressed and the patient expired due to acute renal failure. HS is a fatal cause of AOSD. If a patient has DIC and sepsis and these fail to respond to conservative treatment, then AOSD should be added to the differential diagnosis of sepsis and DIC.