A case of advanced gynecologic pelvic tumors showing the diagnostic utility of HPV analysis

이함박,이용석,이근호,김찬주,박종섭 대한부인종양학회 2009 Journal of Gynecologic Oncology Vol.20 No.4

Gynecologic malignancies may have similar histological characteristics. This may lead to difficulties in determining the origin of the cancer and to distinguish a synchronous neoplasm from a metastatic cancer in advanced cases. Recently, we treated a 59-year-old patient with adenocarcinoma of the uterine cervix, endometrium, fallopian tubes, and ovaries. It was difficult to determine whether the cancer was a single origin metastatic cancer or a synchronous neoplasm. The patient was finally diagnosed with metastatic cancer that originated from the uterine cervix by human papillomavirus (HPV) test. Here we report the case and briefly review of the medical literature. Gynecologic malignancies may have similar histological characteristics. This may lead to difficulties in determining the origin of the cancer and to distinguish a synchronous neoplasm from a metastatic cancer in advanced cases. Recently, we treated a 59-year-old patient with adenocarcinoma of the uterine cervix, endometrium, fallopian tubes, and ovaries. It was difficult to determine whether the cancer was a single origin metastatic cancer or a synchronous neoplasm. The patient was finally diagnosed with metastatic cancer that originated from the uterine cervix by human papillomavirus (HPV) test. Here we report the case and briefly review of the medical literature.

근로기준법 개정에 따른 휴일확대 현황과 쟁점

이함박 국회입법조사처 2019 입법과 정책 Vol.11 No.3

The March 20, 2018, amendment to the Labor Standards Act caught tworabbits: shorter working hours and extended holidays. In particular, thepublic holiday, which used to be a public holiday, was reborn as a legalholiday for all citizens. However, even if the law is enforced, small andmedium-sized businesses, sales service workers, and shift and alternatingworkers, who are forced to work on holidays, are always present. In order for the transition from public holidays to statutory holidays,not to increase holiday work allowances, but to increase actual rest, first,we need to expand direct and indirect government support for small andmedium-sized businesses. Second, for workplaces already operating as holiday contract holidays,it is necessary to broadly interpret the replacement requirements to preventconflicts due to the enforcement of the law and to guarantee practicalrest. 2018년 3월 20일 근로기준법 개정은 실 근로시간 단축과 휴일 확대라는 두 마리의 토끼를 잡았다. 특히 공무원의 공휴일에 해당하였던 관공서 공휴일이 전 국민의 법정휴일로거듭난 것은 매우 의미 있는 성과이다. 하지만 법이 시행되어도 공휴일의 근로가 불가피한 중소영세 사업장, 판매서비스 종사자, 교대・교번 근무자 등이 상존하고 있어 이들에대한 합리적인 대책도 필요하다. 공휴일의 법정휴일화가 휴일근로수당의 증가가 아닌 실질적인 휴식 확대로 이어지기 위해서는 첫째, 중소영세사업장에 대해서는 직・간접적인 정부 지원을 확대하여야 하며 둘째, 이미 공휴일 약정휴일로 운용 중인 사업장에 대해서는 휴일대체 요건을 폭넓게 해석하여 법 시행에 따른 갈등을 예방하고 실질적인 휴식보장을 기하여야 할 것이다. 아울러, 공휴일의 법정휴일화에 따른 영향은 사업장 규모에 의하기보다 직종 유형, 업무특성, 사업의 연속적 필요 등에 의해 더욱 더 민감한 영향이 우려되므로, 2022년 전면시행 시까지 사례별 영향 분석과 함께 입법 보완방안 등에 대해 더욱 더 폭넓은 검토가필요할 것이다.

해외원전 비계획적 방출 및 한국의 환경감시 현황 분석

박수찬,함박눈,권장순,조동건,정지혜,권만재,Park, Soo-Chan,Ham, Baknoon,Kwon, Jang-Soon,Cho, Dong-Keun,Jeong, Jihye,Kwon, Man Jae 한국지하수토양환경학회 2018 지하수토양환경 Vol.23 No.4

Despite of safety issues related to radiological hazards, 31 countries around the world are operating more than 450 nuclear power plants (NPPs). To operate NPPs safely, safety regulations from radiation protection organizations were developed and adopted in many countries. However, many cases of radionuclide releases at foreign NPPs have been reported. Almost all commercial NPPs routinely release radioactive materials to the surrounding environments as liquid and gas phases under control. These releases are called 'planned releases' which are planned, regularly monitored, and well documented. Meanwhile, the releases focused in this review, called 'unplanned releases', are neither planned nor monitored by regulatory and/or protection organizations. NPPs are generally composed of various structures, systems and components (SSCs) for safety. Among them, the SSCs near reactors are closely related to safety of NPPs, and typically fabricated to comply with stringent requirements. However, some non-safety related SSCs such as underground pipes may be constructed only according to commercial standards, causing the leakage of radioactive fluids usually containing tritium ($^3H$). This paper discusses SSCs of NPPs and introduces several cases of unplanned releases at foreign NPPs. The current regulation on the environmental radiological surveillance and assessment around the NPPs in South Korea are also examined.

전자간증 진단에 수용성 fms-Like tyrosine kinase 1, endoglin, 태반성장인자의 유용성

이함박 ( Ham Bak Lee ),길기철 ( Ki Cheol Kil ),남선영 ( Sun Young Nam ),신재은 ( Jae Eun Shin ),천주영 ( Ju Young Cheon ),이영 ( Young Lee ) 대한산부인과학회 2011 Obstetrics & Gynecology Science Vol.54 No.5

목적 전자간증 여성에서의 soluble fsm-like tyrosine kinase 1 (sFlt-1), soluble endoglin (sEng)와 placental growth factor (PIGF)의 임상적인 효용성을 알아보기 위하여 연구하였다. 연구방법 임신 제3삼분기의 전자간증 여성 30명과 정상임신 여성 30명의 혈청에서 sFlt-1, sEng, PIGF를 측정한 환자-대조군 연구를 시행하였다. 우리는 각각의 펩티드를 이용하여 전자간증을 진단함에 있어 민감도, 특이도, 양성예측도 및 음성양측도를 계산하였다. 결과정상 임신에서보다 전자간증 여성에서 혈청 sFlt-1과 sEng의 중간 값이 의미 있게 증가되어 있다. 그러나 PIGF는 그 그룹 간의 의미 있는 차이를 보이지 않았다. 이 연구에서 sFlt-1, sEng의 판정 기준치는 각각 26.3ng/mL와 21.1ng/mL이었다. 이에 따른 sFlt-1, sEng의 민감도, 특이도, 양성예측도 및 음성양측도는 모두 80% 이상이었다. sFlt-1, sEng은 전자간 여성에서 태아성장지연을 보인 군과 그렇지 않은군 사이의 유의한 차이를 나타내지 않았다. 결론 sFlt-1, sEng의 혈청값은 전자간증 환자를 진단하는 데 유용하게 사용될 수 있으나 주산기의 좋지 않은 예후를 예측할 수는 없었다. Objective To evaluate the clinical significance of soluble fms-like tyrosine kinase1 (sFlt-1), soluble endoglin (sEng) and placental growth factor(PlGF) in preeclampsia. Methods We conducted a case-control study analyzing serum levels of sFlt-1, sEng and PlGF in women with preeclampsia (n=30) and normal pregnancy (n=30) in the third trimester. We calculated the sensitivity, specificity, positive, and negative predictive values of each peptide in diagnosing preeclampsia. Results The mean serum level of sFlt-1 and sEng in women with preeclampsia was significantly higher than normal pregnancy. But the mean serum level of PIGF had no significant difference between two groups. The cut-off values of sFlt-1 and sEng showing differential significance were 26.3ng/mL and 21.1ng/mL each. Then the sensitivity, specificity, positive predictive value, negative predictive value was all over 80%. Serum levels of sFlt-1 and sEng were not significantly different between intrauterine growth restriction (IUGR) and non-IUGR group among preeclamptic women. Conclusion Serum levels of both sFlt-1 and sEng may be useful in diagnosing patients with preeclampsia. The serum levels of these factors may not correlate with poor perinatal outcomes.

The change of Pelvic Floor architecture in Korean women using Three-Dimensional Transperineal Ultrasound

김사진,이함박,김민정 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.98 No.-

The purpose of this study was to evaluate the morphological characteristics of the change of female pelvic floor architecture during rest and voluntary pelvic contraction that may be further delineated with three-dimensional (3D) transperineal ultrasonography (US) in Korean women. One hundred forty-nine women (aged 22-50 years) were evaluated between 2009 and 2011. To assure objectivity, one gynecologist measured pelvic floor structures during rest and contraction using 3D transperineal US. The multiplanar display of the scanned volumes allowed detailed morphologic assessment of the pelvic floor architectures and the measurement of distances, area and volume of the pelvic floor architectural components. Compared with rest and voluntary pelvic floor contraction, there are no significant differences in pelvic floor architecture except anus. Also there are no differences in delivery mode, but the contractility of vaginal width in the group with a history of cesarean section is statistically significantly different (p=0.016) compared with those with a history of normal vaginal delivery. Parity is associated with change of the anus and contractility of vaginal transverse diameter, but there were no associations of parity with change of other pelvic floor architecture. Our study evaluates the utility of 3D US for measurement of change of pelvic floor architecture during rest and voluntary pelvic floor contraction. And our measurements provide a baseline for which further investigations in a larger cohort of subjects can be compared, to determine the range and change of normal appearance of the specific pelvic structures.

Anthropometric Breast Measurement: A Study of 87 nulliparous Korean Female

김사진,이함박,이대우,김명신,김민정 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.98 No.-

Anthropometric measurements and proportions of the human body have made a significant contribution to the science of aesthetic and reconstructive plastic surgery. The present study was performed to measure anthropometric breast values in Korean female and compare them with those of women in other nations. The study included 87 nulliparous female between the ages of 20 and 50 years with no physical or developmental deformity. A total of 17 parameters were measured in a standing position. The parameters measured were body weight, height, shoulder width, upper chest width, middle chest width, lower chest width, waist width, hip width, clavicle-nipple length, sternal notch-nipple length, nipple-nipple length, upper arm length, medial mammary radius, lateral mammary radius, nipple-inframammary fold length, nipple projection, and mammary projection. Breast volume, breast ptosis, and retracted nipple rates were also assessed. Results: As a result, an average breast volume for Korean women was obtained (Right: 296.3±258.6 cc, Left: 303.0±270.6 cc), and a table with several linear equations for calculating(Table 1,2). The ideal external view of the breasts with equal volume for both sides and no ptosis was observed in 10.9% (n=11, Table 3) of the volunteers. The percentage of women with unilateral or bilateral retracted nipple was 16.1% (n=14). The results of the present study will help in comparing the anthropometric breast values of Korean women with those of women in other countries. They may also be useful either in planning aesthetic and reconstructive breast surgery or in designing breast augmentation accessories and clothing.

Retroperitonal paraganglioma with huge uterine myoma : A case report

김국원,변상희,이함박,이대우 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.98 No.-

Paragangliomas are uncommon tumors arising from the neuroendocrine elements of the paraganglia and symmetrically distributed along the aorta in close association with the sympathetic chain. Although functional tumors are easier to diagnose due to the clinical findings caused by excess secretion of catecholamines and an elevation of the urinary catecholamine levels, however the diagnosis of nonfunctioning paraganglioma of the retroperitoneum is difficult and only few cases have been made before exploratory laparotomy. Surgical excision remains the mainstay of treatment, although advanced disease and proximity to vital organs can make excision difficult or impossible. This case report describes a patient who initially underwent work up for a huge multiple myomas of uterus and retroperitoneal mass which was discovered to be a retroperitoneal paraganglioma by frozen section. She is fortunate that the tumour did not show any features of malignancy nor metastasis, however a long time follow up is needed in case of any possible recurrence.