근막 결손의 복원과 자궁천골인대 고정을 통한 전자궁적출술 후 질탈출의 성공적 교정

문화숙(Hwa Sook Moon),최진국(Jin Koo Choi),김경서(Kyung Seo Kim),박근식(Kyun Sik Park),황지영(Ji Young Hwang),문성은(Sung Eun Moon),한지원(Ji Won Han),김상국(Sang Gook Kim),김상갑(Sang Gap Kim) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.7

목적 : 본 연구는 전자궁적출술 후 질탈출을 부위-특이적인 결함의 개념에 입각하여 치골경부 근막과 직장질 격막의 연결을 통한 골반내 근막의 복원과 자궁천골인대 고정술을 이용한 질탈출의 성공적인 수술적 교정의 방법과 결과를 보고하고자 한다. 연구 방법 : 1999년부터 2001년 8월까지 자궁적출술 후 질궁탈출 증상으로 문화병원 산부인과를 내원, 탈출된 질의 근막을 재건시킨 다음, 이를 자궁천골인대에 고정시킴으로써 질의 부위-특이적인 교정술을 받은 3명의 환자를 대상으로 하였다. 3명중 1명은 개복술을 하였고 2명은 내시경 수술을 하였다. 결과 : 환자의 연령 분포는 49-67세였으며, 수술시간은 평균 113분 (105-125)이었다. 세 환자 모두 수술 후 질의 상태가 해부학 및 기능적으로 정상이었으며, 9일째 특이사항 없이 퇴원하였다. 수술 후 HRT를 시행한 1명을 포함한 3명 모두 각각 24개월, 12개월, 7개월간의 추적 검사에서도 특이한 합병증이나 재발 없이 좋은 경과를 보였다. 결론 : 골반 근막 결손의 복원과 자궁천골인대 고정술은 전자궁적출술 후 질탈출의 교정에 매우 안전하고 효과적이며, 기능적인 방법으로 사료되며, 자궁천골인대를 질탈출 교정에 이용한 연구는 본 연구가 국내에서 처음이다. Objective : To report the method and efficacy of the site specific-defects repair in the endopelvic fascia and uterosacral ligament suspension for the correction of posthysterectomy vaginal vault prolapse. Methods : This study was performed in 3 patients with posthyterectomy vaginal vault prolapse who underwent the surgery for the reconstruction of endopelvic fascia and the correction of vault prolapsed vagina by using uterosacral ligament suspension at the department of Obstetrics and Gynecology in Moon-Hwa Hospital. Among them, 1 patient was treated by laparotomy, and 2 patients were treated by laparoscope. Results : The age of patients ranged from 49 to 67 years. The mean operation time was 111 minutes (105-120 minutes). The status of postoperative vagina was normal in all 3 patients, who were discharged 9 days after operation without symptoms. No complication or recurrence were found in them despite long-term follow-up for 24 months, 12 months, 7 months, respectively after operation. One patient has been treated with HRT therapy. Conclusion : The reconstruction of the defect of endopelvic fascia and uterosacral ligament fixation may be very safe, effective, and functional in the correction of vaginal vault prolapse. This study reports the treatment of vaginal vault prolapse using uterosacral ligament within Korea for the first time.

영어과 수행평가의 진단과 개선방안

문은진,곽동기 신라대학교 교육과학연구소 2000 교육과학연구 Vol.- No.5

The assessment plays a very important role both in studying and teaching. The assessment is not just to know the result of studying. It has a close relationship with every problems of education. But so far the traditional assessment has evaluated only narrow-minded and fragmentary knowledges. In the globalized and informationized society of 21st century, one should be able to collect, analyse, and criticize the needed information and knowledges. So with the problems of traditional assessment and with the new needs, the performance assessment has played its important role. In the thesis I will diagnose the performance assessmet. I will also take some real examples of English performance assessment which are taken in some middle schools and high schools. Performance assessment is needed to prepare for the globalized and informationized society. And secondly, it would improve the way of teaching and studying. And finally, it could provide the meaningful results of the assessment. We can divide four language skills in English. In recent, the most important skill in English is speaking. As the result of real examples of performance assessment which are taken in some middle schools and high schools, I could see that almost every school take the speaking test in various way. For writing it is up to the schools. Besides the language ability, in some schools teachers reflect the result of students manners and so on. Performance assessment is theoretically a very ideal way of assessment but there are some problems. First, performance assessment can be another burden to teachers. Second, performance assessment wants objectivity and reliability, and teachers' speciality. Fourth, there are too much homework which are related with performance asessment. Fifth, the result of performance assessment can be unreasonable. To solve those problems there are some actions have to be taken. First, to reduce teachers' burden some administrative measures have to be taken. Second, in performance assessment teachers' opinions have to be reflected, and teachers themselves have to make a lot of efforts to be specialists. Third, to help students to perform the assignment efficiently libraries and computer lab have to be opened. Fourth, teachers have to control the quantity of the homework which are related with performance assessment. Fifth, teachers have to reflect the result of students' self-evaluation. There can be much more problems in performance assessment. But it can be the answers for the ideal assessment, studying, and teaching. So to progress performance assessment in this given condition teachers themselves have to do their best. Parents and students also have to trust teachers. These can make a desirable progress of performance assessment.

무선 네트워크에서 I, P, B 프레임 패턴에 따론 멀티미디어의 효율적인 전송

문은지,손예진,강승석 서울여자대학교 2010 정보기술논문지 Vol.8 No.-

The advancement of neiwork technology helps expanding the use of multimedia transmissions, especially over the wireless networks. However, the signal attenuation and interference of the wireless networks results in the frequent packet losses, which produces a quality degradation of the media content. In order to tackle the quality degradation problem, many encoding schemes are introduced for transmitting multimedia data over the wireless networks. MPEG-4 is one of the multimedia encoding schemes to use I, p, and B frames in order to transmit video data. This paper analyzes the relationship between the quality of video and the patterns of the three frame types, and compares the quality (with PSNR) of the receiver-side video data transmitted over the wireless networks with applying diverse encoding patterns. In addition, this paper applies the two network transmission approaches, best effort and quality of service (QoS), to compare the video quality with diverse encoding patterns delivered over the wireless networks. According to the simulation results, the wireless network transmission approaches affect the quality of transmitted video, and especially the QoS approach outperforms the best effort by 11% in terms of the PSNR (Peak Signal to Noise Ratio).

전경대원에서 발생한 결핵의 임상 양상

문창기,박상준,조민구,김영중,김소연,김윤권,정준오,안석진,김은실,서승오,김지훈,최원제,이윤영,박형기,최규영,김현근 대한감염학회 2006 감염과 화학요법 Vol.38 No.6

Background: The purpose of this study was to document the incidence and clinical characteristics of patients with tuberculosis (TB) in combat and auxiliary police, living in a group, in Korea where the incidence rate of active TB in a general population is higher than in Western countries. Materials and Methods:We retrospectively reviewed the medical records of all tuberculosis patients diagnosed at National Police Hospital from January 2002 through December 2004. Results:In 2002-2004, a total of 156 cases of tuberculosis were identified with the mean (Standard deviation) age of 20.6 (±1.0) years. Of these, 134 (85.9%) patients were registered as new cases, 11 (7.1%) as relapse, 2 (1.3%) as failure, 5 (3.1%) as treatment-after-default cases whereas 4 (2.6 %) patients were not included in any categories. Average annual new TB rate and smear-positive TB rate were 86.5/10^(5) and 17.4/10^(5) person-years, respectively. In 12 of 31 smear-positive cases, time from onset of symptoms to diagnosis was more than 30 days. Two multidrug-resistance TB cases were identified and two suspected outbreak episodes of TB had occurred during 3 years. Conclusion:There was no statistically significant difference in the incidence rate of new cases of TB between the general population aged 20 to 29 years and combat and auxiliary police in Korea. 배경 : 국내 결핵의 발생은 감소 추세에 있으나 여전히 후진국형 발생양상을 보이고 있다. 특히 집단생활을 하는 젊은이들에서 발생하는 결핵의 유행이 간헐적으로 알려지고 있어 우려를 낳고 있다. 이에 저자들은 최근 전경대원의 결핵 발병 양상에 대해 알아보고자 본 연구를 시행하였다. 재료 및 방법 : 2002년 1월부터 2004년 12월까지 3년간 경찰병원에서 결핵 진료를 받은 전경대원의 의무기록을 후향적으로 분석하여 연도별 결핵 신환발생률, 도말양성결핵 신환율, 진단 지연, 집단발병, 다제내성결핵을 조사하였다. 결과 : 연도별 결핵 신환자 수(10만명당 발생추정치)는 2002년 50명(83.6명), 2003년 42명(83.7명), 2004년 42명(93.5명)이었고 도말양성 폐결핵 신환자 수는 2002년 10명(16.7명), 2003년 11명(21.9명), 2004년 6명(13.4명)이었다. 3년간 도말양성 폐결핵 환자는 31명이 있었고 그 중 12명은 호흡기 증상 발생 30일이 지나서 진단을 받았다. 다제내성 결핵은 2명이 있었으며 결핵의 집단발병이 의심되는 사례는 2차례 있었다. 결론 : 전경대원과 20-29세 연령군 일반인의 결핵 신환발생률, 도말양성 폐결핵 발생률의 통계적으로 유의한 차이는 없었다.

수입 외국산 모발세정용 화장품의 중금속 농도에 관한 연구

문정아,문덕환,박명희,안진홍,김종은,손병철,김대환,이창희,김휘동,이채언 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.5

Objective : For the purpose of preparing the fundamental data and preventing the health impairment due yo heavy metals in hair cleaner. Methods and Material : The author determined the concentration of heavy metals(Fb, fn, Cr, Ni and Cu) in hair cleaner with flameless atomic absorption spectrophotometer. Results : The results were as follows : 1. The mean concentration of heavy metals in total hair cleaner were 0.046㎍/g for Pt, 0.O67㎍/g for Mn, 0.069㎍/g for Cr, 0.046㎍/g for Ni, and 0.022㎍/g for Cu, respectively. 2. There was not statistically significant difference to mean concentrations of each heavy metal in hair cleaner by producing nation. 3. The highest mean concentration of each heavy metal in hair cleaner by type of use were 0.140㎍/g for Mn in sensitive hair cleaner(p<0.05), 0.053㎍/g for Cu in others products(p<0.01). 4. The mean concentration of heavy metals in hair cleaner by type of hair cleaner were high at 0.O54㎍/g for Pb in shampoo products(p<0.O5), 0.120㎍/g for Cr and 0.06㎍/g for Cu in combination products(p<0.01). 5. The mean concentration of heavy metals in hair cleaner by acidity were high at 0.056㎍/g for Pb, 0.124㎍/g for Cr, and 0.032㎍/g for Cu in alkali products (p<0.05). 6. Correlation coefficient of heavy metal concentration in hair cleaner were 0.175 for Pb and Cr, 0.165 for Pb and Mn, 0.824 for Cr, and Mn, 0.189 for Cr, and Ni, 0.406 for Cr, and Cu, 0.197 for Mn and Ni, and 0.375 for Mn and Cu(p<0.05). 7. Exposure amount of heavy metals per when we used lOg of hair cleaner (onetime using amount) were 0.46㎍ for Pb, 0.67㎍ for Mn, 0.69㎍ for Cr, 0.46㎍ for Ni, and 0.22㎍ for Cu, respectively. Conclusion : As above results, there was very low level concentration of heavy metal in hair cleaner but we are using the hair cleaner everyday, therefore we can exposed to heavy metals as cronic exposure so the author suggest to prepare the program of preventing the health impairment due to heavy metals.

심근 Strain Rate 측정과 임상적용

김미진,정상만,문언수 건국대학교 의과학연구소 2004 건국의과학학술지 Vol.13 No.-

Evaluation of the deformation of a myocardial segment during the cardiac cycle could define regional myocardial properties. Strain is tissue deformation as a function of applied force(stress) and strain rate is a measurement of the rate of deformation. Strain rate is equivalent to the velocity gradient and can be estimated by using myocardial velocity gradient data which is obtained by tissue Doppler imaging technique. The values of systolic peak strain rate, diastolic E-strain rate, diastolic A-strain rate, isovolumic contraction-strain rate, systolic peak strain are measured from the strain rate curve and strain curve. A color coded strain rate imaging could define the areas of left ventricular wall motion abnormalities. These gradable and quantifiable new modalities could evaluate not only the global and regional myocardial function in various cardiovascular diseases including myocardial infarction, heart failure, cardiomyopathy and in stress echocardiography, but also the physiologic phenomenon of normal heart.

간호실무에서 신봉이론(Espoused theories)에 대한 탐색적 연구

서문자,김혜숙,이은희,박영숙,조경숙,강현숙,임난영,김주현,이소우,조복희,이명하,지성애,하양숙,손영희,권성복,김희진,추진아 성인간호학회 2001 성인간호학회지 Vol.13 No.1

As a nursing practice involves nurses' actions in a specific context of health care, this study has focused on exploring the espoused theories in nursing practice within the action science perspectives, Espoused theories are the belief, principles, and rationale expressed by the practitioner as guiding her/his actions in a situation of practice. The data were analysed qualitatively and 25 elements of espoused theories of nursing action were identified and clustered into 6 categories. The 25 elements of espoused theories are as follows: The clinical nurse worked in wholistic and individual nursing, focussed on the patient's needed, comfort and supportive nursing (5 theories of nursing goal) ; excellent skills, knowledge based, assessment and data collection, explaining, educating or a scientific basis(6 theories of nursing intervention): advocacy, value oriented, treatment, account- ability and commitment(4 theories of nursing ethics) ; human respect. partnership, trust(3 theories of patient-nurse relationship) : knowledgable, accumulated clinical experiences and personally lived experiences. positive perspectives(4 theories of nurse), role of intervention. rewarding peer relationship(3 theories of situations) The above mentioned espoused theories are similar to that of nursing textbooks which students learned through basic nursing education and almost the same as the Acts ofa Nurse in Korean. However, we are doubtful whether nurses actually do as they think. Therefore. it is recommended to review the theories-in-use in order to and any discrepancies between the espoused theories and the reality of nursing actions

유세포분석법으로 조사한 Orientia tsutsugamushi Boryong주의 항균제 감수성

김은실,김미경,이혜명,정문현,이진수,박재은,강재승 대한감염학회 2008 감염과 화학요법 Vol.40 No.4

Background : Scrub typhus, an infectious disease caused by Orientia tsutsugamushi, is endemic in Korea. With the introduction of tetracycline and chloramphenicol in clinical practice, the mortality due to scrub typhus has markedly decreased, In 1995, scrub typhus poorly responsive to doxycycline was reported in Thailand; the need for safe antibiotics for the treatment of scrub typhus acquired during pregnancy or for children is emerging; also, broader spectrum antibiotics having anti-Orientia activity may be preferred for empirical therapy of enteric fever syndrome and for complicated scrub typhus. The anti-Orientia activities of various antibiotics, including recently licensed antibiotics, were investigated by flow cytometry. Materials and Methods : O. tsutsugamushi strain Boryong was inoculated into the ECV304 cell line. The infected cells were stained with FS15, a monoclonal antibody reacting against a linear epitope on 56-kDa major outer membrane protein of 0. tsutsugamushi. Then the antimicrobial susceptibilities were measured by flow cytometry and expressed as a growth index (total mass of Orientia). A concentration at which no further decrease in growth index occurred was defined as the minimal inhibitory concentration (MIC). Microbial susceptibilities to the following antibiotics were measured: quinupristin-dalfopristin (Synercid), levofloxacin, ciprofloxacin, moxifloxacin, metronidazole, linezolid, clindamycin, chloramphenicol, doxycycline, azithromycin, and rifampin. Results : Considering the usual serum concentrations of rifampin (M1C=0.025-0.05 ug/mL), azithromycin (M1C=0.05-0.5 ug/mL) and doxycycline (MIC=0.05-0.1 ug/mL), these antibiotics exhibited very low MICs. Synercid (MIC=0.2-1.0 ug/mL), clindamycin (MIC=1.0 ug/mL) and chloramphenicol (MIC=1-2 ug/mL) exhibited moderately low MICs; moxifloxacin (MIC=8 ug/mL), ciprofloxacin (M1C=25.6 ug/mL or more) and levofloxacin (M1C=30 ug/mL) exhibited relatively high MICs; and cefotaxime (MIC>50 ug/mL), metronidazole (MIC>30 ug/mL) and linezolid (>30 ug/mL) exhibited high MICs. Conclusions : Among the new antibiotics, none was superior to doxycycline, azithromycin or rifampin with respect to anti-Orientia activity. Synercid, clindamycin, and moxifloxacin may show moderate therapeutic efficacies in human.

2003년 국내 중증급성호흡기증후군 진료 현황 및 문제점 분석

이진수,김은실,정문현,백제중,정선화,안주희,최영화,이선희,고철우,김성범,김민자,박승철,기현균,송재훈,최상호,김양수,이상오,조용균,박영훈,정숙인,김연숙,이흥범,손창희,장성희,정희진,김우주 대한감염학회 2004 감염과 화학요법 Vol.36 No.3

목적 : 2002년 말 중국에서 SARS가 발생한 이후 국내에서도 2003년 10월까지 총 3명의 추정환자, 17명의 의심환자가 보고되었다. 향후 추가적인 SARS의 유행이 우려되는 상황에서, 그간의 SARS 환자 진료에 있어서의 실질적인 준비사항, 진료 현황 등에 대한 조사를 통해 문제점을 파악하여, 향후 더 나은 대비가 될 수 있도록 개선점을 제시하고자 하였다. 재료 및 방법 : SARS로 의심되는 환자를 진료 경험이 있는 병원의료진을 대상으로 2003년 10월에 설문조사를 실시하였다. 설문에는 SARS 환자 진료 시의 실질적인 조치, 진료 현황, 병실, 응급실 및 외래에서의 격리 시설과 준비사항, 보건당국의 관리와 지원에 관한 사항을 포함하였다. 결과 : 대상이 되는 22개 병원 중 17개(17/22, 77.2%) 병원이 설문에 응하였다. SARS 환자를 위한 격리실은 응급실, 외래, 일반병실 및 중환자실에서 각각 9개(9/17, 52.9%), 5개(5/17, 29.4%), 15개(15/16, 93.7%), 4개(4/16, 25%) 병원에서 음압처리가 되어있지 않은 일인실 혹은 다인실이 사용되었고, 1개(1/16, 6.3%) 병원에서만 일반병실에서 음압격리실이 운영되었다. 입원환자의 진찰 시 개인보호구의 착용은 거의 모든 의료기관에서 이루어졌다. 보건당국에서 SARS지정병원의 시설 등을 사전에 확인한 곳은 1곳(1/12, 8.3%)이였고, 14개 병원(14/15, 93.3%)에서는 보건당국에 의뢰한 검사결과를 통하 받지 못하였다. 결론 : 의료기관에서 SARS 환자용 격리실뿐만 아니라 기존의 격리실 설비 등이 미흡하였으며, 특히 중환자실 및 외래의 준비가 더욱 부족하였다. 보건당국의 의료기관에 대한 종합적인 지원이 부족하였고, 병원과의 원활한 연계가 잘 이루어지지 않았다. SARS 만이 아닌 격리를 필요로 하는 질환의 적절한 진료를 위해 향후 병원 시설의 정비와 정부차원에서의 보다 구체적이고 실질적인 대책마련이 필요하다. Background : There was an worldwide outbreak of the Severe Acute Respiratory Syndrome (SARS) originated from China in late 2002. During that period three cases of suspected SARS and 17 cases of probable SARS were reported in Korea. With the concerns about the reemergence of SARS-coV transmission, it is important to be prepared for any possibility. So, this study is aimed to analysis the past measures in managing SARS and propose the amendatory plans to improve the preparedness. Materials & Methods : Questionnaires were collected among clinicians with any experience in managing the probable or suspected SARS cases in Oct. 2003. 17 out of 22 hospitals responded to the questionnaire. The contents in the questionnaire were practical activities, personal equipments, response plans, isolation facilities in emergency centers, outpatient clinics, general wards and intensive care units, and relationship with the public health department. Results : The dedicated isolation rooms in emergency centers, outpatient clinics, general wards, and intensive care units were prepared in 9 (9/17, 52.9%), 5 (5/17, 29.4%), 15 (15/16, 93.7%), and 4 (4/16, 25.0%) hospitals, respectively. Except for one hospital that newly made negative pressure room for SARS, single or multi-bed rooms without airborne infection control were used in all the other hospitals. The personal precaution principles were kept quite well in general wards. Before the designation of SARS hospital by the public health department prior evalution to see if the hospital was suitable for managing SARS was conducted in only 1 (1/12, 8.3%) hospital. The results of laboratory diagnosis were reported back in 1 (1/15, 6.6%) hospital. Conclusions : The isolation facilities which can control airborne infection were almost deficient not only for SARS but also for other respiratory transmissible diseases. For the infection control of transmissible diseases including SARS, more investment is needed on medical facilities and comprehensive support from the public health department required.

국내 환자에서 분리된 Orientia tsutsugamushi에서 doxycycline 내성

김은실,김미경,이혜명,길세희,정문현,이진수,강재승 대한감염학회 2008 감염과 화학요법 Vol.40 No.5

Background : Doxycycline has been the drug of choice for the treatment of scrub typhus. However, scrub typhus with poor response to doxycycline was first reported in Thailand in 1996. To date, it is not known whether doxycycline resistant scrub typhus is present in Korea. To investigate the doxycycline resistance of scrub typhus in Korea, we performed an experiment to evaluate the degree of growth inhibition of Orientia tsutsugamushi at the minimal inhibitory concentration (MIC) of doxycycline. Materials and Methods : 37 isolates of Orientia tsutsugamushi were collected from Korean patients with scrub typhus during 10 year period (from 1997 to 2007). 34 isolates consisted of Boryong serotype or related serotypes. These strains were stained with FS15, a monoclonal antibody against the linear epitope on the protein located at the outer membrane of O. tsutsugamushi. Three isolates were confirmed as serotype Gilliam, which was stained by anti-Gilliam antibody. The antibody-stainable 35 isolates were incubated in media containing 0.1 and 0.2 ug/mL of doxycycline for 3 days. Then the growth indices of Orient/a were measured by flow cytometry. If the growth index was greater than 10%, the isolate was tentatively classified as an isolate resistant to doxycycline and its MIC was measured. Results : Demographic and treatment data were similar to the results of previous reports. Infection was mainly observed in Inchon and the Chungcheongnam province. No patient showed delayed response to antibiotics. Of 35 hospitalized patients, 4 (11.4%) were managed at the intensive care unit and 1 (2.9%) died of nosocomial pneumonia. All the 2 patients whose isolates were serotype Gilliam Yonchon/Ikeda-like strain were managed at the intensive care unit. Six of the 34 isolates from Korean patients exhibited growth indices greater than 10% at the MIC of doxycycline; however, the MICs of these isolates did not exceed 0.2 ug/mL. One isolate of serotype Gilliam showed an MIC of 0.0125 ug/mL, which seemed to be underestimated due to weak fluorescence of the anti-GiIIiam antibody. Conclusions : Although the number of tested isolates is small, insensitivity of scrub typhus to doxy-cycline is not a major reason for treatment failure in Korea. Serotype Gilliam, especially Yochon/Ikeda-like strain may be associated with severe form of scrub typhus. More studies concerning the antibiotic susceptibility for serotype Gilliam are warranted.