Surgical technique for single-port laparoscopy in huge ovarian tumors: SW Kim`s technique and comparison to laparotomy

( Jeong Sook Kim ),( In Ok Lee ),( Kyung Jin Eoh ),( Young Shin Chung ),( Inha Lee ),( Jung-yun Lee ),( Eun Ji Nam ),( Sunghoon Kim ),( Young Tae Kim ),( Sang Wun Kim ) 대한산부인과학회 2017 Obstetrics & Gynecology Science Vol.60 No.2

Objective This study aimed to introduce a method to remove huge ovarian tumors (≥15 cm) intact with single-port laparoscopic surgery (SPLS) using SW Kim`s technique and to compare the surgical outcomes with those of laparotomy. Methods Medical records were retrospectively reviewed for patients who underwent either SPLS (n=21) with SW Kim`s technique using a specially designed 30×30-cm2-sized 3XL LapBag or laparotomy (n=22) for a huge ovarian tumor from December 2008 to May 2016. Perioperative surgical outcomes were compared. Results In 19/21 (90.5%) patients, SPLS was successfully performed without any tumor spillage or conversion to multi-port laparoscopy or laparotomy. There was no significant difference in patient characteristics, including tumor diameter and total operation time, between both groups. The postoperative hospital stay was significantly shorter for the SPLS group than for the laparotomy group (median, 2 [1 to 5] vs. 4 [3 to 17] days; P<0.001). The number of postoperative general diet build-up days was also significantly shorter for the SPLS group (median, 1 [1 to 4] vs. 3 [2 to 16] days; P<0.001). Immediate post-operative pain score was lower in the SPLS group (median, 2.0 [0 to 8] vs. 4.0 [0 to 8]; P=0.045). Patient-controlled anesthesia was used less in the SPLS group (61.9% vs. 100%). Conclusion SPLS was successful in removing most large ovarian tumors without rupture and showed quicker recovery and less immediate post-operative pain in comparison to laparotomy. SPLS using SW Kim`s technique could be a feasible solution to removing huge ovarian tumors.

담도 및 췌장 악성종양에서의 CAl9-9의 진단적 가치에 대한 평가

명승재,최승목,김은옥,최호순,이성구,김명환,민영일,류진숙 大韓消化器病學會 1995 大韓消化器病學會誌 Vol.27 No.3

특수교육 정보화 체제 구축 방안 연구

김종무,강경숙,강대식,Kim-Sung, Kellie K. 국립특수교육원 2001 연구보고서 Vol.- No.8

본 연구는 특수교육 정보화 관련 국내 · 외 문헌자료와 사례를 소개하고, 국내 특수교육정보화 실태 조사를 실시하여 첫째, 기초 통계자료를 확보하고 둘째, 효율적이면서도 실제적인 정보화체제 구축방안을 제시하는데 그 목적이 있다. 그동안 국내에서 광범위하게 추진되었던 교육정보화 사업에 있어서 전체 학교 학내망 설치와 같은 가시적인 정보화기반 구축 사업에 대해서는 전반적으로 성공적이라는 평가를하고 있지만 특정 수요 집단에게는 정보격차의 심화 및 접근성 문제의 심각성 등 부정적인 결과를 초래하기도 하였다. 이에 본 연구에서는 국내·외 특수교육 정보화 사례와 자료를 소개하고, 국내 특수교육정보화 실태를 파악하기 위한 설문조사를 실시하였다. 설문조사 대상은 특수학교 교사, 학생, 장애학생 부모, 장애인관련 단체 및 기관, 시 · 도교육청이었고, 조사 결과 특수학교 교사의 경우 컴퓨터 보유, 인터넷 사용 등에 있어서는 매우 양호하게 나타났으나 정보 활용기술에 해당하는 영역 즉, 장애학생을 교수하기 위한 자료의 제작과 교수-학습과정에서의 적용 수준에서는 저조하게 나타났다. 비장애학생과 비교할 수는 없지만 장애학생의 컴퓨터보유와 인터넷 사용 유 ·무에 관해서는 40~60%의 응답자가 긍정적으로 응답하였고 체계적인 지원이 수반된다면 좋은 결과가 있을 것으로 분석되었다. 본 연구에서는 정보화 지원 체제 구축 방안으로 크게 예산지원과 행정지원을 포함하여 특수학교, 교사, 학부모, 장애학생, 행정가, 장애인관련 기관 등의 요소로 구분하여 지원 방안을 제시하였다. 소개된 지원내용을 간략히 정리하면 다음과 같다. 첫째, 특수교육정보화 체제 구축을 위한 예산 지원은 외국의 사례에서도 나타났듯이 안정성과 지속성을 확보하기 위하여 '초·중등교육법', '특수교육진흥법'을 통해 지원에 관한 세부 사항을 법으로 규정해야한다. 둘째, 특수교육 정보화 사업과 관련된 부처간 행정 협조체제의 수립과 사업 중복성 등을 피하기 위하여 전담기구나 기관의 지정이 요구된다. 셋째, 특수학교의 경우, 학내망 설치와 더불어 장애인 접근성 문제의 해결을 위한 프로그램 개발과 하드웨어 장비의 지원, 교실간 네트워크 구축, 학교간 WAN 구축 등의 사업이 추진되어야 하며, 특수학급의 경우는 정보화 환경구축이 미흡하기 때문에 소속 교육청 과의 네트워크 구축을 통한 정보공유 및 행정업무의 연계가 필요하고, 다양한 교수-학습자료의 지원이 절실히 요구된다. 넷째, 특수교육 교사의 연수 기회를 확대하고 전문성을 키워줄 수 있는 연수내용과 방법의 개선이 필요하다. 장애학생 교육을 위한 학습자료 제작 기법, 장애인용 프로그램 사용법, 특수단말 장비 및 정보매체 활용 기법 등의 프로그램을 개발하여 집체+원격+화상 형태의 입체적인 연수가 요구된다. 다섯째, 장애학생 부모를 위한 정보화 지원은 학교-교육청간 협력하에 부모 교육 프로그램을 개발하여 우선, 학교와 인근 지역의 장애인관련 기관을 활용하여 정보소양 교육을 실시하고, 언제, 어디서나 교육이 가능한 원격이나 사이버시스템 등을 매개로 부모의 여건을 배려해줄 수 있는 편리한 교육방법이 준비되어야 한다. 여섯째, 교육청별 특수교육 담당장학사의 정보화 수준은 양호한 것으로 평가되지만 특수교육 정보화를 위한 특수학교(급) 교사의 연수지원을 위한 예산규모의 확보나 프로그램 개발 지원 등은 매우 부족한 것으로 나타났는데, 교육부(국립특수교육원)를 중심으로 전체 교육청의 특수교육 정보화 업무를 단일 체제로 묶는 인프라를 구축하여 예산, 프로그램, 네트워크 등을 공유토록 하여 효율성을 확보해야 한다. 일곱째, 장애인관련 단체는 정보화 업무 담당자를 배치하여 장애인과 일반인을 대상으로 활발한 정보화 교육이 이루어지고 있었지만 재정지원이 아직도 부족하고, 장애인용 프로그램과 기기의 보급이 부족하여 한계가 있는 것으로 드러났는데, 마찬가지로 장애인관련 기관을 하나로 묶는 인프라의 구축을 통해 사용되는 프로그램을 표준화시키고 예산지원의 중복성을 피해야하며 기관 이용자에 대한 관리의 편리성도 함께 도모해야 할 것이다. This study intends to collect baseline data and to present effective and practical methods of establishing special education IT system. An extensive review of both domestic and foreign literature and case studies of best practices were conducted for this research as well as the evaluation of the current state of technology usage and adoption in special education in Korea. Previous nationwide educational technology projects have accomplished notable and successful results such as building Intranet for schools. However, such efforts have, in away, created and aggravated the disproportionate gap, often called as the digital divide, against certain groups of people with unique needs. Also, the accessibility to such technology and information has emerged as a serious problem as the role of technology expanded. This study introduced both domestic and foreign examples of technology in special education and relevant resources, and conducted a large-scale survey to examine the current stage of technology adoption and usage in special education in Korea. The survey was administered to special education teachers, students, parents of students with disabilities, disability-related organizations and relevant agencies, and to municipal and provincial department of education. The results found satisfactory levels of computer ownership and usage of Internet among special education teachers. However, utilizing and incorporating such Information and technology into classroom activities and into teaching material development were still limited. Although the data were not comparable to those from students without disabilities, about 40 to 60 percent of the respondents showed positive attitudes toward computer ownership and Internet usage of students with disabilities, suggesting desirable outcomes with appropriate systematic support. Based on the findings, this study recommended detailed methods of building broad financial or budgetary assistance systems for special education schools, teachers, parents, students, administrators, and disability-related organizations. First, as shown in the experiences of foreign countries, financial support from the government to establish the system for the special education information technology has to be mandated under the 'Elementary and Secondary Education Act', the 'Special Education Promotion Act' to ensure and enhance stability and continuity. Second, designation of a single commanding and responsible agency is called for to efficiently coordinate inter-agency collaboration among governmental agencies and departments, and to avoid redundancy of work. Third, for special education schools, tasks such as building school-wide Intranet, development of software solving accessibility issues, subsidizing funds for computer hardware purchase, connecting classrooms through networking system and establishing inter-school WAN are of critical importance. Fourth, the contents and methods of professional development and training for special education teachers should be improved to professionalize teachers, and expansion of such opportunities are also called for. Fifth, IT support for parents of students with disabilities is also important. Parent education and training programs should be developed through active collaboration between local department of education and schools, and such training programs may be offered at schools or disability-related facilities. Distance learning or online courses, which the parents can access regardless of time or location, are other feasible alternatives. Sixth, the results found that administrative staffs of special education at each local department of education displayed satisfactory competence levels. However, the amount of budget assigned for special education teacher training or program development was seriously insufficient. Therefore, the Ministry of Education (or KISE) should build a universal infrastructure of IT, which encompasses and shares budget, program and network systems across all the IT offices of the local department of education. Seventh, although most disability organizations have IT specialist and offered IT education programs for both persons with and without disabilities, they have been experiencing continued problems of insufficient financial support and lack of adaptive technology devices and accessible programs. Therefore, building a universal infrastructure across disability organizations is called for to standardize programs, to prevent overlaps in funding, and thus, to enhance administrative efficiency.

한국인 알코올 의존 환자에서 알코올 대사 효소 유전자형 빈도의 남녀 차이

김성곤,김철민,이덕기,황인복,이현숙,김성연,전은숙,송영상,박제민,최병무,김명정 大韓神經精神醫學會 2005 신경정신의학 Vol.44 No.2

Objectives : There are a number of preceding epidemiological studies reporting gender differences in the genetic etiology of alcohol dependence. The author investigated gender difference in the frequencies of ADH2 and ALDH2 genoypes between the patients with alcohol dependence and normal control. Methods : The subjects were 141 alcohol dependent patients (104 males, 37 females) and 138 normal control (79 males, 59 females). The frequencies of 1/1 and 1/2+2/2 (2+ afterward) genotypes for ADH2 and ALDH2 were investigated in male and female between alcohol dependence and normal control group. DNA was extracted from WBC in peripheral venous blood and PCR-RFLP method was used out for genotyping. Results : First, the frequency of ADH2 1/1 genotype was significantly higher in alcohol dependent patients than normal control in both genders. Second, while there was no gender difference in the frequency of ADH2 1/1 genotype in normal controls, in the patient group however, the frequency was significantly higher in females than males. Third, in male subjects with alcohol dependence, the frequency of ALDH2 1/1 genotype was significantly higher than in male normal control subjects. On the other hand, in female subjects with alcohol dependence, the frequency of ALDH2 2+ genotype was significantly higher than in female normal control subjects. Conclusion : These results suggest that while the risk of alcohol dependence is predominantly affected by ALDH2 1/1 geno-type in male, the female ADH2 1/1 genotype is mainly associated with the risk of alcohol dependence. This means that there are gender differences in the genetic etiology of alcohol dependence.

소장 질환이 의심되는 환자에서 캡슐내시경과 CT 소견의 비교

이성수,홍성숙,김정훈,김연수,김진오,권석범,박성태,장윤우,최득린,권귀향 순천향의학연구소 2007 Journal of Soonchunhyang Medical Science Vol.13 No.1

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On the Interpretive Complex Phenomena in terms of Apparent Imperfections

Kim, Sung Hun,Choe, Hee Sook 한국현대언어학회 2001 언어연구 Vol.17 No.1

Kim, Sung-Hun & Choe, Sook Hee. 2001. 의미해석 복합체에 관한 고찰: 외견상 비완벽성을 중심으로. 언어연구 17-1, 297-311. 본 논문에서는 Chomsky(1998, 1999)의 외견상 비완벽성 개념에 의하여 설명될 수 있는 문법 현상인 의미해석 복합체에 관하여 조사한다. 한국어의 격 첨사들이 초점과 같은 정보 구조에 미치는 효과들을 최소주의 이론에서 어떻게 설명하고 있는지를 논의한다. 특히, 어떤 문맥에서는 격 첨사의 초점 정보 효과들이 외견상 비 완벽성에 의하여 포착되는 의미해석 복합체 현상(Chomsky 1999)이라고 제안한다. 또한 한국어에서 어떤 장거리 뒤섞기 현상들은 외견상 비완벽성에 기인하는 정보 구조 효과를 일으키는 것으로 간주한다. 다시 말해서, 장거리 뒤섞기는 비완벽성이지만 장거리 뒤섞기의 초점 효과들은 외견상 비완벽성을 이끈다고 주장한다. (단국대학교/한국과학기술원)

한국인 여성에서 비타민 D 수용체 유전자 , 에스트로겐 수용체 유전자 및 제 1 형 콜라겐 α1유전자의 다형성과 최대골량의 연관성에 관한 연구

김은숙,김상욱,김기수,김홍규 대한내분비학회 2001 Endocrinology and metabolism Vol.16 No.1

Background: Genetic suggest that strongest effect is observed in the premenopausal peak bone mass, which become less with age. However, the evaluation of candidate genes polymorphisms has been most frequently done in postmenopausal women and the results have been controversial. Therefore, we studied the possible association of the peak bone mass and candidate for osteoporosis genes polymorphism in premenopausal women. Methods: The associations between BMD and polymorphisms of the vitamin D receptor (3'-end region by BsmI restriction enzyme and start codon by FokI restriction enzyme), estrogen receptor (by PvuII and XbaI restriction enzyme), and type I collagen al (Spl binding site by MscI and Ball restriction enzyme) genes were examined in 100 healthy young Korean women who had a peak bone mass (age 20 35 years). Bone mineral densities were measured by dual energy X-ray absorptiometry (DEXA). Dietary calcium intake was also measured using a food frequency questionnaire. Results: The frequencies of the B allele of the vitamin D receptor gene BsmI polymorphism and the X allele in the estrogen receptor gene, XbaI polymorphisms were lower in Koreans than those in Caucasians. The allelic frequencies of the vitamin vitamin D receptor gene Fokl polymorphism and the estrogen receptor gene PvuII polymorphism were similar to those of Caucasians. No significant association was found between BMD and the vitamin D receptor genotype according to Bsml or FokI polymorphisms. There was also no significant relation between the PvuII or XbaI polymorphisms of the estrogen receptor gene and BMD. The associations between BMD and cross-genotypes combining the vitamin D receptor gene (BsmI and FokI) and estrogen receptor gene (PvuII and XbaI) polymorphisms were also analyzed. Among the subjects who lacked the Bf haplotype of the vitamin D receptor gene, the BMD of the femoral neck area was significantly higher in subjects lacking Px haplotypes of the estrogen receptor gene than in those having Px haplotype (p $lt; 0.05). When dietary calcium intake was taken into consideration, there were significant differences in BMD according to the cross-genotype in the group having a low calcium intake ($lt; 500 mg/day). The subjects that lacked the Bf and Px haplotypes had a significantly higher BMD in the femoral neck (p $lt; 0.01), Wards triangle (p $lt; 0.0~5), and in the trochanteric area (p $lt; 0.05) than those who lacked Bf but a Px haplo~type. We did not find a polymorphism in the Spl bindi~ng site of the type I ~collagen ~al gene in our subjects. Conclusion: These data suggest that a complex interaction of vitamin D and the estrogen receptor gene with the dietary calcium intake, rather than a polymorphism of a sing~le gene, may influence peak bone mass in healthy young Korean women (J Kor Soc Endocrinol 16:97-114, 2001).

말초염증에 의한 등족뿌리신경절의 brain-derived neurotrophic factor 합성의 변화

김상열,김정기,김효신,이상지,하선옥,홍해숙,김동선 대한해부학회 1998 Anatomy & Cell Biology Vol.31 No.3

항암화학요법 중 호중구감소증이 발생한 저위험군 발열 환자들을 대상으로 한 경구 항균제 요법의 임상적 유용성 및 안정성에 대한 연구

김연숙,이혁,기현균,김춘관,김신우,김성민,백경란,김원석,윤성수,이홍기,강원기,박찬형,박근칠,송재훈 대한화학요법학회 2000 대한화학요법학회지 Vol.18 No.1

목적 : 항암화학요법 중 호중구감소증을 동반한 발열이 발생하는 암환자들을 치료하기 위한 다양한 항균제와 여러 가지 방법들이 시도되고 있는 가운데, 합병증과 사망률의 발생가능성이 적은 저위험군 환자들을 대상으로 초기 72시간동안 정주 항균제를 투여한 이후 경구 항균제로 전환하는 요법의 유용성과 안정성을 평가해보고자 본 연구를 시행하였다. 방법 : 1998년 2월부터 1999년 9월까지 본원에서 항암화학요법 중 호중구감소증과 발열이 발생한 환자들 가운데 기저 암질환이 고형암이거나 림프종이고, 입원당시 패혈증의 증후가 없으며 입원 72시간이내에 해열되고 백혈구수치가 증가 추세인 환자들을 대상으로 하여 72시간 동안 정주 항균제를 투여한 이후 경우 ciprofloxacin 750㎎을 하루 2회씩 투여하여 총 4일간 투여하였다. 모든 환자들은 열이 떨어지고 호중구감소증이 회복될 때까지 입원하도록 하였다. 결과 : 총 38명 환자의 40예가 등록이 되었고, 환자들의 기저암 질환은 고형함이 72.5%, 림프종이 27.5%였다. 입원당시 평균 호중구치수는 156/㎕였고, 호중구수치가 100/㎕미만인 경우는 65%였으며, 호중구감소증이 지속된 기간의 평균은 2.4일이었다. 40예 중 39예가 항균제의 변형이나 추가 없이 호중구감소증과 발열로부터 회복이 되어 97.5%의 성공율(95% 신뢰구간: 86.8-99.9%)을 보였다. 부작용으로 피부발진이 있었던 경우가 한 예 있었는데, 증상이 경하여 경구 항균제를 지속할 수 있었다. 심와부의 동통으로 복용을 지속할 수 없어서 대상에서 제외된 예가 또 한 예 있었다. 결론 : 항암요법 중 호중구감소증과 발열을 동반한 환자들 가운데 저위험군 환자들에서 항균제 72시간정주 이후 경구 항균제로의 전환요법은 효과적이고도 안전한 치료방법이라고 할 수 있다. Background : Oral antibiotic therapy following empirical intravenous antibiotics may be effective and safe for febrile neutropenic patients with lowrisk for complications. Methods : We conducted a prospective clinical trial of oral antibiotic therapy in the patients with neutropenia and fever during chemotherapy for cancer. Underlying malignancies were solid tumor or lymphoma with short duration of neurtropenia and the patients had no evidence of clinically or microbiologically documented infections. Oral ciprofloxacin was given to the patients who lacked signs of sepsis on admission, had a rising tendency of neutrophil count (ANC >100 /㎕ ) at 72 hours, and were afebrile at 72 hours. All patients were hospitalized until neutropenia and fever resolved. Results : A total of 40 episodes of 38 patients were enrolled from February 1998 to September 1999. The mean neutrophil counts on admission were 156/㎕ and the mean duration of neutropenia was 2.4 days. The episodes which had neutrophil count below 100 /㎕ were 26 (65%). Treatment was successful in 39 of 40 episodes (97.5% : 95 % confidence interval, 86.8% to 99.9%). Adverse reactions of oral ciprofloxacin were skin rash and epigastric soreness in two cases, respectively. There were no deaths during the study. Conclusions : For low-risk febrile patients with neutropenia during cancer chemotherapy, switch therapy to oral ciprofloxacin at 72 hours following intravenous broad-spectrum antibiotics is effective and safe,

혈관질환 정보관리 시스템

김동익,김덕경,허세호,이병붕,김용신,김은숙,문지영,도영수,신성욱,김동수,김만태,진재욱,김용신 대한혈관외과학회 2002 Vascular Specialist International Vol.18 No.1

As medical technology progresses rapidly, there is a rise in the average age along with the Korean dietary lifestyle becoming more westernized, which leads to an increase in the number of vascular disease patients in Korea. Thus, we need to manage the medical information of a disease systematically in order to diagnose and treat constructively. However, since there has been no standardized method of man agement to date, a great deal of information could not be properly utilized nor studied. Therefore, the departments of Cardiology, Radiology and Neurology of Samsung Seoul Hospital recently got together to develop an information management system called the Vascular Data System. This program was developed to be run on win98 O/S, upper Pentium Ⅲ, and upper 128 MB Memory, and its source code is Dephi 4.0. It was configured for the user to set the configurations as well as do a variety of search and analysis. If this program were to be updated continuously, it may be used extensively as well as in various parts of clinical research activities.