대학병원에서 발생하는 폐결핵 치료지연

강신명 ( Shin Myung Kang ),이준구 ( Jun Gu Lee ),정재호 ( Jae Ho Chung ),한창훈 ( Chang Hoon Han ),변민광 ( Min Kwang Byun ),정우영 ( Wou Youn Chung ),박무석 ( Moo Suk Park ),김영삼 ( Young Sam Kim ),김세규 ( Se Kyu Kim ),장준 ( 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.60 No.3

태반조기박리 ( Abruptio placentae ) 의 6년간 관찰 ( 1963 - 1968 )

강신명(SM Kang),김수자(SJ Kim),이경자(KZ Lee),이일준(IJ Rhee) 대한산부인과학회 1970 Obstetrics & Gynecology Science Vol.13 No.8

Abruptio placenta is a serious complication in pregnancy when dealing with maternal death as well as fetal loss especially in the country having high incidence of toxemia. 1. We have encountered 34 cases of Abruptio placentae which occured among a total of 10,640 deliveries in Ewha Womens University Hospital, Seoul during the period of 6 years from 1963 to 1968, the incidence being one case per 330 deliveries or 0.32%. Although this incidence was considered relativity low both the maternal & fetal death rate were markdly high. 2. The leading causative predisposing factor of the abruptio pladentae in this series was toxemia occupying one-third(38%) of the cases. The other known cause was shortness of the umbilical cord(26%) including it`s strangulation. Indeed every efforts to prevent the toxemias of pregnancy are important at present among the numerous caucative factors. 3. The majority of placentae occured between age of 30&40, and more in multigravidas(88%). It was interesting to notice that more than one-half(56%) of the cases of abruptio placentae had a tendency of prematurity occuring from 27 to 37 weeks of gestation period. 4. Abruptio placentae with concealed hemorrhage was serious in it`s nature. However the fetal death rate were considered to be high(80%) even in the mild group which probably due to the delayed admission from the patient side. 5. The average amount of blood transfusion needed was 3 pints in the mild cases, and 6 pints or more in the severe cases. 6. About one-half(56%) of the abruptio placentae were treated by Cesarean section mostly for the severe cases with shock or for the fetal distress. The perinatal mortality was reduced to 53% in these section group. 7. The incidence of prenatal care undergone was very low(only 18%). Both quantative and qualitive prenatal care would be important to prevent abruptio placentae, and it should be warn if any toxemic state or sudden pain develops in multigravidas, over 30 year of age, particularly during 27-37 weeks of gestation. 8. The prognosis of the patient with abruptio placentae admitted in 4 hours after it`s onset was much fair than the delayed in which revealing the partial or less than one-half area of the placental detatchment with some hopeful(25%) fatal salvage. Therefore the abruptio placentae should be terminated promptly in 2~4~8 hours after the accident has occurred.

견위분만

강신명(SM Kang),전혜자(HJ Chun),강민자(MJ Kang),조정신(JS Cho) 대한산부인과학회 1971 Obstetrics & Gynecology Science Vol.14 No.7

본 이화의대에 입원한 견위분만의 발생빈도는 과거 6년간 총분만 10679명중 276명으로서 1:36즉 2.5%였다. Management of the breech delivery is still a difficult problem because there is no practical way of measurement of fetal biparietal diameter up to date, and fetal mortality remains still high. It seemed very important to evaluate the pelvic capacity and to juge the fetal size accurately by experienced obstetrician before the labor takes place in order to reduce the unnecessary fetal loss or hypoxia which affect second generations. The data to be presented are based on 276 cases of breech presentation seen past 6 years between January 1963 and December 1968 in Ewha Woman`s University Hospital, Seoul, Korea. the following results were obtained. 1. The incidence of breech delivery was one in every 38 cases or 2.5% of 10,679 cases of total deliveries during past 6 years. In this study, breech presentation associated with twins and infant weighing under 1,000gm were excluded. 2. Placenta previa is a most commonly associated etiologic factor(6 cases) in breech presentation in which the incidence is significantly high, 3 times the average one in this institute. 3. Operative delivery or Cesarean section was required in 19% of the total cases of breech presentation with 1,000gm or more of the birth weight, and in 24% of the cases of term breech presentation. 4. In cases of that anteroposterior diameter of pelvic inlet in 10cm or less, or interspinous diameter of mid-pelvis is 9.5cm or below, approximately one-half(48%) of the cases of breech presentation necessitated Cesarean section. 5. In general, the more big the infant`s birth weight the greater the incidence of Cesarean sectionrequired such as 28% done in the moderate sized infants (3.0kg-3.49kg), and 37% in the rather large infants weighing 3.5kg-3.99kg in breech presentation. 6. In careful revewing the fetal distress in vaginal breech delivery according to the birth weight, the frequency of infant with poor condition or lower Apgar Score of 6 or less were 19% of the cases among average term babies weighing 3.0kg. However in case of infant body weight exceeding 3.0kg, the hypoxic infant rate were significantly increased up to 61% of the case or 3 times the one with 3.0kg birth weight. Severe hypoxic infants with Apgar Score of 4 or less were apt to occur in the footling presentation (68%), twice as much as that in complete breech presentation. No fetal fractures or dislocation and Erb`s paralysis were seen in this whole subject. 7. When dealing with breech vaginal delivery, over all 6 cases of more than average sizd infant wighing from 3.3kg to 3.5kg or more were dead due to breech delivery whereas all alived among 132 cases of average size of infant weighing from 3.0kg-3.2kg. However, infants weighing 3.3kg or more who were deliveried by Cesarean section were all alived. In this whole series of breech presentation, no maternal death were ween except 3 cases of mild degree of cervical lacerations. 8. The corrected perinatal mortality in the vaginal breech delivery was 9.3% among the premature infants and 4.1% among the term babies.

제왕절개술후 감염과 Hygiene 질내 전처치의 가치

강신명(SM Kang),조행원(HW cho),우복희(BH Woo),박정희(JH Park) 대한산부인과학회 1968 Obstetrics & Gynecology Science Vol.11 No.7

During 1967 puerperal infection following Cesarean section has been evaluated with or without using the pre-operative vaginal application of 1% Hygiene solution(Amphoteric surface active agent) on the 50 section, among, 600 total deliveries in Ewha Womans University Hospital, Seoul. In order to reduce the post-Cesarean section infection 1% Hygiene solution was routinely applied preoperatively into vagina and it was throughly cleaned out. Particularly it has been focused to those who were potentialy infected pre-operatively. 1. The post-Cesarean section infection(38`C or over excess 48 hours) has been significantly reduced to 28% of the cases by using pre-operative vaginal application of 1% Hygiene solution in comparison with the 48% in the control group. 2. There were 2 wound infections or pus formation (8%) due to staphylococcus infection in the control group of Cesarean section, however none in the sections with pre-operative vaginal application of 1% Hygiene solution. 3. In the potentially infected section cases (mostly due to staphylococcus aureus) the incidence of endometritis can be reduced to 50% of the control group`s frequency by using pre-operative vaginal application of 1% Hygiene solution.

산후출혈

강신명(SM Kang) 대한산부인과학회 1973 Obstetrics & Gynecology Science Vol.16 No.7

출혈은 우리나라 모성사망 원인의 제2위(약 35%)를 점하며 그 출혈사의 주요 원인은 이완성 자궁출혈과 태반잔유이었으며 또한 그들 전부가 도착사였다는 점이 주목된다. 이러한 불필요한 출혈사를 방지하기 위해서는 자가분만이 없도록하는 대책이 시급하며, 또한 의료인의 재수련제, 혈액공급, 준비등이 보다 완벽해야 기특될 것이다. 이완성자궁출혈이 우리나라에 많은 주요원인 즉 소인은 임신중독증과 자궁이 큰 상태 즉 이상의 태아 또 는 쌍태양수과다증 등이며 기타 유도분만등 이므로 이들 위험합병임신분만에 대하여는 각별한 철학과 대 책을 세워야 할 것이다. 즉 이러한 산모에 대하여 분만직후 예방적자궁수축제 정맥점적을 실시한 결과 산 후출혈로 인한 쇼크의 발생빈도를 58%(미실시군)에서 14% 즉 1/4로 현저히 감소 내지 에방할 수 있었다. 이러한 위험성임신 분만에 대하여 충분한 혈액공급 준비, 간호인원 및 기구재과 등의 대비가 되어 있지 않았을 때는 산과병원에 전송 협진을 요구하는 것이 현명한 방책일 것이라고 확신한다. Postpartum hemorrhage is usually defined as blood loss in excess of 500cc. If this occurs within the first 24 hours of delivery it is classified as late postpartum hemorrhage. During past 10 years(1961-1970) Common causes of maternal mortality among total deliveries of 18749 cases in Ewha Womans University Hospital, Seoul, Korea were toxemia of pregnancy (27 cases or 41.5%), hemorrhage (23 cases or 34.8%) and infection (4 cases or 6%). Majority cases of hemorrhagic death were dead on arival rather than hospital death. We have found that all the maternal death due to atonic uterine hemorrhage (13 cases) and retained placenta (4cases) were occured as D.O.A., none of hospital death except few cases of placenta previa and postoperative bleeding. Such un-necessary hemorrhagic D.O.A. could be reduced by the increasing nation wide hospital cares rather than home deliveries, and adequate obstetrical training of midwive and general practioners. The usual incidence of postpartum hemorrhage in Ewha Womans University Hospital was 2.6% of the total deliveries. It was mainly consit of atonic uterine bleeding and late postpartum bleeding. Reasons for predominantly often or a common predisposing factor in atonic uterine hemorrhage in Korea presumably lie in the high incidence of toxemas of pregnancy accounts for more than half or 65% of the cases of atonic uterine hemorrhage. The incidence of shock due to atonic uterine hemorrhage in high risk mothers; Such as associated with preedampsia, large baby forned, twins, Hydramnios and oxytocin induction was significantly reduced or prevented from 58% to 14% or 1/4 by instituting prophylactic oxytocin intravenous drip right after the delivery.

이중 공기공급 이유체 선회노즐의 유량비 변화에 따른 미립화 특성에 관한 실험적 연구

강신명(Shinmyoung Kang),이지근(Jeekeun Lee),노병준(Byungjoon Rho) 대한기계학회 2007 대한기계학회 춘추학술대회 Vol.2007 No.10

The regulations to reduce the exhaust emissions from vehicles are becoming increasingly stringent and encompassing more types of vehicles. In the case of heavy duty diesel engines, the Urea-SCR system is currently considered to reduce the NOx emission as a proved technology, and it is widely studied to get the high performance and durability. In the Urea-SCR system, urea-water solution is injected into the exhaust pipe using the specially designed nozzle with high precision dosing unit. However, the injection nozzles occur some problems, including nozzle clogging, deposition of urea-water solution on the inner wall of exhaust pipe. In this study, the atomization characteristics of the dual air supplying twin-fluid swirl nozzle were investigated experimentally using PIV and PDA systems. The effect of assist air flowrate supplying from the dual air port was investigated. The mean velocity, turbulent intensity and SMD distributions of the sprays were measured along the centerline and radial direction. As the experimental results, the higher axial velocity is observed in the central part of the spray, and the SMD decreased with the increase of ALR.

분만시 회음의 소독처치 와 그가치

강신명(SM Kang),이순배(SB Rhee),박기영(KY Park),김인숙(IS Kim) 대한산부인과학회 1967 Obstetrics & Gynecology Science Vol.10 No.3

Aseptic technique or reduction of the bacterial flora on the pudendal area in delevery preparation still requires constant re-evaluation. In this paper a new class of disinfectant, the amphoteric surface active agent, hygiene(TEGO 1 03 G) is applied to prepare the perineal area and it`s effects were compared with other varies con- ventional agents and were evaluated clinically by the incidence of transient episotomy fever or sub- clinical infection of clean surgical incision-episiotomy(Showing transient elevation of body tempe- rature orally up to 37`c. or more, lasting less than 4 hours any time in postpartum 3 days period but excluding all othe febrile sources) as well as in vitro study. The data to be presented are based on 169 primiparas deliveried in Ewha Womans University Hospital, Seoul, Korea(33 suing Hygiene, 15 with Mercurochrome, 13 with Cresol, 30 soap and water, 29 soap and water plus prophylactic systemic antibiotics). From this study following conclusions have been reached. 1.The effect of pudendal perineal aseptic technic or disinfectant best can sharply be compared and evaluated clinically by the incidence of transient episiotomy fever or subclinical infection of clean incision-episiotomy(Showing transient fever of 37`c. or more orally in any time of postpart- um 3 days period, but excluding all other febrile sources) rather than by gross episiotomy wound infection which is often encontering many different criterias or even by in vitro biocides effect alone which is also proven to be incorrect unless using serial basin bethod or neutralizing, reducing age- nts. 2.The transient episiotomy fever(Subclinical infection) is strongly correlated with quantitative bacterial innoculation as well as it`s types. It suggested that the most responsible pathogens were staphylococcus aureus and some Streptococcus. On the other hand E. coli appeared to be relatively non-causeative one in the pudendal perineal area; probably female perneum resistant particularly to the normally inhabiting enteric microorganisms. 3.1% Hygiene(TEGO 103G) was superior to a rapid physol wash, Mercurochrome or Cresol wa- sh in reducing subclinical infection of clean episiotomy(tranisent fever) mostly acused by Staphyloc- occus aureus. It seemed also sensitive to Streptococcus. 4.Routine prophylactic antibiotics reduced some transient dpisiotomy fever, but not all of the inc- idence of higher temperatures presumably caused by massive bacterial innoculations. Proper aseptic perineal technic will prevent the clinicl infection of episiotomy wound and subclinical transient episiotomy fever as well. The corection of low hemoglobin level should also be considered in this aspect.

이중 공기공급 이유체 선회노즐의 유량비 변화에 따른 미립화 특성에 관한 실험적 연구

강신명 ( Shin Myoung Kang ),김덕진 ( Duck Jin Kim ),이지근 ( Jee Keun Lee ),노병준 ( Byung Joon Rho ) 한국액체미립화학회 2007 한국액체미립화학회 학술강연회 논문집 Vol.2007 No.-

경관임신 2예

강신명(SM Kang),조성원(SW Cho),김원자(WJ Kim),노영자(YJ Rho) 대한산부인과학회 1964 Obstetrics & Gynecology Science Vol.7 No.1

1. 여기에 보고한 2예중 하나는 해부학적분류에 가깝고 다른 하나는 병리 및 임상적분류에 속하는 경관임신들이었다. 2. 이 2예는 모두 술전에 진단이 붙지 못하고 예 1은 전행소파술을 받은 후의 완고한 출혈이었으므로 인공유산후경손상으로 인상되었고, 예 2는 절박유산, 그후 천연유산으로 인상되었다. 전자는 시험소파술후 질식자궁척출을 하였고 후자는 일차 소파 및 경내팩킹을 하였는데 모두 결과 양호하였다. 3. 예 1에 있어서 자궁척출술시 저자가 곤란을 당한 것은 출혈이 보통이상으로 많아서 술중 2,000cc의 수혈을 하였다. 경관임신 때는 정상체부임신때와 달라서 골반상과 특히 방광 및 직장부착부에 혈관증대, 확장 등의 생리적변화가 일어나 있어서 술시 박리곤란 내지 극심한 출혈이 나타난다고 착자는 생각되었다. 따라서 자궁척출시에도 시험소파때와 같이 다량의 혈액을 준비하고서 한다는 것은 역시 대단히 중요하며 이로써 모성사망율도 감소될 것이다. 내반이 확실히 퇴행되었을 때(천연유산등)는 출혈의 위험이 적을 것이라고 본다(예 3). : 자궁경관임신, 자궁경부임신, 자궁외임신.... 2 cases of Cervical pregnancy meeting the criteria of Paalman and McElin; One closed to anatomical proof, the other proved pathologically and suggested clinically have been reported. It was impossible to me to make correct diagnosis preoperatively on either cases. Cases I, who had previous curettage therapeutic abortion(8 weeks gestation) 5 days prior to the admission was treated as post D. & C. hemorrhage or cervical injury, in which performing repeated curettages and cervical packings followed by vaginal hysterectomy. Case II, with vaginal spotting of 7 days duration was treated as threatened abortion at 7 weeks gestation, later as missed abortion, in which carrying out single curettage and cervical packing successfully. The results of 2 cases were good despite of one encountered a stomy hemorrhage during the hysterectomy. I would like to emphasize and urge that even in performing the hystectomy for cervical pregnancy, large amount of blood should be prepaired and available just like performing for the trical of curettage before any treatment is initiated, because I have experienced unforgetable severe hemorrhage during the hysterectomy, requiring up to 2.000 c.c. of blood transfusions(case I); probably due to the physiologic changes in cervical pregncy unlike the corporeal pregnancy, causing unusual vascularization or varicoses over the pelvic floor or vesico & recto-cervical areas depend on the site of implantation. The placenta regression type such as terminated as missed abortion (case II), however will be less chance of bleeding.

신증후군 범주의 단백뇨를 보인 Churg-Strauss 증후군

강신명 ( Shin Myung Kang ),김창오 ( Chang Oh Kim ),박용범 ( Yong Beom Park ),이원기 ( Won Ki Lee ),정현주 ( Hyeon Joo Jeong ),신동환 ( Dong Hwan Shin ),이수곤 ( Soo Kon Lee ) 대한류마티스학회 2000 대한류마티스학회지 Vol.7 No.2

Churg-Strauss syndrome or allergic granulomatosis and angiitis is a part of spectrum of systemic vasculitis characterized by asthma, ecisinophilia, mono or polyneuropathy, nonfixed pulmonary infiltrates, paranasal sinus abnormality and extravascular eosinophil infiltration. We experienced a case of Churg-Strauss syndrome of 21-year-old male patient with purpura and pitting edema on both hands and feet. He also had heavy proteinuria of nephrotic range and renal failure. Renal biopsy demonstrated crescentic glomerulonephritis with massive infiltration of eosinophils, lymphocytes and plasma cells in the interstitium. Under the treatment with prednisolone and cyclophosphamide, serum creatinine level and amount of proteinuria were reduced.